Abstract
Background
Attitudes and beliefs about back pain have considerable influence on pain and recovery. Poor clinical outcomes are more likely when activities are avoided due to fear of pain or injury, when people are anxious, have catastrophic thoughts, or low recovery expectations. General practitioners play an important role in back pain management. Evidence suggests current practice may not be aligned with clinical guidelines.
Aim
The first aim of this thesis was to understand attitudes and beliefs about low back pain and how these are influenced. The second was to develop an intervention to assist general practitioners decrease the perceived threat associated with acute low back pain and optimise clinical management.
Methods
A systematic review investigated the association between health professional attitudes and beliefs and patient related factors.
In-depth interviews were conducted with 11 general practitioners, 12 people experiencing acute low back pain, and 11 people experiencing chronic low back pain. These interviews were analysed with a framework of Interpretive Description.
A cross-sectional survey was conducted to examine the prevalence of back pain-related beliefs. The survey instrument was developed based upon themes identified in qualitative analysis. This survey was posted to a random sample of 1000 New Zealanders.
The Fear Reduction Exercised Early (FREE) approach to acute low back pain was developed based upon findings from qualitative analysis and the population survey. The acceptability and utility of this intervention was tested by 25 general practitioners based at two general practices.
Results
There was strong evidence of an association between health professionals’ and patients’ beliefs about back pain, and moderate evidence that health professional attitudes and beliefs are associated with their clinical management of patients.
GPs predominantly approached acute back pain from a biomedical perspective which conflicted with guideline recommendations. This perspective decreased their empowerment to manage back pain and resulted in patients reportedly being given overly protective activity advice.
Participants with acute and chronic pain viewed their back as a vulnerable structure which required protection. They looked at back pain as being a particularly bad condition due to its complexity and the way it affected their lives. Participants perceived they were heavily influenced by health professionals. Many of the explanatory models and management approaches used by these professionals reinforced participants’ beliefs about the back’s vulnerability.
602 responses were received to the survey. The beliefs identified in qualitative analysis appeared to be widely held among the New Zealand population and were broadly similar to those previously found in other countries.
The FREE approach to acute low back pain appeared to be acceptable and useful to general practitioners who trialled it. There were significant positive changes in participants’ beliefs.
Conclusion
People experiencing low back pain were negatively disposed towards their back and many messages received from health professionals reinforced these negative views. GP management of back pain may be enhanced by improved understanding of how the biopsychosocial model relates to acute pain. The FREE approach may assist GPs to effectively manage acute low back pain. Further testing is required to evaluate its effect.