Welcome back to SpineIQ’s Back Blog! Last week, we introduced the topic of the month: self-management. This week we get into some specifics. But first we want to take a moment and explain that self-management concepts from you (their clinician) are not the same as home care for advice from the internet or a neighbor. Advice you provide carries credibility and concern for their long term health and welfare and can increase patient confidence in you as a clinician. Many clinical practice guidelines recommend self-management guidance, with a focus on patient education and advice to stay active. However, patients can be uncertain about what actual action steps they should take if the information they receive is vague and non-specific.1,2 Your delivery, and how much the patient feels understood, listened to, and equipped to engage in their own care as a result, is more likely to engage the patient in self-care practices.3 As every evidence-based clinician already knows, translating existing guidelines into language that is meaningful to patients is not a trivial task. After all, to coin the old expression, patients want to know what TIME it is, not HOW to build a clock. To help with this difficult task, below we have summarized the evidence from a recent systematic review regarding patients’ preferences and expectations regarding conservative care management for low back pain. 4
What information do patients feel that they need to encourage self-management?
Patients report that they want to learn simple, doable, basic information about low back pain, accompanied by a realistic prognosis.
- Advice: Start out by learning more about your patient’s expectations so that you are able to determine if they can be met. Then explain what is known about low back pain – namely that it is a common condition, that the exact trajectory can be somewhat unpredictable, and that while it may reoccur in the future, 50% of people feel completely better within 14 days.5
Patients report that they want information about management of low back pain, both in general and specific to their particular condition.
- Advice: Outline the full range of treatments available, with a summary of risks and benefits associated with each. Often it may be appropriate to recommend that patients follow the advice of the American College of Physicians and try non-pharmacologic treatments (e.g., exercise and manual therapy) prior to pharmacological treatments (e.g. NSAIDs).2Such therapies can have equivalent or better results as NSAIDs or paracetamol (acetaminophen), with less risk. By engaging in a full discussion of their options, many patients will feel comfortable with the decision to engage in conservative approaches first, while also recognizing your overall expertise regarding the management strategies available for treating low back pain
- Advice: Encourage physical activity to the level of patient tolerance. The current literature indicates that no specific movement or posture is inherently bad or risky for low back pain.6,7 Your understanding of biomechanics and the patient’s underlying condition can be used tailor activity-related recommendations that are patient-specific.
- Advice: Desires and goals are huge motivators. When making recommendations, it is important to consider the patient’s sensitive movements, circumstances, comorbidities, lifestyle needs, and the activities that are important to them.
How do patients prefer to have self-management information delivered?
Patients want high-quality information that does not conflict with what they have heard from other healthcare professionals.
- Advice: Ask the patients what information they have received about low back pain from other healthcare professionals and tailor your information accordingly. You want to avoid the backfire effect. Ease into providing differing opinions as you build therapeutic alliance. Discrediting another healthcare professional is never a good idea.
- Advice: Introduce patients to valid, trustworthy, and consistent sources that they can access on the internet or other publically available places.
Patients want low back pain information to be delivered in language they can easily understand
- Advice: Avoid medical jargon and try to deliver the information with an understanding and calm tone. Either showing a patient yourself or asking a staff member to demonstrate aspects of the advice you are providing can help ensure understanding of what you are recommending and why your suggestions are important to consider.
Patients want and expect their practitioners to equip them with strategies to self-manage their back pain. Clinicians who adapt recommendations to meet the specific needs of individual patients are likely to be more successful this process. Self-management is an important part of an evidence-based, patient-centered co-management approach to spine care delivery. When your patient has a voice in the outcome, the outcome is inevitably better.
But enough from us! We would love to know what innovative and create ways YOU are implementing guideline recommendations in your clinic. Please share what has worked in your clinic by posting below or emailing us at firstname.lastname@example.org.
Next week, we will continue exploring other evidence-based advice that can help clinicians encourage self-management in their clinic!
- National Guideline Centre (UK). Low Back Pain and Sciatica in Over 16s: Assessment and Management. National Institute for Health and Care Excellence (UK); 2016. Accessed June 11, 2021. http://www.ncbi.nlm.nih.gov/books/NBK401577/
- Qaseem A, Wilt TJ, McLean RM, Forciea MA, Clinical Guidelines Committee of the American College of Physicians. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2017;166(7):514-530. doi:10.7326/M16-2367
- Sundararajan V, Konrad TR, Garrett J, Carey T. Patterns and determinants of multiple provider use in patients with acute low back pain. J Gen Intern Med. 1998;13(8):528-533. doi:10.1046/j.1525-1497.1998.00163.x
- Lim YZ, Chou L, Au RT, et al. People with low back pain want clear, consistent and personalised information on prognosis, treatment options and self-management strategies: a systematic review. J Physiother. 2019;65(3):124-135. doi:10.1016/j.jphys.2019.05.010
- Schreijenberg M, Chiarotto A, Mauff KAL, Lin C-WC, Maher CG, Koes BW. Inferential reproduction analysis demonstrated that “paracetamol for acute low back pain” trial conclusions were reproducible. J Clin Epidemiol. 2020;121:45-54. doi:10.1016/j.jclinepi.2020.01.010
- Saraceni N, Kent P, Ng L, Campbell A, Straker L, O’Sullivan P. To Flex or Not to Flex? Is There a Relationship Between Lumbar Spine Flexion During Lifting and Low Back Pain? A Systematic Review With Meta-analysis. J Orthop Sports Phys Ther. 2020;50(3):121-130. doi:10.2519/jospt.2020.9218
- Swain CTV, Pan F, Owen PJ, Schmidt H, Belavy DL. No consensus on causality of spine postures or physical exposure and low back pain: A systematic review of systematic reviews. J Biomech. 2020;102:109312. doi:10.1016/j.jbiomech.2019.08.006