The impact of General Practitioner Consultations on Outcomes in Low Back Pain; What is Effective Reassurance?

Nicola Holt

Research output: ThesisDoctoral Thesis

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Low back pain (LBP) is common and costly, and notoriously difficult to treat when chronic. Reassurance is commonly recommended in primary care LBP management guidelines, although it is poorly defined and its impact on outcomes remains unknown. A systematic review of 16 prospective cohort studies found that emotional (affective) reassurance improved satisfaction, but was associated with poorer outcomes for general patient populations. Cognitive reassurance, which is persuasive and provides information, was linked to improved patient outcomes. Interviews with 23 LBP patients who had recently consulted their GP found three areas which were reassuring to patients: physicians understanding the patient; implicitly reassuring behaviours indicating that the physician wants to help and takes the pain seriously; and explicit explanations of what is wrong and how to manage it. It was only through explicit accounts that concerns were addressed. A patient self-report measure of reassurance during primary care consultations was developed and validated using Rasch modelling, consisting of four subscales: data-gathering; relationship-building; generic reassurance; and cognitive reassurance. Follow-up results from LBP patients with recent consultations (n= 318) indicated that reassurance significantly predicted post-consultation satisfaction and enablement, but failed to predict outcomes 3-months later for all patients. However, for a group of participants with low psychosocial risk scores, those who received more cognitive reassurance experienced less pain and disability at follow-up, while those who indicated more data-gathering and relationship-building were significantly more anxious, indicating a potentially harmful effect of providing too much emotional support to patients who do not require it. Barriers to reassurance were explored through systematic review of literature review papers, and evidence-based solutions to these were considered. Recommendations for how to effectively reassure LBP patients, including persuading patients that they have no serious disease and convincing them that their symptoms are benign are offered.
Original languageEnglish
Awarding Institution
  • Royal Holloway, University of London
  • Pincus, Tamar, Supervisor
Award date7 Aug 2016
Publication statusUnpublished - 2016

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