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The Attitudes and Beliefs of Clinicians Treating Back Pain: Do They Affect Patients’ Outcome? 

The Attitudes and Beliefs of Clinicians Treating Back Pain: Do They Affect Patients’ Outcome?
Chapter:
The Attitudes and Beliefs of Clinicians Treating Back Pain: Do They Affect Patients’ Outcome?
Author(s):

Tamar Pincus

, Rita Santos

, and Steven Vogel

DOI:
10.1093/med/9780199558902.003.0112
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date: 22 September 2017

There is a rising interest in the treatment-extrinsic factors that may affect outcome in patients with back pain, and in the role that communication with clinicians might play to reduce or increase obstacles to recovery. Research in this area is still in its early stages. There are some methodological issues related to measuring clinicians’ beliefs. In addition, since it is not clear which clinicians’ beliefs increase obstacles to recovery in patients, interventions have tended to focus on the messages communicated to patients, and have attempted to increase knowledge and awareness of guideline recommendations in clinicians. In general, such campaigns have been moderately successful, but results may be significantly improved if specific beliefs demonstrated to have a negative effect on patients were addressed directly.

Clinicians’ education, the role of the clinical environment, habitual clinical behaviour, and practical considerations must also play a considerable role in clinical encounters. There is scope and a need to investigate these systematically. Most important is the link between non-treatment interventional behaviour and patient outcomes. This may represent an important component of the ‘non-specific’ aspects of care that seem to add to the effectiveness of specific interventions. The difficulty in establishing a clear causal path from clinicians’ beliefs, through their behaviour, to affect patients’ perceptions and behaviour and culminate in positive or negative outcome is illustrated in Figure 21.1 (informed by Evans 2007). There is to date no prospective study that examines the relationship between clinicians’ beliefs and patients’ outcome, along the causal route indicated in Figure 21.1. Clearly, the methodological complexity of such a study will be considerable. In addition, there is a need to clearly identify and measure factors extrinsic to beliefs that play a part in clinicians’ clinical decisions and communication to patients.

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