Thursday, October 31, 2001 8:24–9:07 am General Session 5: Outcome Predictors: 8:24 The effect of an optimized patient–clinician encounter on low back pain recovery

Abstract

Purposes of study: Although certain aspects of the patient–clinician relationship have been shown to speed the recovery of patients with low back pain (LBP), the effects of receiving a causal explanation have not been studied in patients with LBP. The relative effects of each of the distinct aspects of the patient–clinician encounter on outcome are also not known.Methods used: A prospective cohort of 1,633 patients with acute and chronic LBP seen by 208 randomly selected North Carolina clinicians was studied (June 1992 to March 1993). Four types of clinicians were involved: primary care providers, chiropractors, orthopedic surgeons and clinicians in a group model health management organization. We evaluated time to recovery from LBP as reported by patients within 6 months after their index clinical visit. Patients were interviewed by telephone at approximately 7 days after the initial clinic visit, and at 2, 4, 8, 12 and 24 weeks. Patients reporting complete recovery during an interview were asked a sequence of questions concerning the care they received (Table 1)Table 1Questions asked to assess patients' perception of patient–clinician encounter and association with time to recovery.Questions asked to patientAssociation with LBP recovery (adjusted hazard ratio* and 95% CI)Did the doctor who enrolled you in this study:Take a detailed history of your back pain?1.09 (0.93, 1.28)Do a careful examination of your back?1.46 (1.18, 1.79)Explain the cause of your back problems clearly?1.52 (1.26, 1.83)Give you useful advice on how to manage your pain?1.40 (1.15, 1.69)Give you useful advice on how to prevent the pain from happening again?1.25 (1.07, 1.46)Give you useful advice on how to sit, sleep and get about?1.11 (0.96, 1.28)Discuss your problem with someone else in your family?1.04 (0.87, 1.25)Help you with your employment situation?0.86 (0.74, 1.00)Listen to your opinions and concerns?1.25 (0.94, 1.65)CI = confidence interval.*Hazard ratios with values above 1 indicate that the factor being studied is positively associated with a faster time to recovery.. Cox proportional hazard modeling was performed to evaluate the independent association of each of the factors related to the patient–clinician encounter with time to recovery. Models were adjusted for clinician specialty, patient marital status, gender, education, type of insurance, age and household income.of findings: Of the respondents, 82% (n=1,261) reported that their clinician explained the cause of their LBP episode. The mean recovery time for patients who experienced recovery was 12.7 weeks (±10.3 weeks). Sixty-seven percent (n=1,089) reported recovery during the 24-week study period. Of the nine factors related to patient perception examined in this study, careful back examination, causal explanation and advice for management and prevention were each significantly associated with faster recovery from LBP episodes (Table 1).Relationship between findings and existing knowledge: Previous studies have demonstrated that physical contact, listening to the patient's opinions and concerns and providing information about management and prevention of disease are clinically important aspects of the patient interview. Although causal explanation has been shown to be associated with patient satisfaction, its relationship with LBP clinical outcomes has not been described in the literature.Overall significance of findings: There are several aspects of the clinical encounter that have a significant effect on outcome for LBP patients.Disclosures: No disclosures.Conflict of interest: Joanne Garrett, and; Timothy Carey, received grant research support from the Agency for Health Policy and Research (H506664).