Testing a Model of Consultation-based Reassurance and Back Pain Outcomes With Psychological Risk as Moderator : A Prospective Cohort Study. / Holt, Nicola; Mansell, Gemma; Hill, Jonathan; Pincus, Tamar.

In: Clinical Journal of Pain, Vol. 34, No. 4, 04.2018, p. 339-348.

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Testing a Model of Consultation-based Reassurance and Back Pain Outcomes With Psychological Risk as Moderator : A Prospective Cohort Study. / Holt, Nicola; Mansell, Gemma; Hill, Jonathan; Pincus, Tamar.

In: Clinical Journal of Pain, Vol. 34, No. 4, 04.2018, p. 339-348.

Research output: Contribution to journalArticlepeer-review

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@article{8a0e32eec52c4d58ad58bcf40ee86c1e,
title = "Testing a Model of Consultation-based Reassurance and Back Pain Outcomes With Psychological Risk as Moderator: A Prospective Cohort Study",
abstract = "Objectives: Reassurance is an essential part of treatment for low back pain (LBP), but evidence on effective methods to deliver reassurance remains scarce. The interaction between consultation-based reassurance and patients' psychological risk is unknown. Our objective was to investigate the relationship between consultation-based reassurance and clinical outcomes at follow up, in people with and without psychological risk.Methods: We tested the associations between specific reassurance components (data gathering; relationship building, generic reassurance and cognitive reassurance), patients' psychological risk (the presence of depression, anxiety, catastrophizing or fear-avoidance), and post-consultation outcomes including; satisfaction and enablement, disability, pain and mood at 3-month follow-up.Results: Adjusted linear regression models using data from patients who had recently consulted for LBP in primary care (n=142 in 43 practices) indicated that all reassurance components were strongly associated with increased satisfaction, while generic reassurance was significantly associated with post-consultation enablement. Generic reassurance was also associated with lower pain at three months, while cognitive reassurance was associated with increased pain. A significant interaction was observed between generic reassurance and psychological risk for depression at three-months: high rates of generic reassurance were associated with lower depression in low risk patients, but with higher rates of depression for high risk groups.Discussion: The findings support the hypothesis that different components of reassurance are associated with specific outcomes, and that psychological risk moderates this relationship for depression. Doctors' reassuring behaviours might therefore have the potential to improve outcomes in people with LBP, especially for patients with higher psychological risk profiles.",
author = "Nicola Holt and Gemma Mansell and Jonathan Hill and Tamar Pincus",
year = "2018",
month = apr,
doi = "10.1097/AJP.0000000000000541",
language = "English",
volume = "34",
pages = "339--348",
journal = "Clinical Journal of Pain",
issn = "0749-8047",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

RIS

TY - JOUR

T1 - Testing a Model of Consultation-based Reassurance and Back Pain Outcomes With Psychological Risk as Moderator

T2 - A Prospective Cohort Study

AU - Holt, Nicola

AU - Mansell, Gemma

AU - Hill, Jonathan

AU - Pincus, Tamar

PY - 2018/4

Y1 - 2018/4

N2 - Objectives: Reassurance is an essential part of treatment for low back pain (LBP), but evidence on effective methods to deliver reassurance remains scarce. The interaction between consultation-based reassurance and patients' psychological risk is unknown. Our objective was to investigate the relationship between consultation-based reassurance and clinical outcomes at follow up, in people with and without psychological risk.Methods: We tested the associations between specific reassurance components (data gathering; relationship building, generic reassurance and cognitive reassurance), patients' psychological risk (the presence of depression, anxiety, catastrophizing or fear-avoidance), and post-consultation outcomes including; satisfaction and enablement, disability, pain and mood at 3-month follow-up.Results: Adjusted linear regression models using data from patients who had recently consulted for LBP in primary care (n=142 in 43 practices) indicated that all reassurance components were strongly associated with increased satisfaction, while generic reassurance was significantly associated with post-consultation enablement. Generic reassurance was also associated with lower pain at three months, while cognitive reassurance was associated with increased pain. A significant interaction was observed between generic reassurance and psychological risk for depression at three-months: high rates of generic reassurance were associated with lower depression in low risk patients, but with higher rates of depression for high risk groups.Discussion: The findings support the hypothesis that different components of reassurance are associated with specific outcomes, and that psychological risk moderates this relationship for depression. Doctors' reassuring behaviours might therefore have the potential to improve outcomes in people with LBP, especially for patients with higher psychological risk profiles.

AB - Objectives: Reassurance is an essential part of treatment for low back pain (LBP), but evidence on effective methods to deliver reassurance remains scarce. The interaction between consultation-based reassurance and patients' psychological risk is unknown. Our objective was to investigate the relationship between consultation-based reassurance and clinical outcomes at follow up, in people with and without psychological risk.Methods: We tested the associations between specific reassurance components (data gathering; relationship building, generic reassurance and cognitive reassurance), patients' psychological risk (the presence of depression, anxiety, catastrophizing or fear-avoidance), and post-consultation outcomes including; satisfaction and enablement, disability, pain and mood at 3-month follow-up.Results: Adjusted linear regression models using data from patients who had recently consulted for LBP in primary care (n=142 in 43 practices) indicated that all reassurance components were strongly associated with increased satisfaction, while generic reassurance was significantly associated with post-consultation enablement. Generic reassurance was also associated with lower pain at three months, while cognitive reassurance was associated with increased pain. A significant interaction was observed between generic reassurance and psychological risk for depression at three-months: high rates of generic reassurance were associated with lower depression in low risk patients, but with higher rates of depression for high risk groups.Discussion: The findings support the hypothesis that different components of reassurance are associated with specific outcomes, and that psychological risk moderates this relationship for depression. Doctors' reassuring behaviours might therefore have the potential to improve outcomes in people with LBP, especially for patients with higher psychological risk profiles.

U2 - 10.1097/AJP.0000000000000541

DO - 10.1097/AJP.0000000000000541

M3 - Article

VL - 34

SP - 339

EP - 348

JO - Clinical Journal of Pain

JF - Clinical Journal of Pain

SN - 0749-8047

IS - 4

ER -