Misbeliefs about non-specific low back pain and attitudes towards treatment by primary care providers in Spain: a qualitative study

Ester García-Martínez, Jorge Soler-González, Joan Blanco-Blanco, Francesc Rubí-Carnacea, María Masbernat-Almenara, Fran Valenzuela-Pascual, Ester García-Martínez, Jorge Soler-González, Joan Blanco-Blanco, Francesc Rubí-Carnacea, María Masbernat-Almenara, Fran Valenzuela-Pascual

Abstract

Aim: To identify misbeliefs about the origin and meaning of non-specific chronic low back pain and to examine attitudes towards treatment by primary health care providers.

Design: Generic qualitative study.

Methods: Ten semi-structured interviews were conducted between October and November 2016 with physicians and nurses from primary health care centres in Lleida. The interviews were transcribed and analysed using inductive thematic analysis via Atlas.ti-8 software.

Results: Five themes were identified: i. beliefs about the origin and meaning of chronic low back pain, ii. psychosocial aspects of pain modulators, iii. Therapeutic exercise as a treatment for chronic low back pain, iv. biomedical attitudes of primary health care providers, and v. difficulties in the clinical approach to chronic low back pain.

Conclusion: Primary health care providers have a unifactorial view of chronic low back pain and base their approach on the biomedical model. Professionals attribute chronic low back pain to structural alterations in the lumbar spine while psychosocial factors are only recognized as pain modulators. For professionals, therapeutic exercise represents a possible solution to chronic low back pain; however, they still do not prescribe it and continue to educate on postural hygiene and recommend limiting physical and/or occupational activities, as opposed to clinical practice guidelines. These findings suggest that to improve the adherence of primary health care providers to the biopsychosocial model, it may be necessary first to modify their misbeliefs about non-specific chronic low back pain by increasing their knowledge on pain neurophysiology.

Trial registration: ClinicalTrials.gov Identifier: NCT02962817 . Date of registration: 11/11/2016.

Keywords: Low Back pain; Medicine; Nursing; Pain management; Primary health care; Qualitative research.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2022. The Author(s).

References

    1. MINISTERIO DE SANIDAD CYBS. Situación de Salud. Informe Anual del Sistema Nacional de Salud 2018. Resumen Ejecutivo. Informes, Estudios e Investigación. 2020;3–11.
    1. Sit RWS, Yip BHK, Chan DCC, Wong SYS. Primary care physicians ’ attitudes and beliefs towards chronic low Back pain: an Asian study. PLoS One. 2015;10(1):e0117521.
    1. Catal S. Informe breu núm. 37: Dolor lumbar. 2018. Barcelona: Servei Català de la Salut. Departament de Salut. Generalitat de Catalunya; 2020; 2020. p. 1–4.
    1. Della Mora LS, Perruccio AV, Badley EM, Rampersaud R. Differences among primary care patients with different mechanical patterns of low back pain: a cross-sectional investigation. BMJ Open. 2016;6(e013060):1–9.
    1. Ramond-Roquin A, Bouton C, Bègue C, Petit A, Roquelaure Y, Huez J-F. Psychosocial risk factors, interventions, and comorbidity in patients with non-specific low Back pain in primary care: need for comprehensive and patient-centered care. Front Med. 2015;2(73):1–14.
    1. Skelton AM, Murphy EA, Murphy RJL, Dowd TCO. Patients’ views of low back pain and management in general practice. Br J Gen Pract. 1996;March 1991:153–156.
    1. Foster NE, Pincus T, Underwood M, Vogel S, Hons DO, Breen A, et al. Treatment and the process of care in musculoskeletal conditions. A multidisciplinary perspective and integration. Orthop Clin North. 2003;34(2):239–44.
    1. Bordas JM, Forcada J, García JA, Joaniquet FX, Pellisé F, Mazeres O, et al. Patologia de la columna lumbar en l’adult. Barcelona: Institut Català de la Salud; 2004. pp. 1–49.
    1. Koes BW, Van Tulder M, Lin CC, Macedo LG, Mcauley J, Maher C. An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. Eur Spine J. 2010;19:2075–2094. doi: 10.1007/s00586-010-1502-y.
    1. Bishop A, Thomas E, Foster NE. Health care practitioners attitudes and beliefs about low back pain: a systematic search and critical review of available measurement tools. Pain. 2007;132:91–101. doi: 10.1016/j.pain.2007.01.028.
    1. Foster NE, Anema JR, Cherkin D, Chou R, Cohen SP, Gross DP, et al. Prevention and treatment of low back pain: evidence, challenges, and promising directions. Lancet. 2018;391:2368–2383. doi: 10.1016/S0140-6736(18)30489-6.
    1. Houben R, Ostelo R, Vlaeyen J, Wolters P, Peters M, Stomp-van den Berg S. Health care providers ’ orientations towards common low back pain predict perceived harmfulness of physical activities and recommendations regarding return to normal activity. Eur J Pain. 2005;9:173–183. doi: 10.1016/j.ejpain.2004.05.002.
    1. Domenech J, Sánchez-zuriaga D, Segura-ortí E, Espejo-tort B, Lisón JF. Impact of biomedical and biopsychosocial training sessions on the attitudes, beliefs, and recommendations of health care providers about low back pain: a randomised clinical trial. Pain. International Association for the Study of Pain; 2011;152(11):2557–2563.
    1. Gardner T, Refshauge K, Smith L, Mcauley J, Goodall S, Hübscher M. Physiotherapists ’ beliefs and attitudes influence clinical practice in chronic low back pain: a systematic review of quantitative and qualitative studies. J Physiother. 2017;63(3):132–143. doi: 10.1016/j.jphys.2017.05.017.
    1. Mckay RT, Dennett DC. The evolution of misbelief. Behav Brain Sci. 2009;32(6):493–510. doi: 10.1017/S0140525X09990975.
    1. Darlow B, Fullen BM, Dean S, Hurley DA, Baxter GD, Dowell A, et al. The association between health care professional attitudes and beliefs and the attitudes and beliefs, clinical management, and outcomes of patients with low back pain: a systematic review. Eur J Pain. 2012;16:3–17. doi: 10.1016/j.ejpain.2011.06.006.
    1. Darlow B. Beliefs about back pain: the confluence of client, clinician and community. Int J Osteopath Med. 2016;20:53–61. doi: 10.1016/j.ijosm.2016.01.005.
    1. Buchbinder R, Jolley D, Wyatt M. Population based intervention to change back pain beliefs and disability: three part evaluation. BJM. 2001;322:1516–1520. doi: 10.1136/bmj.322.7301.1516.
    1. Coudeyre E, Rannou F, Tubach F, Baron G, Coriat F, Brin S, et al. General practitioners fear-avoidance beliefs influence their management of patients with low back pain. Pain. 2006;124:330–337. doi: 10.1016/j.pain.2006.05.003.
    1. Magalhães M, Costa L, Cabral C, Machado L. Attitudes and beliefs of Brazilian physical therapists about chronic low back pain : a cross-sectional study. Rev Bras Fisioter. 2012;16(3):248–253. doi: 10.1590/S1413-35552012005000014.
    1. Rainville J, Bagnall D, Phalen L. Health care providers’ attitudes and beliefs about functional impairments and chronic Back pain. Clin J Pain. 1995;11(4):287–295. doi: 10.1097/00002508-199512000-00006.
    1. Martínez Díaz JD, Ortega Chacón V, Muñoz Ronda FJ. El diseño de preguntas clínicas en la práctica basada en la evidencia. Modelos de formulación. Rev Electrón Trimest Enfermería. 2016;43:431–438.
    1. Salgado Lévano AC. Investigación cualitativa: diseños, evaluación del rigor metodológico y retos. Liberabit. 2007;13(13):71–78.
    1. Caelli K, Ray L, Mill J. “Clear as mud”: toward greater clarity in generic qualitative research. Int J Qual Methods. 2003;2(2):1–13. doi: 10.1177/160940690300200201.
    1. Bradshaw C, Atkinson S, Doody O. Employing a qualitative description approach in health care research. Glob Qual Nurs Res. 2017;4:233339361774228. doi: 10.1177/2333393617742282.
    1. Palinkas LA, Horwitz SM, Green CA, Wisdom JP, Duan N, Hoagwood K, et al. Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Adm Policy Ment Health. 2015;42(5):533–544. doi: 10.1007/s10488-013-0528-y.
    1. Wu Suen LJ, Huang HM, Lee HH. A comparison of convenience sampling and purposive sampling. J Nurs. 2014;61(3):105–111.
    1. Endacott R. Clinical research 4: qualitative data collection and analysis. Intensive Crit Care Nurs. 2005;21:123–127. doi: 10.1016/j.iccn.2004.10.001.
    1. Teddlie C, Yu F. Mixted methods sampling: a typology with examples. J Mix Methods Res. 2007;1(1):77–100. doi: 10.1177/1558689806292430.
    1. Bellamy K, Ostini R, Martini N, Kairuz T. Seeking to understand: using generic qualitative research to explore access to medicines and pharmacy services among resettled refugees. Int J Clin Pharm. 2016;38(3):671–675.
    1. Vaismoradi M, Turunen H, Bondas T. Content analysis and thematic analysis: implications for conducting a qualitative descriptive study. Nurs Health Sci. 2013;15(3):398–405. doi: 10.1111/nhs.12048.
    1. Allison T, Peter S, Jonathan C. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Heal Care. 2007;19(6):349. doi: 10.1093/intqhc/mzm042.
    1. Konno S, Sekiguchi M. Association between brain and low back pain. J Orthop Sci. 2018;23(1):3–7. doi: 10.1016/j.jos.2017.11.007.
    1. Edwards RR, Dworkin RH, Sullivan MD, Turk D, Ajay D. The role of psychosocial processes in the development and maintenance of chronic pain disorders. J Pain. 2017;17(9):1–39.
    1. Rhon DI, Fritz JM, Greenlee TA, Dry KE, Mayhew R, Laugesen MC, et al. Move to health-a holistic approach to the management of chronic low back pain: an intervention and implementation protocol developed for a pragmatic clinical trial. J Transl Med. 2021;19:357. doi: 10.1186/s12967-021-03013-y.
    1. Slade SC, Kent P, Patel S, Bucknall T, Buchbinder R, Affiliations I, et al. Barriers to primary care clinician adherence to clinical guidelines for the management of low back pain: a systematic review and meta-synthesis of qualitative studies. Clin J Pain. 2016;32(9):800–816. doi: 10.1097/AJP.0000000000000324.
    1. Hall AM, Scurrey SR, Pike AE, Albury C, Richmond HL, Matthews J, et al. Physician-reported barriers to using evidence-based recommendations for low back pain in clinical practice: a systematic review and synthesis of qualitative studies using the theoretical domains framework. Implement Sci. 2019;14:49. doi: 10.1186/s13012-019-0884-4.
    1. Lj G, Ra M, Clarke C, Martin D, La C, Bh S, et al. Physical activity and exercise for chronic pain in adults: an overview of Cochrane reviews (review). Cochrane Database Syst Rev. 2017;1(4).
    1. Gordon R, Bloxham S. A systematic review of the effects of exercise and physical activity on non-specific chronic low Back pain. Health Serv Res. 2016;4(22):1–19.
    1. Searle A, Spink M, Ho A, Chuter V. Exercise interventions for the treatment of chronic low back pain: a systematic review and meta-analysis of randomised controlled trials. Clin Rehabil. 2015;10:1–13.
    1. Kolber MR, Ton J, Thomas B, Kirkwood J, Moe S, Chan K, et al. PEER systematic review of randomized controlled trials: management of chronic low back pain in primary care. Can Fam Physician. 2021;67(1):e20–e30.
    1. Darlow B, Dowell A, Baxter GD, Perry M. The enduring impact of what clinicians say to people with low Back pain. Ann Fam Med. 2013;11(6):527–534. doi: 10.1370/afm.1518.
    1. Boutevillain L, Dupeyron A, Rouch C, Richard E, Coudeyre E. Facilitators and barriers to physical activity in people with chronic low back pain: a qualitative study. PLoS One. 2017;12(7):1–16. doi: 10.1371/journal.pone.0179826.
    1. Edmond SN, Keefe FJ. Validating pain communication: current state of the science. Pain. 2015;156(2):215–219. doi: 10.1097/01.j.pain.0000460301.18207.c2.
    1. Cherkin DC, Maccornack FA, Berg A. Managing low Back pain-a comparison of the beliefs and behaviors of family physicians and chiropractors. West J Med. 1988;149(4):475–80.
    1. Sanders T, Foster NE, Ong BN. Perceptions of general practitioners towards the use of a new system for treating back pain: a qualitative interview study. BMC Med. 2011;9(49):1–11.
    1. Van Erp RMA, Huijnen IPJ, Jakobs MLG, Kleijnen J, Smeets RJEM. Effectiveness of primary care interventions using a biopsychosocial approach in chronic low Back pain: a systematic review. Pain Pract. 2019;19(2):224–41.
    1. García-Martínez E, Soler-González J, Rubí-Carnacea F, García-Martínez B, Climent-Sanz C, Blanco-Blanco J, et al. The influence of an educational internet- based intervention in the beliefs and attitudes of primary care professionals on non-specific chronic low back pain : study protocol of a mixed methods approach. BMC Family Practice. 2019;20(1):1–8.

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit