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 clinicians to patients with back pain at their initial consultation.

Methods

A secondary analysis was conducted with 25 audio-recordings and transcriptions of consultations between patients with back pain and physiotherapists in a primary care outpatients department. Using a Framework approach, the data were coded and analysed to identify the content of advice given and mode of delivery.

Results

The mean duration of consultation was 38 min 59 s (range 26:21–53:16). Advice was given in 88% (n = 22/25) of 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 using heat. Gaps were identified in the advice given, most notably there was a lack of specificity relating to the frequency and duration of recommended tasks and activities.

Conclusions

Advice and reassurance are integral to enabling people to self-manage their back pain. It is important to avoid contradictory and unhelpful messages. Despite its importance, little is known about the advice offered by clinicians during initial back pain consultations highlighting the need for guidance to be patient-centred and tailored.

中文翻译：

---

物理治疗师对初级保健中背痛患者的建议

背景

背痛指南支持提供建议，使人们能够自我管理并继续正常活动。然而，关于临床医生提供的建议内容知之甚少，该项目旨在确定临床医生在初次咨询时向背痛患者提供的建议。

方法

对 25 份背痛患者与初级保健门诊物理治疗师之间咨询的录音和转录进行了二次分析。使用框架方法，对数据进行编码和分析，以确定所提供建议的内容和交付方式。

结果

平均会诊持续时间为 38 分 59 秒（范围 26:21–53:16）。88% (n = 22/25) 的咨询提供了建议，96% 包括额外的运动指导。认知保证是显而易见的，重点是让人们有信心在疼痛中“移动你的背部”，并鼓励积极的生活方式改变。除了安慰和讨论以增强信心之外，给出的建议的关键主题是：活动促进；姿势改变；关于坐姿的实用自助建议；疼痛管理建议，包括药物治疗和热敷。在给出的建议中发现了差距，最显着的是缺乏与推荐任务和活动的频率和持续时间相关的特异性。

结论

建议和保证对于使人们能够自我管理背痛是不可或缺的。避免相互矛盾和无益的信息很重要。尽管它很重要，但对临床医生在最初的背痛咨询期间提供的建议知之甚少，强调需要以患者为中心和量身定制的指导。