Abstract
Purpose and background
Back pain guidelines endorse giving advice to enable people to self-manage and continue normal activities. Little is known however, about the content of advice that clinicians give and this project aimed to identify the advice given by physiotherapists to patients with back pain at their initial consultation.
Patients and methods
Twenty-five audio-recordings of patients with back pain and physiotherapists in a primary care outpatient department were collected, transcribed, coded and thematically analysed using a Framework approach to identify the content of advice given.
Results
The mean duration of consultation was 38 minutes 59 seconds (range 26:21–53:16). Advice was given in 88% (n=22/25) consultations and 96% included additional exercise instruction. Cognitive reassurance was evident, focussing on getting people confident to ‘move your back’ despite pain and encouraging active lifestyle changes. Beyond reassurance and discussion to enhance confidence, the key topics of advice given were: activity promotion; postural changes; practical self-help advice regarding ways to sit; pain-management advice including medication and the use of heat. Gaps were identified in the completeness of the advice given and there was a lack of specificity, especially relating to the frequency of recommended tasks and activities.
Conclusion
Advice and reassurance are integral to enabling people to self-manage their back pain. Despite its importance, little is known about the advice offered by clinicians. This novel, observational study identifies the topics of advice given by clinicians in back pain consultations and recognises the need for guidance to be patient-centred and specific.
No conflicts of interest
Sources of funding: The data were collected as part of Lisa Roberts's Arthritis Research UK academic fellowship [17830]. Lisa Roberts currently holds an NIHR senior clinical lectureship (round 3).
