title: Severity of back pain may influence choice and order of practitioner consultations across conventional, allied and complementary health care: a cross-sectional study of 1851 mid-age Australian women.
abstract: Back pain is a common, disabling and costly disorder for which patients often consult with a wide range of health practitioners. Unfortunately, no research to date has directly examined the association between the severity of back pain and back pain sufferers' choice of whom and in what order to consult different health practitioners.
  
  
  
  This is a sub-study of the large nationally representative Australian Longitudinal Study on Women's Health (ALSWH). The mid-age cohort women (born 1946-51, n = 13,715) of the ALSWH were recruited from the Australian national Medicare database in 1996. These women have been surveyed six time, with survey 6 being conducted in 2010 (n = 10,011). Mid-age women (n = 1851) who in 2010 had sought help from a health care practitioner for their back pain were mailed a self-report questionnaire targeting their previous 12 months of health services utilisation, health status and their levels of back pain intensity.
  
  
  
  A total of 1620 women were deemed eligible and 1310 (80.9 %) returned completed questionnaires. Mid-age women with back pain visited various conventional, allied health and CAM practitioners for care: 75.6 % consulted a CAM practitioner; 58.4 % consulted a medical doctor; and 54.2 % consulted an allied health practitioner. Women with the most severe back pain sought conventional care from a general practitioner, and those who consulted a general practitioner first had more severe back pain than those who consulted another practitioner first. Following the general practitioner visit, the women with more severe back pain were more likely to be referred to a conventional specialist, and those with less severe back pain were more likely to be referred to a physiotherapist.
  
  
  
  Our findings suggest that women with more severe back pain are likely to visit a conventional practitioner first, whereas women with less severe back pain are likely to explore a range of treatment options including CAM practitioners. The improvement of back pain over time following the various possible sequencing of consultations with different types of health practitioners is a topic with implications for ensuring safe and effective back pain care and worthy of further detailed investigation.
authors.affiliation: Faculty of Health, University of Technology Sydney, PO Box 123, Ultimo, NSW, 2007, Australia. david.sibbritt@uts.edu.au.
authors.forename: David
authors.initials: D
authors.lastname: Sibbritt
authors.affiliation: Faculty of Health, University of Technology Sydney, PO Box 123, Ultimo, NSW, 2007, Australia.
authors.forename: Romy
authors.initials: R
authors.lastname: Lauche
authors.affiliation: Research Group for Studies of Integrative Health Care, Karolinska Institutet, Solnavägen 1, 171 77, Solna, Sweden.
authors.forename: Tobias
authors.initials: T
authors.lastname: Sundberg
authors.affiliation: Faculty of Health, University of Technology Sydney, PO Box 123, Ultimo, NSW, 2007, Australia.
authors.forename: Wenbo
authors.initials: W
authors.lastname: Peng
authors.affiliation: Faculty of Health, University of Technology Sydney, PO Box 123, Ultimo, NSW, 2007, Australia.
authors.forename: Craig
authors.initials: C
authors.lastname: Moore
authors.affiliation: Faculty of Arts and Social Sciences, University of New South Wales, Sydney, NSW, 2052, Australia.
authors.forename: Alex
authors.initials: A
authors.lastname: Broom
authors.affiliation: Faculty of Arts and Social Sciences, University of New South Wales, Sydney, NSW, 2052, Australia.
authors.forename: Emma
authors.initials: E
authors.lastname: Kirby
authors.affiliation: Faculty of Health, University of Technology Sydney, PO Box 123, Ultimo, NSW, 2007, Australia.
authors.forename: Jon
authors.initials: J
authors.lastname: Adams
mesh_terms: D001315:Australia; D001416:Back Pain; D000529:Complementary Therapies / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D005260:Female; D006282:Health Personnel / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged
keywords: Back pain; Complementary medicine; Health service utilisation; Women