title: Practitioner self-confidence and patient outcomes in acute low back pain.
abstract: OBJECTIVE
  To compare outcomes for patients with acute low back pain who received care from practitioners with different self-confidence scores on a 4-item scale.
  
  
  METHODS
  Cross-sectional survey of practitioners. Prospective cohort study of patient outcomes.
  
  
  METHODS
  Private practices and a group model health maintenance organization.
  
  
  METHODS
  One hundred eighty-nine practitioners, including private practice traditionally trained medical physicians, chiropractors, and physicians in a group model health maintenance organization, who were randomly chosen from practices across the state of North Carolina. These practitioners enrolled 1633 patients with acute low back pain into a prospective cohort study.
  
  
  METHODS
  The practitioner survey contained 10 questionnaire items that measured aspects of practitioner confidence and attitudes in assessing and treating patients with low back pain. Patients were interviewed by telephone after the initial office visit and at 2, 4, 8, 12, and 24 weeks, or until complete recovery, whichever came first.
  
  
  RESULTS
  Of 189 study practitioners, 95% responded to the survey. A 4-item scale, shown by factor analysis to describe practitioners' self-confidence, demonstrated good internal consistency among physicians and chiropractors. Chiropractors had significantly stronger self-confidence scores than physicians. Among patients of primary care physicians and chiropractors, those who received care from practitioners with stronger self-confidence scores did not differ in the time to functional improvement, overall patient satisfaction, or their perception of the completeness of care.
  
  
  CONCLUSIONS
  The level of practitioner self-confidence, as measured by a 4-item scale, did not predict patient outcomes in the treatment of acute low back pain.
authors.affiliation: Department of Family Medicine, University of North Carolina at Chapel Hill, USA.
authors.forename: D R
authors.initials: DR
authors.lastname: Smucker
authors.forename: T R
authors.initials: TR
authors.lastname: Konrad
authors.forename: P
authors.initials: P
authors.lastname: Curtis
authors.forename: T S
authors.initials: TS
authors.lastname: Carey
mesh_terms: D000208:Acute Disease; D002684:Chiropractic; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D005163:Factor Analysis, Statistical; D005260:Female; D006279:Health Maintenance Organizations; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis / Q000628:therapy; D008297:Male; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D011320:Primary Health Care; D011331:Private Practice; D011446:Prospective Studies; D012647:Self-Assessment; D011795:Surveys and Questionnaires