To investigate sociodemographic and clinical characteristics in patients operated for lumbar disc herniation in public and private hospitals, and evaluate whether selection for surgical treatment were different across the two settings. A cross-sectional multicenter study of patients who underwent a total of 5308 elective surgeries for lumbar disc herniation at 41 hospitals. Data were included in the Norwegian Registry for Spine Surgery (NORspine). Of 5308 elective surgical procedures, 3628 were performed at 31 public hospitals and 1680 at 10 private clinics. Patients in the private clinics were slightly younger, more likely to be man, have higher level of education, and more likely to be employed. The proportions of disability and retirement pension were more than double in public as compared to private hospitals. Patients operated in public hospitals were older, had more obesity and co-morbidity, lower educational level, longer duration of symptoms, and sick leave and were less likely to return to work. Patients operated in public hospitals reported more disability and pain, poorer HRQol and general health status than those operated in private clinics. The differences were consistent but small and could not be attributed to less strict indications for surgical treatment in private clinics.Purpose
Methods and results
MRI of the lumbar spine is a clinically important examination in low back pain (LBP) when serious underlying pathology or radiculopathy is suspected or when pain does not improve, e.g. to identify herniated discs. The general population has high confidence in this modality. Little documented knowledge exists about how the MRI results should be communicated to the patients in an optimal way. The aim of this study was to explore the patients' perspectives, i.e. worries, thoughts and interpretations of terms used when health care providers convey the MRI results. 79 patients with chronic LBP were included in a broader study of consultations at Funen Back Centre by which the results of MRI were conveyed. 43 of these patients were selected for a qualitative study until information saturation was reached. After the clinical consultation, each patient was interviewed using a semi-structured interview guide. The interviews were audio-recorded and fully transcribed. The transcripts were analysed using Giorgi's method as modified by Malterud. There was a broad variation in the patients' worries, thoughts and expectations prior to the consultations. Worries were linked to a diversity of possible causes (or finding no explanation) of the pain as well as consequences for function and treatment. We found a broad spectrum of interpretations of terms used, for instance content and meaning of “wear and tear” or disc herniation. Subjects had a high confidence in the reliability of MRI.Purposes of the study and background
Summary of methods used and results
