Practitioner self-confidence and patient outcomes in acute low back pain.
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.
Smucker
D R
DR
Department of Family Medicine, University of North Carolina at Chapel Hill, USA.
Konrad
T R
TR
Curtis
P
P
Carey
T S
TS
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