title: The effects of patient-professional partnerships on the self-management and health outcomes for patients with chronic back pain: A quasi-experimental study.
abstract: BACKGROUND
  Self-management may be a lifelong task for patients with chronic back pain. Research suggests that chronic pain self-management programmes have beneficial effects on patients' health outcome. Contemporary pain management theories and models also suggest that a good patient-professional partnership enhances patients' ability to self-manage their condition.
  
  
  OBJECTIVE
  (1) To investigate whether there is a reciprocal relationship between self-management of chronic back pain and health-related quality of life (HRQoL); (2) to examine the impact of a good patient-professional partnership on HRQoL, either directly, or indirectly via change in the ability to self-manage pain.
  
  
  METHODS
  This quasi-experimental study was designed to take place during routine service appointments and conducted in a community-based pain management service in the United Kingdom. A patient-professional partnership was established in which patients were actively involved in setting up goals and developing individualised care plans. Through this, health professionals undertook patients' health needs assessment, collaborated with patients to identify specific problems, provided written materials and delivered individualised exercise based on patients' life situation. Patients were recruited following initial consultation and followed up three months later.
  
  
  METHODS
  A total of 147 patients (65% female) with a mean age of 48 years (standard deviation (SD): 14 years) were enrolled in the study. Of these, 103 subjects completed the study. Patients were included if they were aged 18 and over, suffered from chronic back pain, had opted in to the clinic and had sufficient ability to read and understand English. Patients were excluded if they opted out this service after the initial assessment, suffered from malignant pain or required acute medical interventions for their pain relief.
  
  
  METHODS
  Self-reported measures of HRQoL, patient-professional partnerships and self-management ability were collected at baseline and three months later. Pathways proposed were depicted using structural equation modelling.
  
  
  RESULTS
  There was no association between patients' self-management ability and HRQoL at baseline. However, a positive direct effect was detected at three months (-0.38, p<0.01). A patient-professional partnership was not found to be beneficial for patients' HRQoL through a direct pathway, but via an indirect pathway where self-management was a mediator (-19.09, p<0.01).
  
  
  CONCLUSIONS
  This study suggests that the increase in patients' self-management ability may lead to improvement in HRQoL after pain management support provided in a partnership with health professionals. A good patient-professional partnership appears to be beneficial as an augmentation to self-management practice for patients with chronic back pain.
authors.affiliation: School of Healthcare, University of Leeds, Leeds, UK. Electronic address: y.fu@leeds.ac.uk.
authors.forename: Yu
authors.initials: Y
authors.lastname: Fu
authors.affiliation: Department of Health Sciences, University of York, York, UK.
authors.forename: Ge
authors.initials: G
authors.lastname: Yu
authors.affiliation: School of Healthcare, University of Leeds, Leeds, UK.
authors.forename: Elaine
authors.initials: E
authors.lastname: McNichol
authors.affiliation: Leeds Community Healthcare NHS Trust, Leeds, Leeds, UK.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Marczewski
authors.affiliation: School of Healthcare, University of Leeds, Leeds, UK.
authors.forename: S
authors.initials: S
authors.lastname: José Closs
mesh_terms: D000328:Adult; D001416:Back Pain / Q000628:therapy*; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012648:Self Care
keywords: Chronic back pain; Health-related quality of life; Patient–professional partnership; Self-management