The Effects of Patient-Provider Communication on 3-Month Recovery from Acute Low Back Pain

摘要

id="p1">Background: Patient-provider communication has been indicated as a key factor in early recovery from acute low back pain (LBP), one of the most common maladies seen in primary care; however, associations between communication and LBP outcomes have not been studied prospectively. id="p-2">Methods: Working adults (n = 97; 64% men; median age, 38 years) with acute LBP completed baseline surveys, agreed to audio recording of provider visits, and were followed for 3 months. Using the Roter Interaction Analysis System, 10 composite indices of communication were compared with 1- and 3-month patient outcomes. id="p-3">Results: Patients (n = 30) with significant pain and dysfunction persisting at 3 months provided more biomedical information (t[75], 2.61; P .05) and engaged in more negative rapport building (t[75], 2.33; P .05) but showed no increase in psychosocial/lifestyle communication during the initial visit (P .05). Providers asked these patients more biomedical questions (r = 0.35 with dysfunction), more psychosocial/lifestyle questions (r = 0.30), made more efforts to engage the patient (t[75], 4.49; P .05), and did more positive rapport building (t[75], 2.13; P .05). id="p-4">Conclusions: Providers adapt their communication patterns to collect more information and establish greater rapport with high-risk patients, but patients focus more on biomedical than coping concerns. To better elicit psychosocial concerns from patients, providers may need to administer brief self-report measures or adopt more structured interviewing techniques. class="kwd-group KWD">

>class="kwd-search" href="/search?fulltext=Back+Pain&sortspec=date&submit=Submit&andorexactfulltext=phrase">Back Pain

>class="kwd-search" href="/search?fulltext=Communication&sortspec=date&submit=Submit&andorexactfulltext=phrase">Communication

>class="kwd-search" href="/search?fulltext=Patient-Centered+Care&sortspec=date&submit=Submit&andorexactfulltext=phrase">Patient-Centered Care

>class="kwd-search" href="/search?fulltext=Patient-Provider+Communication&sortspec=date&submit=Submit&andorexactfulltext=phrase">Patient-Provider Communication

>class="kwd-search" href="/search?fulltext=Prognosis&sortspec=date&submit=Submit&andorexactfulltext=phrase">Prognosis id="p-5">Patient-centered communication has become a core value in primary care medicine.id="xref-ref-1-1" class="xref-bibr" href="#ref-1">1,id="xref-ref-2-1" class="xref-bibr" href="#ref-2">2 The basic tenets of patient-centered communication are to understand medical problems in the context of a patient's lifestyle, preferences, and beliefs and to engage patients in collaborative decision making.id="xref-ref-3-1" class="xref-bibr" href="#ref-3">3,id="xref-ref-4-1" class="xref-bibr" href="#ref-4">4 More patient-centered communication is associated with improved patient satisfaction,id="xref-ref-5-1" class="xref-bibr" href="#ref-5">5 fewer malpractice complaints,id="xref-ref-6-1" class="xref-bibr" href="#ref-6">6 increased adherence,id="xref-ref-7-1" class="xref-bibr" href="#ref-7">7 and improved perceptions of health status.id="xref-ref-5-2" class="xref-bibr" href="#ref-5">5 Moreover, patient-centered communication seems consistent with ideals of enabling patients, forming a therapeutic alliance, being culturally competent,id="xref-ref-8-1" class="xref-bibr" href="#ref-8">8 and making medical care accessible and understandable to patients.id="xref-ref-1-2" class="xref-bibr" href="#ref-1">1,id="xref-ref-9-1" class="xref-bibr" href="#ref-9">9,id="xref-ref-10-1" class="xref-bibr" href="#ref-10">10 Though not all studies of patient-centered communication have shown benefits,id="xref-ref-11-1" class="xref-bibr" href="#ref-11">11 there is substantial evidence of a relationship with patient health outcomes, patient satisfaction, and patient adherence in primary care.id="xref-ref-12-1" class="xref-bibr" href="#ref-12">12–15 In general, patients prefer a balance between psychosocial and biomedical topics and the opportunity to ask questions.id="xref-ref-15-1" class="xref-bibr" href="#ref-15">15 These aspects of care may be especially pertinent to long-term management and recovery from acute episodes of musculoskeletal pain. id="p-6">Low back pain (LBP) is one of the most common pain conditions affecting working-age adults, and LBP is a leading c