Messages to healthcare professionals from patients with low back pain

Low back pain is a considerable health problem which affects people around the world, causing major healthcare costs and personal suffering. Modern health care system has not been able to solve this problem and we need to have more understanding from patients point of view of the challenges patients face during their clinical journey and also of successful solutions to be able to help patients with low back pain more effectively. Many studies have been conducted about patients’ experiences about low back pain management around the world but not in Finland. We were interested to know what are patients’ conceptions of their encounters in the Finnish healthcare system.

Seventeen patients with prolonged or episodic low back pain classified as “high risk” with STaRT back screening tool were interviewed in open recall interviews, using videos of patients’ initial physiotherapy sessions that had been recorded previously. The data were analysed using the phenomenographic method.

The results of this study showed a range of clinical interactions – from very negative and disempowering, to empowering and life changing. Patients’ conceptions of their clinical journey were formulated by a variety of themes: convincing care, lifestyle change, participation, reciprocality and ethicality of encounters. The themes varied in four categories: “non‐encounters”, seeking support, empowering collaboration and autonomic agency.

The key differences between the first and second categories were professionals “being present” and patients starting to understand their low back pain. Between the second and third category, the key aspects were strong therapeutic alliance and the active participation of the patient. Finally, the key differences between the third and fourth categories that led towards autonomic agency of the patient were the patient being in charge and taking responsibility while knowing that help was available if required. The results seem to be mostly similar with previous research done in different cultures and contexts. Our results may help in improving the care of patients with low back pain and can be used in training professionals in biopsychosocial approach in low back pain management and give insights for professionals for reflecting own practice.

In the table there are messages gathered from our data from patients with disabling back pain to to health care professionals.

We find it unhelpful when you… We find it helpful when you…
– don’t listen to us

– interrupt us

– dont consider our expectations

– give inconsistent information

– give us scary information

– provide information we don’t understand

– do not give a clear explanation for our pain

– dont support us

– dont involve us in our rehabilitation plan

– don’t provide us with a clear treatment plan

– don’t write things down for us

– sign us off as sick

– blame us for our problem

– are in a hurry and rush us

– dont follow us up

– overtreat us unnecessarily







– are confident and thorough

– care and take time to listen to our worries, concerns and fears

– can understand how pain has an impact on our life

– explain why we have pain using simple language

– provide examples and resources

– reassure us and build our confidence

– are empathetic and supportive

– summarise things for us

– understand our goals and life circumstances

– remember that we are people

– use humour with us

– make us feel safe

– help us reflect and become aware of our body

– put us in charge with you working as a coach

– give us time

– provide clear instructions (written or on electronic devices) and a long-term plan that is flexible and adapted to our lives

– help us modify our lifestyle

– give us feedback

– let us contact you

– get our family involved in our care

Riikka Holopainen is a physiotherapist and a PhD student from University of Jyväskylä, faculty of Sports and Health Sciences, Finland. She is currently working on the second article of her PhD thesis, that is part of a CFT research project in Finland. The working topic of her thesis is the biopsychosocial approach in low back pain management and the next article will be about physiotherapists learning processes related to CFT training. Her PhD supervisors are Arja Piirainen and Ari Heinonen from University of Jyväskylä, Jaro Karppinen from University of Oulu and Peter O’Sullivan from Curtin University as well as collaborating with Steven Linton from Örebro University.

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