Our patient education dynamic spine models helps a low back pain sufferer a better understanding of their sources of pain. Very often, an  accurate diagnosis can be found and the mechanics around the pain triggers can be learned and avoided for a period of time to wind down pain generators.

A dynamic spine model can empower a patient to help him or her get to know the motions postures and loads related to pain. Once the specific movements are identified, a patient can learn what exercises and movement strategies that will reduce their symptoms. A disc bulge is often an MRI finding but it also tells a story about hypermobility very often. For lumbar spinal stenosis, it is also very common for a person to have symptoms while their spine is in relative extension. The Lumbar Spinal Stenosis Model helps a practitioner deliver this important message to engage with accurate patient education.

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Study Finds Link between Persistent LBP and Heightened Pain Sensitivity

somatosensory changes, LBP

A four-month study 1 of acute lower back pain (LBP) patients and a pain-free control group found a correlation between persistent LBP and somatosensory changes over time that appeared to increase pain and other types of neurological sensitivity in chronic LBP patients. Because even baseline pain awareness was elevated in the subjects that later developed chronic LBP, the authors of the study suggest further studies that would examine the evident link between heightened pain sensitivity and its possible role in the development of chronic LBP.

initial LBP diagnosis also be evaluated for potential psychological issues. Click To Tweet

They also suggest patients undergoing initial LBP diagnosis also be evaluated for potential psychological issues that might be contributing factors to their pain.

The Study

Quantitative sensory responses (QSR) were collected and analyzed at less than three weeks prior to the onset of an acute LBP episode (baseline), a two-month follow-up, and at four months for 25 LBP patients and a pain-free control group of 48 subjects.  LBP patients were recruited from a variety of treatment facilities, physicians, and practitioners. Excluding criteria included any history of serious spinal injury or back surgery, pregnancy, or any painful condition requiring at least a month of treatment in the past year or one that affected the subject’s ability to function in any way on a regular basis or required the use of long-term pain medications. Demographics including sex, age, race, work status, and body mass index (BMI) were collected from the LBP and pain-free control participants at the beginning of the study.

Collecting Initial and Follow-Up Data

Patients with LBP answered questions about their pain’s onset, duration, intensity, and how well they were able to function while in pain. The participants then answered questions about their levels of depression, anxiety, and scale of stress. Back pain patients also answered questions that would indicate how much they catastrophized their pain and how self-sufficient they were at dealing with their pain, as well as questions designed to measure the sensory and emotional or affective connection to their pain. They were screened by questionnaires to determine possible neuropathic features of their LBP. All participants involved in the study were given the questionnaires to complete at each of their three assessments, and they were then classified into blind groups according to their answers.

Sensory Testing

All patients were tested for their cold-pain threshold (CPT), followed by a test for their heat-pain threshold (HPT), mechanical wind-up ratio (WUR), pressure-pain threshold (PPT), two-point discrimination (TPD), and conditioned pain modulation (CPM). The testing was conducted at the same three body sites on the backs and hands of all patients. The LBP patients’ back testing was conducted at the location of their greatest pain. Thermal pain thresholds were measured using three consecutive measurements. Pain from the stimulus of a single pin-prick, followed by that of a 10-pin prick, was used to measure the WUR of all subjects and then compared using analysis of a numerical calculation. Three measurements of pressure-pain were used to calculate the PPT. A ruler was used to calculate the TPD of all subjects.

A series of 30-second contacts with a thermally-heated device was used to measure heat pain, and a cold foot bath was used to determine the subjects’ sensitivity to cold, as they were asked to withdraw their foot when they were no longer capable of tolerating the cold water. They were then asked to rate their discomfort at 30, 60, and 90 seconds on a pain scale, and their score was given a negative or positive inhibitory response value. Data and statistics were computed and analyzed by the researchers using statistical software.

Results

The data collected in this study showed that the chronic LBP group had a significantly increased pain sensitivity during early and later pressure and mechanical tests and were more cognizant of pain responses at baseline than their pain-free and recovered acute LPB study counterparts. The psychological effects of their pain were also measured higher at the two and four-month follow-up than their recovered LBP counterparts. This could mean that those patients were neurologically and/or psychologically more prone to pain, even prior to the development of their LBP symptoms. The study authors suggest better standardization of a CPM protocol in future studies to take psychological factors of the patients into account and improve the reliability of future test results.

 

KEYWORDS: correlation between persistent LBP and somatosensory changes, link between heightened pain sensitivity and its possible role in the development of chronic LBP. patients undergoing initial LBP diagnosis also be evaluated for potential psychological issues, cold-pain threshold, heat-pain threshold, conditioned pain modulation

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Importance of Physician-to-Patient Communication in Musculoskeletal Physiotherapy Consultations

Physician-to-Patient Communication, Patient Education, Communication, Musculoskeletal

A qualitative phenomenological study of 15 musculoskeletal patients and their physiotherapists found that patients were better able to express their concerns and outcome expectations when their practitioners utilized a patient-centric, communicative approach during their initial healthcare consultation. When practitioners were well-versed in contemporary pain and pathology theories, they were better able to anticipate and elicit feedback about their patients’ concerns, leading to a more positive dialogue and better patient satisfaction. Practitioners who have developed systems and approaches to encourage proactive communication from their patients about their health concerns were more likely to have positive patient outcomes than those who relied only upon their prior medical expertise in diagnosing and treating their patients.

Purpose of the Study

Recent healthcare approaches have trended away from the strictly traditional biomedical paradigm to include the biopsychosocial approach to patient consultation and treatment. The newer model recognizes the importance of communication in empowering patients to take an active role in their own treatment and encourages them to consider and express their own health agendas, allowing their clinicians to more fully understand and attend to their specific healthcare needs. To develop a true partnership with their patients, healthcare practitioners must be willing to abandon the “doctor knows best” attitude and develop better communication skills that will allow for a patient-clinician treatment collaboration. This study proposed to investigate the relationship between a clinician’s communication technique and skills and how well the patient was able to express healthcare concerns during an initial consultation.

Methods

15 musculoskeletal patients and their physiotherapists were interviewed after an initial consultation encounter of between 15 and 20 minutes, which was recorded and later analyzed, utilizing predetermined topic guides, including: presenting problems and symptoms; understanding diagnosis theories, how the patients reacted to referrals, the behavior of the clinician during the consultation, desirable and undesirable treatment activities, fears, concerns, and emotional or social issues related to the patient’s treatment or diagnosis.

Findings

Each of the patients involved in the study presented with a range of two to five topics they wanted to discuss with their clinician. The data determined three main themes when it came to important topics of patient-clinician communication during consultations:

Clarity of the patient’s agenda

The first theme identified was how clear or unstructured a patient’s agenda was during their consultation. Some patients had very clear health agendas and were able to communicate their expectations and needs effectively to their clinician. Others were more passive and had more difficulty in communicating their expectations. These patients would have likely benefitted from a practitioner who was better able to create an atmosphere of trust and confidence, which would encourage the patient to discuss their needs.

The need for information and understanding

Patients who had more information about and better understood their health concerns were better at identifying and expressing their expectations and needs during their consultation. The subjects reported being more satisfied with and reassured by their consultation when their clinician took the time to explain and discuss the healthcare issue with them, rather than simply offering a diagnosis and treatment plan. When the clinicians offered evidence-based information regarding their diagnosis and reassurance that their health problem was not due to a serious underlying condition or likely to create too much disruption in their lives, they felt more satisfied with their experience. They were also happier about their consultation when their clinician was able to illicit further information regarding their symptoms and concerns, especially when the patients had neglected to mention these concerns, either through forgetfulness or reluctance to communicate their fears.

Developing Collaboration

Patients in the study reported feeling more supported and engaged when their healthcare provider used a person-centered approach during the interview at their initial consultation. They were better able to trust and have confidence in providers that projected a sense of partnership and were concerned with the social, emotional and physical condition of their patients, rather than treating their dysfunction as a stand-alone concern.

The results of this study emphasize the need for clinicians to create an atmosphere of trust, collaboration, and communication in their patient consultations, rather than relying exclusively on their medical expertise during diagnosis and treatment. By encouraging their patients to more effectively communicate their healthcare concerns, and by creating an atmosphere of collaboration between themselves and their patients, healthcare providers can empower and reassure their patients, which may improve diagnosis, treatment, and healthcare outcomes.

 

KEYWORDS: Importance of Physician-to-Patient Communication, patient-centric, communicative approach, clinician’s communication technique and skills, desirable and undesirable treatment activities, fears, concerns, emotional or social issues related to the patient’s treatment or diagnosis

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Dynamic Imaging Study Suggests Some Degenerative Spondylolisthesis Patients May Not Require Fusion

Degenerative, Spondylolisthesis model, vertebra model, spondylolisthesis

An in vivo dynamic radiographic imaging study of two sets of subjects (symptomatic and asymptomatic) revealed that some degenerative spondylolisthesis (DS) patients showed a greater range of aberrant motion, creating occult instability, in their mid-range kinematic images than previously exhibited on static imaging studies. The new data could have important clinical and diagnostic implications, as practitioners learn to distinguish between DS patients who might benefit from non-surgical interventions and those who require fusion to treat their condition.

Degenerative Spondylolisthesis model

A degenerated lumbar disc model with a grade 1 spondylolisthesis.

Background

Surgical spinal fusion and decompression with laminectomy are the remedies most often prescribed to patients suffering from lumbar DS, but some patients may be treated with decompression alone and avoid costly and potentially risky surgical procedures. Understanding how lumbar spinal instability contributes to DS can help predict which patients may be at risk of destabilization after laminectomy and thus require surgical fusion. The authors of this study sought to compare static and dynamic clinical radiographs to see if the full spectrum of rotational and translational kinematics were evident in MRI’s of subjects utilizing flexion/extension poses.

The Study

Seven Degenerative Spondylolisthesis patients and seven asymptomatic control subjects were imaged during torso flexion as a tracking system measured and calculated the movement of each vertebra and AP slip. Static, and dynamic radiograph images were obtained and compared. The results showed that the static radiographs did not detect the full spectrum of aberrant motion and underestimated AP slip. In contrast, the continuous dynamic imaging showed that DS patients demonstrated a wide range of aberrant motion with high kinematic heterogeneity that was not visible on the static radiographs.





Implications

The results of this ISSLS bioengineering prize-winning study suggest that the presence or absence of lumbar instability in DS patients should be considered and evaluated prior to prescribing treatment. Mid-range kinematics and AP translation may play an important role in determining the relative effectiveness of decompression and laminectomy with—or without—surgical fusion and might spare a subgroup of lumbar DS patients unnecessary expense, risk, and recovery from procedures that are potentially superfluous (or harmful) to their recovery.

KEYWORDS: Some DS Patients May Not Require Fusion Surgery to Improve, some degenerative spondylolisthesis (DS) patients showed a greater range of aberrant motion, creating occult instability, in their mid-range kinematic images, from non-surgical interventions and those who require fusion, static radiographs did not detect the full spectrum of aberrant motion and underestimated AP slip, kinematics and AP translation may play an important role in determining the relative effectiveness of decompression and laminectomy

 

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Study of Human Lumbar Foramen Dimensions During Activity Show Changes are Segment-Dependent

Lumbar Foramen

 An in vivo study of cross-sectional lumbar foramen dimensions during a weight-lifting activity showed that all levels of the lumbar intervertebral foramen (LIVF) area decreased, except for the L5-S1 segment during lumbar extension, which had consistent measurements of the foramen, height, and width throughout the activity. The results of the study could provide insight into ways to improve the diagnosis or treatment of lumbar foramen stenosis.

Purpose of the Study

Radiculopathy caused by nerve root compression is a common symptom of LIVF stenosis and is often treated surgically, through the implantation of an interspinous device or decompression. Because the LIVF is surrounded by mobile facet joints, its shape undergoes changes during typical daily movement. As it changes shape, it may put pressure on nerve roots or other structures that may cause pain. Complications arising from the changing dynamic anatomy of the LIVF during activity can lead to failed back surgery syndrome, so understanding how movement and weight-bearing affects the LIVF is important to effective treatment and maintenance of back pain.

The Study

An MRI study of 10 healthy subjects (five male, five female) in supine, relaxed positions was conducted, and 3D spine models were constructed based upon the results of the scans. The lumbar spines of the subjects were then imaged during lumbar extension postures of 45 degrees to a maximally-extended position, while the subjects were holding an 8-pound dumbbell in both hands. These scans were also used to create 3D vertebral models of the in-vivo dimensions during activity, and a data analytic design was created to determine the area, height, and width of the L2-S1 vertebral levels during the activity for 45-degree flexion, upright position, and maximal extension.

Results

Researchers found that the LIVF area in L2-L3, L3-L4, and L4-L5 decreased during weight-lifting activity. The LIVF widths also showed a similar decrease, but the heights remained throughout the extension activity. However, the foramen area, height, and width at L5-S1 did not change during the weight-lifting. Overall, the data for all other areas demonstrated a change of approximately 10 percent from 45 degrees flexion to an upright standing posture, and again from upright standing to maximal extension. This information underscores how patients with LIVF stenosis may experience nerve root impingement pain during extension postures and feel relief from that pain during flexion. Understanding the in vivo dynamics of the functioning lumbar spine may help practitioners in the treatment and diagnosis of lumbar foramen stenosis.

 

lumbar spinal stenosis, spinal canal narrowing

A superior view of our Lumbar spinal stenosis model with a dynamic disc bulge and dynamic ligamentum flavum.

KEYWORDS: Lumbar Foramen Dimensions During Activity, in vivo study of cross-sectional lumbar foramen dimensions during a weight-lifting activity, insight into ways to improve the diagnosis or treatment of lumbar foramen stenosis, Radiculopathy caused by nerve root compression, Complications arising from the changing dynamic anatomy of the LIVF during activity, nerve root impingement pain during extension postures

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Diurnal Disc Shape and Height Changes – Basic Science and Natural Variations to Understand Back Pain

Diurnal Disc Shape

The spine undergoes natural shape and fluid changes over the course of 24 hours. Often, back pain symptoms vary as well over the day and night cycle.  But the small changes and the links to pain have not been researched thoroughly. Here, a group of researchers from Duke University looked at the reliability of measuring intervertebral disc shape with recumbent MRI. This large avascular structure is linked to back pain and has significant diurnal variation in the human body. It would seem wise to further understand its diurnal disc shape changes.

Some people feel pain in the mornings and others feel things more so at the end of the day. Yet others feel pain more so when they lie down.

The intervertebral disc hydraulically keeps vertebrae separated. Water is squeezed out throughout the day as the human frame is vertical, and this water gets resorbed when an individual lays down. During the process, the disc changes shape and height. And when pain is involved, these shape and height changes can bear increased ( or decreased ) physical stress on structures that may be inflammatory. These can include annular fissures, disc bulges, disc herniations, disc protrusions, encroaching nerve or rootlets of nerves and the shingling of facet joints, just to name a few.

The purpose of this study was to determine intra and inter-rater reliability using MRI to measure diurnal changes of the intervertebral discs.

They did find excellent reliability, and interestingly they saw the most significant change in the posterior annulus region of L5-1. The diurnal variations were in line with what others had seen in previous work. Boos at al. in 1996 saw a 1-2mm change over the course of an 8h workday while Hutton et al. in 2003 saw a volume change of 1-2 cm3.

This research is essential if we are to fully understand back pain origins. Often pain syndromes related to the lower back present with symptoms that are diurnal. At Dynamic Disc Designs, we have models to help explain these subtle but significant changes to the discs, assisting patients to understand the onset of their pains and the diurnal disc shape and the natural variations.

 

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Exploring the Link Between Lower Back Pain, Disc Degeneration and Intradiscal Pressure

intradiscal pressure, model

A study of in vivo intradiscal pressure in subjects with and without lower back pain (LBP) sought to find out how disc degeneration affects intradiscal pressure, measure the loading capacity of the L4/L5 IVD segment, and determine any relationship between movement in that disc segment and the spinal loading capacity. The researchers found that there was a significant relationship between spinal loading and the angle of the motion segment in healthy discs in vivo. In degenerated discs, the intradiscal pressure was much lower than that measured in healthy discs. Further study with wider parameters is suggested to fully understand the phenomenon and the problems associated with it.

Study Motivation and Design

The only way to directly measure spinal loading in humans is via the measurement of intradiscal pressure—a complex in vivo task. Most current knowledge about loading capacities were derived from pioneering studies in the 1960’s and 1970’s by Nachemson, but little corroborating evidence has been published on the topic since. These early studies utilized an inefficient means of evaluating intradiscal pressure—the polyethylene coated disc pressure needle until 1965, and after that, another needle designed specifically for intradiscal pressure measurements. This new needle was not without its deficits and required special handling and was prone to destroying structural defects on insertion. The current study’s authors utilized a newly designed silicone-based needle to measure the pressure and spinal load in 28 patients suffering from LBP, sciatica, or both at the L4/L5 segment, and in eight healthy volunteers with an average age of 25 years-old.

Magnetic resonance imaging (MRI) was performed on the healthy subjects prior to the beginning of the study to ensure no disc degeneration in the volunteers. The 28 LBP patients (10 women and 18 men with a mean age 45 years) were also imaged prior to pressure measurements being taken to visualize the amount of water content in their discs. These patients were diagnosed with disc herniation (16 patients) or spondylosis (12 patients).

The subjects were measured while in the prone position, without sedation but with a “local” dose of anesthesia. A guiding needle was used to position the pressure sensor needle into the nucleus pulposus of the L4/L5 IVD discs. Fluoroscopy was used to confirm correct placement of the needle had been achieved. The subjects were measured in eight positions: prone, upright standing, lateral decubitus, flexion and extension standing, and upright, flexion, and extension sitting positions. Radiograms of the lateral view were also taken of each of the subjects during their testing.

Observations

Pressure measurements in this study indicate that respiration creates a fluctuation in intradiscal pressure even when subjects are in the prone position and utilizing no other muscle activities. An IVD that is healthy is also elastic, with an intradiscal pressure that fluctuates in correspondence to muscle activities and respiration. It is possible that the normal pressure changes involved with respiration could be associated with the maintenance of the nutritional content inside the nucleus pulposus. There was a slight difference between horizontal and vertical pressures in healthy and degenerated discs and in the silicon gel, which may indicate that the nucleus pulposus has a similar pressure tropism to silicon gel. Normal discs had high water content, which explains the small difference between the horizontal and vertical pressure measurements. There was, however, a significant difference between the pressures of the total value (horizontal and vertical and whole posture) of healthy and degenerated discs. These values may not have been significant enough to measure in previous studies utilizing the less efficient needle-types. The information obtained in this study through the use of the sensitive silicone pressure needle will help in developing a better understanding of degenerative disc disease.

 

KEYWORDS: Link Between Lower Back Pain, Disc Degeneration and Intradiscal Pressure, relationship between spinal loading and the angle of the motion segment in healthy discs, respiration creates a fluctuation in intradiscal pressure, degenerative disc disease

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Post-Treatment Interviews Offer Insight into How Conceptions about Care Affect Outcomes in LBP Patients

Post-Treatment Interviews, LBP patients

A phenomonenographic study of post-treatment interviews of lower back pain (LBP) patients’ conceptions regarding their clinical experience revealed common themes that correlated to negative or positive treatment efficacy and suggests practitioner approaches that may empower and create a therapeutic alliance between patients and their health care providers (HCP).

Effective Treatment Involves Holistic Approach

LBP is a worldwide phenomenon that affects adults of all ages. It is a leading cause of lost work and wages and may require long-term treatment with a variety of practitioners. Managing LBP can be challenging, especially when one’s HCP limits treatment or discourse to strictly biomedical or physiological causations. To more effectively address patients’ needs, a holistic, psychosocial approach to understanding LBP and creating effective treatments may be more conducive to patient empowerment and satisfaction with treatment outcomes. The study of post-treatment interviews sought to determine common themes in patients’ conception of their treatment and suggests models that might encourage better, more satisfying care.

Study Design and Data Collection and Analysis

To better understand and describe the full contextual nature of patient experiences with their HCP and treatments, researchers utilized the phenomenographic study design method and created a hierarchical structure of categorized themes derived from the data sets. The study authors were concerned with patients’ conceptions of their practitioner visits, rather than mere opinions. The 17 volunteers (five men and 12 women with a mean age of 46 years) were chosen from LBP patients who were undergoing treatment for episodic or chronic conditions and were categorized as “high risk” on the Keele STarT Back Screening Tool, indicating high levels of psychological risk factors in their daily lives. All of the volunteers agreed to participation in the study and were asked to view videos of their HCP encounters and respond to interview questions regarding their physiotherapy consultation and treatment experience. The experience of viewing and discussing the video prompted many of the subjects to reflect upon their overall healthcare journey. The researchers asked the subjects to talk about who they were and how they ended up in LBP treatment. Further questions queried the patients about the experience of being treated, examined, and the explanations they received from their HCP about their LBP, as well as how aligned they felt with the process of therapy and their HCP.

Categorizing Data

The conceptions of LBP patients were categorized into themes that included: convincing care, lifestyle change, participation, reciprocity, and the ethicality of their encounters. Each of the themes was then broken down into four categories: “non-encounters,” seeking support, empowering cooperation, and autonomic agency.

Invalid “Non-Encounters” Left Patients Frustrated

Patients that described their encounters as “non-encounters” felt that their HCP experience was invalidated by not being listened to or receiving the level of care they had expected during treatment. They complained that their treatment was inconsistent or that the explanations they received during their encounter was inadequate, which left them frustrated, afraid, or filled with anxiety. Some of these patients abandoned therapy altogether and resigned themselves to a life filled with pain. Others opted for more treatments or sought a clearer diagnosis—requesting imaging or surgery to explain or alleviate their symptoms. When their condition was not clearly explained or cured, they felt that treatment was ineffective or that they had been patronized. Those living with long-term pain discussed how their condition had inhibited them in social and work life when they did not get the support they needed. They felt helpless when it came to their own care and were disheartened as they moved from provider to provider seeking out appropriate care. They reported having to wait for long periods of time to receive care and said they felt tired from work and lacked the energy or resources to enjoy leisure activities. They complained that their HCP seemed not to hear them or were dismissive about their own thoughts when it came to their LBP. They were given information that replicated what they already knew or were talked down to with medical jargon that was unhelpful because they did not understand its meaning. They felt their practitioners were disinterested in them and rushed them through an impersonal therapy routine. Some patients felt blamed by their HCP for their pain or received unnecessary treatments that “robbed” them of their time and money, without benefit.

Seeking Support from Care Providers

Patients that sought support in understanding their LBP and treatment options were sometimes frustrated in their efforts to receive a confident examination and interview with a qualified professional who treated them with respect. These patients reported wanting clear explanations of their LBP, delivered in language that was understandable to them. They were most satisfied when their HCP took the time to give a thorough examination and helped them to find reasons for their symptoms. By interviewing patients thoroughly, HCP’s were better able to discern their patients’ life circumstances and give them the type of support needed, including teaching them to recognize and deal with stress in their bodies. Attentive practitioners were best able to be empathetic and supportive to their patients’ needs.

Cooperation and Support Empowered Patients

Patients reported feeling empowered when their HCP gave them the opportunity to take an active part in their own treatment plan. They were best able to do this when the provider gave them understandable explanations about their condition and how treatment techniques and lifestyle changes would benefit their recovery. Having sensible, written treatment plans—rather than merely verbal explanations, which they might forget—made the patients feel more secure and involved in their care. Physiotherapists who were able to demonstrate how the patients’ everyday activities affected their spinal health gave the patients a renewed sense of familiarity with their bodies and helped them to make better choices during normal activities that would reduce strain and injury to their spines. This newfound mind/body connection created a sense of confidence and balance that was beneficial to the patients’ overall well-being and treatment outcome. By learning to associate their LBP with their own physical and psychosocial health, patients gained insight and were likely to make lifestyle changes—including getting adequate rest and relaxation—that benefited them overall. Building a therapeutic, cooperative relationship with their HCP involved reciprocal understanding, good listening skills, and an attitude of respect. When a provider was able to repeat in their own words what their patient had said to them, the patients knew they were truly being heard.

The Development of Autonomic Agency

The group of patients who were best able to transform from patients to active participants in their own care felt the most empowered and reported that their treatment therapy extended beyond office visits and into their lives, work, and homes. Having a clear plan for their future—even when regular physiotherapy was needed—and knowing they could contact their providers with questions or concerns about their health empowered the patients to utilize the instructions and information they had received from their HCP’s and see steady, lasting improvement in their symptoms.

These patients had learned from their care providers about the importance of a family and friend support system and that it was necessary to relax and find a centered calm in life. They learned that strenuous exercise was not necessary to physical well-being and that less taxing types of exercise were sufficient to improve fitness and reduce daily stresses. Overall, they reported better moods due to their lifestyle changes and improved relationships with their loved ones and peers. They accredited many of these changes to the ability of their HCP’s to listen to them and introduce the idea of how psychosocial issues in their lives affected their overall health. They felt confident with their providers because their concerns and goals were discussed and considered when developing a plan of long-term treatment.

Conclusion

Post-treatment interviews in this study indicate the need for HCP’s to develop a patient-centric approach in to therapy that involves listening, cooperation, clear, written instructions, and an overall respect for the patient. When practitioners involve their patients in the process of healing and wellness, and when they see the patient as a whole person whose psychosocial involvements are integral to their physiological health, they are able to inspire confidence and empower their patients to effectively participate in their own acute and long-term LBP management.

 

KEYWORDS: how conceptions about care affect outcomes in LBP patients, empower and create a therapeutic alliance between patients and their health care providers, a holistic, psychosocial approach to understanding LBP, patients’ conceptions of their practitioner visits, understanding their LBP and treatment options, the importance of a family and friend support system