ABSTRACT: To determine whether patterns of patient-provider communication might vary depending on psychosocial risk factors for back disability.
Working adults (N = 97; 64% men; median age = 38 years) with work-related low back pain completed a risk factor questionnaire and then agreed to have provider visits audiotaped. Verbal exchanges were divided into utterances and coded for content, then compared among low-, medium-, and high-risk patients.
Among high-risk patients only, providers asked more biomedical questions, patients provided more biomedical information, and providers used more language to engage patients and facilitate communication. There were no group differences in psychosocial exchanges.
Clinicians may recognize the need for more detailed assessment of patients with multiple psychosocial factors, but increases in communication are focused on medical explanations and therapeutic regimen, not on lifestyle and psychosocial factors.
Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine 09/2009; 51(9):1032-40. · 1.88 Impact Factor
ABSTRACT: To assess the validity of the Back Disability Risk Questionnaire (BDRQ) to predict developing chronic back disability.
Five hundred nineteen working adults (67% male) seeking outpatient care for acute, work-related back pain (<or=14 days) completed the BDRQ. After the initial medical evaluation, clinicians provided prognostic impressions in a 10-item questionnaire. Pain, functional limitation, and work status were assessed at 3-month follow-up.
In multivariate analyses, the presence of persistent pain, functional limitation, or impaired work status (31.4%) was predicted by six BDRQ questions: injury type, work absence preceding medical evaluation, job tenure, prior back surgery, worries about re-injury, expectation for early return-to-work, and stress. Classification accuracy at 3 months was 76.3%. Initial clinician impressions showed no multivariate associations with outcomes.
The BDRQ may provide prognostic information not observed in a routine medical evaluation for acute BP.
Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine 02/2009; 51(2):185-94. · 1.88 Impact Factor
ABSTRACT: To identify subgroups of patients with work-related back pain based on disability risk factors.
Patients with work-related back pain (N = 528) completed a 16-item questionnaire of potential disability risk factors before their initial medical evaluation. Outcomes of pain, functional limitation, and work disability were assessed 1 and 3 months later.
A K-Means cluster analysis of 5 disability risk factors (pain, depressed mood, fear avoidant beliefs, work inflexibility, and poor expectations for recovery) resulted in 4 sub-groups: low risk (n = 182); emotional distress (n = 103); severe pain/fear avoidant (n = 102); and concerns about job accommodation (n = 141). Pain and disability outcomes at follow-up were superior in the low-risk group and poorest in the severe pain/fear avoidant group.
Patients with acute back pain can be discriminated into subgroups depending on whether disability is related to pain beliefs, emotional distress, or workplace concerns.
Journal of Occupational and Environmental Medicine 03/2007; 49(2):185-93. · 2.06 Impact Factor
ABSTRACT: We sought to assess the relationship between perceptions of provider communication and treatment satisfaction for acute, work-related low-back pain (LBP).
In a prospective cohort study, 544 working adults (67% men) with acute LBP provided 1- and 3-month assessments of pain, function, and work status.
In a multiple regression analysis, positive provider communication (took problem seriously, explained condition clearly, tried to understand my job, advised to prevent re-injury) explained more variation in patient satisfaction at 1 month than was explained by clinical improvements in pain and function. At 3 months, clinical improvement variables surpassed provider communication as predictors of patient satisfaction.
Patients with work-related LBP place a high value on provider counseling and education, especially during the acute stage (<1 month) of treatment.
Journal of Occupational and Environmental Medicine 10/2005; 47(10):1036-43. · 2.06 Impact Factor
ABSTRACT: Inception cohort (<or=14 days after pain onset) with 1-month follow-up.
To determine whether disability risk factors provided by patients and clinicians at a first medical visit for acute occupational low back pain predict outcomes.
Improving health and work outcomes for patients with occupational low back pain may require early identification of risk factors for persistent pain and disability. Previous studies of back pain prognosis have not assessed patients at the time of initial provider contact, and many have not differentiated between occupational and nonoccupational injuries.
Patients (183 female, 385 male) presenting to occupational health clinics with recent onset occupational low back pain (<or=14 days duration) completed a 16-item survey of potential disability risks including demographic, injury, workplace, psychosocial, and symptom factors. After the initial visit, clinicians completed an additional 10-item questionnaire of symptoms and initial prognosis. Outcome variables of functional limitation and work status were assessed 1 month after pain onset.
In multivariate analyses, functional improvement and return to work were more strongly predicted by employer factors (job tenure, physical work demands, availability of modified duty, earlier reporting to employer) and self-ratings of pain and mood than by health history or physical examination. A logistic regression model had a sensitivity of 74.3% to predict those remaining out of work and a specificity of 70.1%.
Early screening for disability risk factors may be helpful to identify those patients at greatest risk for delayed recovery from occupational low back pain. Intervention strategies for high-risk patients might be improved by focusing on job factors, pain coping strategies, and expectations for recovery.
Spine 04/2005; 30(5):572-80. · 2.08 Impact Factor
ABSTRACT: patient-provider communication has been indicated as a key factor in early recovery from acute low back pain (LBP), one of the most common maladies seen in primary care; however, associations between communication and LBP outcomes have not been studied prospectively.
working adults (n = 97; 64% men; median age, 38 years) with acute LBP completed baseline surveys, agreed to audio recording of provider visits, and were followed for 3 months. Using the Roter Interaction Analysis System, 10 composite indices of communication were compared with 1- and 3-month patient outcomes.
patients (n = 30) with significant pain and dysfunction persisting at 3 months provided more biomedical information (t, 2.61; P < .05) and engaged in more negative rapport building (t, 2.33; P < .05) but showed no increase in psychosocial/lifestyle communication during the initial visit (P > .05). Providers asked these patients more biomedical questions (r = 0.35 with dysfunction), more psychosocial/lifestyle questions (r = 0.30), made more efforts to engage the patient (t, 4.49; P < .05), and did more positive rapport building (t, 2.13; P < .05).
providers adapt their communication patterns to collect more information and establish greater rapport with high-risk patients, but patients focus more on biomedical than coping concerns. To better elicit psychosocial concerns from patients, providers may need to administer brief self-report measures or adopt more structured interviewing techniques.
The Journal of the American Board of Family Medicine 24(1):16-25. · 2.05 Impact Factor