Outcomes/Effectiveness Research

Greater patient satisfaction with care for low back pain seems to reduce pain and disability in the short term and leads to greater perception of improvement in the long term

Low back pain is one of the most common reasons why people visit physicians and chiropractors. Regardless of whether patients see doctors or chiropractors, those who are more satisfied with their care are less likely to report suffering from pain and disability at 6 weeks and more likely to perceive improvement during an 18-month period, according to a study supported in part by the Agency for Healthcare Research and Quality (AHRQ) (HS07755). A second AHRQ-supported study (HS09499) links physician-patient agreement to better patient satisfaction and health outcomes. Both studies are discussed here.

Hurwitz, E.L., Morgenstern, H., and Yu, F. (October, 2005). "Satisfaction as a predictor of clinical outcomes among chiropractic and medical patients enrolled in the UCLA low back pain study." Spine 30(19), pp. 2121-2128.

Greater patient satisfaction with care for low back pain seems to reduce pain and disability in the short term and leads to greater perception of improvement in the long term, according to this study. Researchers randomized 681 patients with low back pain at 3 California clinics to medical care with and without physical therapy and chiropractic care with and without physical modalities. They followed the patients for 18 months to measure patient care satisfaction and pain and disability at 6 weeks, and at 6, 12, and 18 months.

On a 40-point scale, a 10-point increase in satisfaction, observed at 4 weeks following randomization, boosted the chances of remission from clinically meaningful pain and disability at 6 weeks by 61 percent. However, this was not true at 6, 12, or 18 months for either medical or chiropractic patients. Also, patients who were highly satisfied perceived more improvement than patients who were less satisfied throughout the 18-month followup period. Thus, patient satisfaction with care may be associated with small short-term clinical benefits for low back pain patients.

Staiger, T.O., Jarvik, J.G., Deyo, R.A., and others (2005, October). "Brief report: Patient-physician agreement as a predictor of outcomes in patients with back pain." Journal of General Internal Medicine 20, pp. 935-937.

This study found that agreement between physicians and patients about their diagnosis, diagnostic plan, and treatment plan is associated with greater patient satisfaction and better health outcomes in patients with back pain. Researchers enrolled 380 patients with back pain in a trial comparing rapid magnetic resonance imaging with standard x-rays. One month later, they asked patients to rate their agreement with their physician on diagnosis, diagnostic plan, and treatment plan. They then examined patient satisfaction with care at 1 and 12 months, and functioning and health status at 12 months.

Higher total physician-patient agreement at 1 month was correlated with higher patient satisfaction at 1 month. Higher agreement independently predicted better patient satisfaction, mental health, social function, and vitality at 12 months.