Health care provider back pain beliefs unaffected by a media campaign

SJPHC 2008; 26 (1): 50-56

Erik L. Werner; MD PhDFamily doctor, Arendal, Norway

Research Unit for General Practice / Unifob Health, Bergen, Norway

Background

• LBP: 5 – 10 % of all contacts in family practice

• Societal burden: NOK 15 bill. / year

• Individual burden: 15% of all sick listing and disability pension

Background

• Australian media campaign 1997 – 99: 15% reduction of LBP claims

• ”Aktiv Rygg” – (”Active Back”): a media campaign in two Norwegian counties 2002 - 2005

The media campaign

• Vestfold and Aust-Agder counties (325 000 inh)

• local papers

• local TV and radio

• local cinemas

• web site (www.aktivrygg.no)

• pamphlets

• posters

Additional intervention

• Health care providers:

- family doctors

- physiotherapists

- chiropractors

• Peer support intervention at work places

Health care provider beliefs…..

• ….. are important because they transmit beliefs to their patients –

• and these beliefs are determinants for the course of the back pain episode!

The ”Active Back Study”: the health care providers

Material

• 1100 providers

• 2 intervention counties: Vestfold and Aust-Agder

• Telemark as control county

The ”Active Back Study”: the health care providers

The intervention

• The media campaign

• Additional written info about the campaign

• Specific courses and meetings

• Posters, hand-outs

The ”Active Back Study”: the health care providers

The study

• Questionnaires before – during - and after the campaign

• Knowledge, attitudes and practices

The ”Active Back Study”: the health care providers

Results

• 1105 providers in 2002 875 in 2005

• 243 providers answering both in 2002 and 2005 included in study

- 85 ( 31 ) doctors

- 83 ( 28 ) physiotherapists

- 11 ( 5 ) chiropractors

Providers reporting ”great interest of LBP”(n = 1105; 2002)

% of LBP patients of all patients in practice

Campaign exposure

Statements of beliefs – level of agreement• Back pain recovers best by itself(true)• Radiograph and newer imaging tests are useful to identify the cause

of the pain (false)• In most cases, back pain recovers by itself in a couple of weeks, no

matter what we do (true)• Most often it will be possible to find and exact cause of the pain

(false)• One recovers faster from back pain if one continues at work or

returns as soon as possible (true)• Any treatment at a doctor, physiotherapist or chiropractor is

symptomatic pain relieving (true)• Disc herniation should most often have surgery (false)

Sum score – level of agreement with messages of the campaign in percent

Conclusion

• No differences in LBP beliefs among health care providers following the campaign

• A general tendency of improvement in beliefs

• Doctors more in line with guidelines than other health care providers

• Differences between the provider groups increased during the campaign

Back pain recovers best by itself (agree / totally agree)

In most cases, back pain recovers by itself in a couple of weeks, no matter what we do

(agree /totally agree)

Any treatment at a doctor, physiotherapist or chiropractor is symptomatic pain relieving

(agree / totally agree)

Why is this important?

• People get frustrated by different messages from different providers

• Patients share beliefs of their providers

• Longstanding (chronic) back pain is a matter of beliefs and attitudes more than a pathoanatomical disorder

Thanks to….

Co-writers:• Douglas Gross• Stein Atle Lie• Camilla Ihlebæk

”Aktiv Rygg” staff:• Even Lærum• Aage Indahl• Erik Lindh

Supervisors • Holger Ursin• Jan Sture Skouen