Consultation-based reassurance for people with low back pain
Research type
Research Study
Full title
Consultation-based reassurance for people with low back pain consulting about spine surgery
IRAS ID
214210
Contact name
Tamar Pincus
Contact email
Sponsor organisation
Royal Holloway University of London
Duration of Study in the UK
3 years, 11 months, 30 days
Research summary
We propose research in people consulting spinal surgeons for musculoskeletal LBP for whom surgery is not deemed an appropriate method of treatment. Our previous research in primary care shows that a reliable and valid measure of consultation-based reassurance enables testing reassurance against patient’ outcomes. Reassurance is strongly linked to satisfaction, and different types of reassurance are associated also with long- term outcomes, such as anxiety and further care seeking. Different levels of reassurance are indicated for patients with and without psychological obstacles to recovery. However, little is known about the role of reassurance in people who consult in surgical settings, especially in relation to the recommendation not to have surgery, whatever the reason. We recognise that there are several reasons to exclude surgery as a treatment option, and that these range from positive messages about symptoms resolving, to negative messages, suggesting that all reasonable avenue of treatment have been exhausted.
We will adapt our measure of reassurance to comprehensively represent consultation-based reassurance in surgical settings, using qualitative interviews with patients who have recently attended consultations and have been advised that surgery is not indicated. We will then carry out a prospective cohort of 200 patients, using the baseline information to re-examine the clinimetric properties of the questionnaire in this new setting. We will measure patients’ psychological risk profiles and expectations pre-consultation. Post consultation, we will measure perceived reassurance, consultation-based satisfaction, intention to adhere to advice, sense of control over the problem, and reduced health concerns. We will then test the mediating role of consultation-based reassurance on outcomes at three months (disability, pain, further GP visits for LBP, days off work for LBP), adjusting for psychological risk, pain, disability and duration at baseline. This will identify gaps for training and inform interventions to improve patient’ outcomes.REC name
London - Bromley Research Ethics Committee
REC reference
16/LO/1833
Date of REC Opinion
10 Oct 2016
REC opinion
Favourable Opinion