General practitioners' treatment orientations towards low back pain: influence on treatment behaviour and patient outcome.
BACKGROUND
In low back pain (LBP) treatment and research attention has shifted from a biomedical towards a biopsychosocial approach. Patients' LBP beliefs and attitudes were found to predict long-term outcome, and recently it has been suggested that the health care providers' ideas about LBP are also important predictors of treatment behaviour and outcome.


OBJECTIVE
In the present study we examined whether (1) differences in General Practitioners' (GP) LBP treatment orientation are associated with differences in actual treatment behaviour and (2) whether treatment orientation is related to LBP outcome in patients.


METHODS
Two hundred twenty two patients consulting their GP with a new episode of LBP were recruited and completed questionnaires on (among others) LBP outcome (graded chronic pain scale) at baseline, during 12 months of follow-up and at the end of the study. Data on treatment were collected from the GPs. The GPs also completed a set of questionnaires on LBP treatment orientation. Associations between measures of treatment orientation, treatment recommendations, treatment behaviour and LBP outcome were analysed.


RESULTS
A biomedical treatment orientation was found to be associated with more concern about tissue damage and the effect of physical activity on pain and recovery in vignettes. No associations were found between treatment orientation measures, actual treatment behaviour and LBP outcome.


CONCLUSIONS
Associations were not found as expected. Still these findings are relevant and may feed a clinically important debate on widely accepted assumptions about the role and influence of health care providers in changing patients' pain behaviours.
Sieben
Judith M
JM
Department of Anatomy and Embryology, Maastricht University, Maastricht, The Netherlands. j.sieben@ae.unimaas.nl
Vlaeyen
Johan W S
JW
Portegijs
Piet J M
PJ
Warmenhoven
Franca C
FC
Sint
Ageeth G
AG
Dautzenberg
Nadine
N
Romeijnders
Arnold
A
Arntz
Arnoud
A
Knottnerus
J André
JA
D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D015331:Cohort Studies; D003469:Culture; D005081:Exercise Therapy / Q000009:adverse effects / Q000193:education; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000523:psychology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods; D010809:Physical Fitness / Q000502:physiology; D010821:Physicians, Family / Q000193:education* / Q000523:psychology*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome