Follows Coia and Morley's (1998) model which splits effective reassurance into two categories (cognitive and affective), and posits that affective reassurance can be harmful to long-term recovery due to heuristic processing of necessary information, whereas cognitive reassurance is persuasive and so produces long-term changes in beliefs and attitudes to low back pain (LBP). A systematic review of the literature (Pincus et al, 2013) has allowed formulation of a model in which components of cognitive and affective reassurance are linked to outcomes after primary care consultations, however there has yet been no focussed research on this model in specific LBP populations. This three-year doctoral study aims to develop an instrument from our model, in order to measure cognitive and affective reassurance in general practice consultations for LBP. To do this, qualitative interviews with LBP patients will be used to identify salient aspects of GPs' communication which are important from the patient's perspective. This data will be combined with a literature review to produce a measure which encompasses the important components of both affective and cognitive reassurance. The measure will be tested in a prospective cohort study of LBP patients, which will use the principles of Rasch analysis to assess the reliability of the measure and produce a final instrument which can be said to measure reassurance in consultations. Follow-up data from this prospective cohort, taken at three months post-consultation, will test whether GPs' use of cognitive and affective reassurance during consultations has an impact on short-term outcomes in LBP patients. A parallel prospective cohort study will be run in physiotherapy clinics. In this study, as patients are referred to the clinic by their GP, we will be able to capture baseline data on the participants' mood, LBP status, and illness perceptions. This data will add to our understanding of reassurance in LBP by highlighting which, if any, types of patients respond better or worse to different kinds of reassurance. The overall aim of this research is to identify what constitutes effective reassurance in LBP consultations, produce a reliable instrument to measure cognitive and affective reassurance, and begin to identify sub-groups of patients for whom reassurance is especially effective.
Based on a literature-derived model of reassurance in general practice consultations for low back pain (LBP) developed by Professor Pincus and colleagues (in preparation), this research aims to develop a measure of such reassurance and use it to discover whether consultations with GPs who make good use of reassurance result in improved outcomes for LBP patients.
1. LBP patients' views on effective reassurance during GP consultations.
2. Psychometric properties of an instrument to measure reassurance.
3. Whether GPs' use of cognitive and affective reassurance can predict outcomes in LBP at a 3-month follow-up.
4. How reassurance affects sub-groups of patients in different ways.