A systematic scoping review on what patients expect from their treatment by chiropractors, physiotherapists and complementary and alternative medicine concludes that:
- Back patients look for more evidence-based information about the causes of low back pain, its course and the effect of current treatment methods.Despite evidence for active treatment methods for low back pain, the planned procedures are often not completed.
- This systematic scoping review shows that it might be because the treatment does not live up to the patients’ expectations regarding their need for a holistic, personal treatment, pain management or an explanation of their symptoms. Consequently, they turn to other treatment methods.
- There is a need for new initiatives to educate patients in the mechanisms of low back pain, prognosis and the effect of existing treatment.
The studies summed up in the review are predominantly from the UK, but they also include studies from North America, Europe, Australia, the Middle East and Asia.
Positive attitude to physiotherapy – with reservations
Many patients think physiotherapy aids pain relief, furthers a better understanding of the treatment strategies for pain, prevents low back pain from getting worse and improves mobility and disability. And patients want their treatment to accommodate them individually rather than one treatment fits all.
Patients are also worried that they are unable to complete their exercise programmes and whether they risk damaging their back by exercising. Their worries may stem from their view that they have not had enough information about the development of their low back pain, best practice treatment and confusion regarding the correct exercise techniques.
According to the researchers, practitioners can help remove theses worries by informing their patients about the rationale behind a chosen treatment and exercise and about how safe the treatment is, and they point out that a greater understanding of the choice of treatment may support the patients’ self-confidence and continuous self-management.
Varying attitudes towards chiropractic
The attitudes towards chiropractic varied in the articles included in the study. Some patients see chiropractic as effective, while others are worried about adverse effects. Some patients are satisfied with the chiropractic treatment, while others think the pain was only relieved temporarily and resulted in adverse effects such as muscle pain.
To a large degree, patients seek chiropractic treatment because they are looking for fast non-pharmalogical pain relief. They believe that low back pain is caused by a structural change in the back, which can be changed through chiropractic treatment.
Chiropractic treatment is preferred by males and people in jobs and with high incomes, patients with a positive attitude to self-management and opponents of prescription medicine. Many of those who present with a chiropractor, say they prefer to get treated for their back pain by a chiropractor rather than by a GP.
CAM for physical fitness
Patients who prefer CAM, defined as acupuncture, massage, spinal manipulation and heat treatment of the pain area, do so to improve their disability and physical fitness. They believe alternative medicine relieves pain, relaxes the muscles and stimulates the nerves.
However, there are reservations regarding CAM. In one of the studies mentioned in the paper, the patients consider CAM to be an experimental or desperate step, which the patients resort to when their pain is unbearable, or if they cannot get an appointment with their GP. Some patients fell that CAM has a limited or transitory effect, while others question the legality of CAM and are afraid of being cheated.
What can we do with this new information?
The authors of the paper suggest the results of the study may help impact a development towards patient focused guidelines for the management of low back pain, which involves patients’ expectations and expressed needs together with the existing evidence for the effects of treatment. They see this as a way of increasing the implementation of evidence-based treatment and a part of achieving better outcomes in the management of low back pain.
The systematic scoping review is based of 44 studies found in the MEDLINE, EMBASE, CINAHL and psychINFO databases in the period 1990 – 2016.
Louisa Chou et al.
Patients' perceived needs for allied health, and complementary and alternative medicines for low back pain: A systematic scoping review. Health Expectations 2018 https://doi.org/10.1111/hex.12676