科研之友
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摘要
Background. Low back pain (LBP) is a significant health problem and common reason to visit the GP. Evidence suggests GPs experience difficulty applying evidence-based guidelines. %26lt;br%26gt;Objective. Explore GPs%26apos; underlying beliefs about acute LBP and how these influence their clinical management of patients. %26lt;br%26gt;Methods. Eleven GPs from one geographical region within New Zealand were recruited by purposive sampling. Audio recordings of semi-structured qualitative interviews were transcribed verbatim. Data were analysed with an Interpretive Description framework. %26lt;br%26gt;Results. Four key themes emerged related to the causes of acute LBP, GP confidence, communicating diagnostic uncertainty and encouraging movement and activity. Acute LBP was seen as a direct representation of tissue injury, consequently the assessment and management of patients%26apos; attitudes and beliefs was not a priority. Participants%26apos; confidence was decreased due to a perceived inability to diagnose or influence the tissue injury. Despite this, diagnoses were provided to patients to provide reassurance and meet expectations. Guideline recommendations regarding activity conflicted with a perceived need to protect damaged tissue, resulting in reported provision of mixed messages about the need to be both active and careful. %26lt;br%26gt;Conclusions. GPs%26apos; initial focus upon tissue injury during acute care, and providing a diagnostic label, may influence patients%26apos; subsequent alignment with a biomedical perspective and contribute to consultation conflict and patients%26apos; perception of blame when discussion of psychosocial influences is introduced. Demonstrating the relevance of the biopsychosocial model to acute LBP may improve GPs%26apos; alignment with guidelines, improve their confidence to manage these patients and ultimately improve outcomes.
- 出版日期2014-12
