Acute low back pain management in general practice: uncertainty and conflicting certainties
Acute low back pain management in general practice: uncertainty and conflicting certainties
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DOI：
10.1093/fampra/cmu051
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发表时间：
2014-12-01
期刊：
影响因子：
2.2
通讯作者：
Dowell, Anthony
中科院分区：
文献类型：
--
作者：
Darlow, Ben;Dean, Sarah;Dowell, Anthony
背景。腰痛（LBP）是一个重要的健康问题，也是去看全科医生的常见原因。有证据表明，全科医生在应用循证指南方面存在困难。探讨全科医生对急性腰痛的潜在信念，以及这些信念如何影响他们对患者的临床管理。通过有目的抽样，从新西兰的一个地理区域招募了11名全科医生。半结构化定性访谈的录音逐字抄录。采用解释性描述框架对数据进行分析。四个关键主题出现与急性腰痛的原因，GP信心，沟通诊断的不确定性和鼓励运动和活动。急性腰痛被视为组织损伤的直接表现，因此评估和管理患者的态度和信念不是一个优先事项。由于无法诊断或影响组织损伤，参与者的信心下降。尽管如此，医生还是向患者提供了诊断结果，以打消他们的疑虑，满足他们的期望。关于活动的指南建议与保护受损组织的感知需求相冲突，导致报告中提供的关于积极和谨慎的需求的混合信息。全科医生在急性护理期间最初关注组织损伤，并提供诊断标签，可能会影响患者随后与生物医学观点的一致，并在讨论心理社会影响时导致咨询冲突和患者对责备的看法。证明生物心理社会模型与急性腰痛的相关性可以提高全科医生对指南的一致性，提高他们管理这些患者的信心，并最终改善结果。
Background. Low back pain (LBP) is a significant health problem and common reason to visit the GP. Evidence suggests GPs experience difficulty applying evidence-based guidelines.Objective. Explore GPs' underlying beliefs about acute LBP and how these influence their clinical management of patients.Methods. Eleven GPs from one geographical region within New Zealand were recruited by purposive sampling. Audio recordings of semi-structured qualitative interviews were transcribed verbatim. Data were analysed with an Interpretive Description framework.Results. Four key themes emerged related to the causes of acute LBP, GP confidence, communicating diagnostic uncertainty and encouraging movement and activity. Acute LBP was seen as a direct representation of tissue injury, consequently the assessment and management of patients' attitudes and beliefs was not a priority. Participants' confidence was decreased due to a perceived inability to diagnose or influence the tissue injury. Despite this, diagnoses were provided to patients to provide reassurance and meet expectations. Guideline recommendations regarding activity conflicted with a perceived need to protect damaged tissue, resulting in reported provision of mixed messages about the need to be both active and careful.Conclusions. GPs' initial focus upon tissue injury during acute care, and providing a diagnostic label, may influence patients' subsequent alignment with a biomedical perspective and contribute to consultation conflict and patients' perception of blame when discussion of psychosocial influences is introduced. Demonstrating the relevance of the biopsychosocial model to acute LBP may improve GPs' alignment with guidelines, improve their confidence to manage these patients and ultimately improve outcomes.