What it means to have a bad back and how does it look

It is common for people with low back pain (LBP) to see their local doctor for assessment and advice – especially when symptoms are severe or prolonged enough to be worrying. Doctors’ management approaches vary, but clinical guidelines consistently recommend some principles of ‘best practice’ care to follow when there is low suspicion of a serious problem. These include providing their patients with high quality information that is reassuring, encouraging them to remain active, and avoiding x-rays or scans.

Despite these recommendations, scans are frequently requested. In this study we were concerned with investigating the impact that receiving the results of scans has on people with LBP. Many scan reports describe degenerative features that patients interpret as abnormal, often without due consideration of whether the findings have relevance to their current complaint. The intriguing fact is that many frequently reported degenerative findings are also commonly found in adults without pain. Would patients think differently about the condition of their back, or behave differently, if they had a better understanding of what a normal spine looks like on a scan?

In a randomized, online, scenario-based study design, we investigated the impact of providing varied types to information on the ‘back-related perceptions’ of ‘virtual patients’ with LBP. Participants were provided with a scenario describing a person who injures their back while lifting, and were asked to imagine that they were person described in the scenario as they answered some question. The scenario was further developed to describe the person’s concern about their slow recovery and their decision to go to see their doctor. Participants were then randomly allocated to 3 groups:

  1. A scan is recommended and the participant receives information about normal scan findings prior to receiving their own results.
  2. A scan is recommended, but the participant does not receive any information prior to receiving their results.
  3. The doctor provides high quality information and does not recommend a scan.

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