Distinctiveness of psychological obstacles to recovery in low back pain patients in primary care Manipulation of patient-provider interaction: discussing illness representations or action plans concerning adherence.
& NA ; Many psychological factors have been suggested to be important obstacles to recovery from low back pain , yet most studies focus on a limited number of factors . We compared a more comprehensive range of 20 factors in predicting outcome in primary care . Consecutive patients consulting 8 general practice s were eligible to take part in a prospect i ve cohort study ; 1591 provided data at baseline and 810 at 6 months . Clinical outcome was defined using the Rol and and Morris Disability Question naire ( RMDQ ) . The relative strength of the baseline psychological measures to predict outcome was investigated using adjusted multiple linear regression techniques . The sample was similar to other primary care cohorts ( mean age 44 years , 59 % women , mean baseline RMDQ 8.6 ) . The 20 factors each accounted for between 0.04 % and 33.3 % of the variance in baseline RMDQ score . A multivariate model including all 11 scales that were associated with outcome in the univariate analysis accounted for 47.7 % of the variance in 6 months RMDQ score ; rising to 55.8 % following adjustment . Four scales remained significantly associated with outcome in the multivariate model explaining 56.6 % of the variance : perceptions of personal control , acute/chronic timeline , illness identify and pain self‐efficacy . When all independent factors were included , depression , catastrophising and fear avoidance were no longer significant . Thus , a small number of psychological factors are strongly predictive of outcome in primary care low back pain patients . There is clear redundancy in the measurement of psychological factors . These findings should help to focus targeted interventions for back pain in the future According to Leventhal 's Self-Regulatory Model of Illness , patients have ideas and action plans related to the management of their disease . The aim of this study is to examine whether ideas and action plans relating to hypertension change as a result of general practitioner 's ( GP 's ) discussing them during consultation , and whether these changed ideas and actions plans affect adherence . The study employed an experimental design , highlighting three conditions : ( 0 ) care-as-usual consultation ; ( 1 ) discussing patient 's ideas about their disorder ; and ( 2 ) discussing patient 's action plans .  Ten GP-trainees performed care-as-usual consultations  , were subsequently assigned to a training in either Condition 1 or 2 , and performed the trained conversations .  Hundred and eight patients with hypertension were consecutively assigned to the conditions , and completed question naires a week before , immediately after the consultation , and 1 month later . The training result ed in two new , feasible and different types of conversations that managed to affect some of the patient 's ideas and action plans . It is concluded that the study provided GPs with a tool to discuss illness representations and actions plan of patients with hypertension . Implication s for the management of hypertension adherence in primary care are discussed
This systematic review answered two questions among adults with chronic conditions : When included in the same statistical model , are Common Sense Model constructs and self-efficacy both associated with ( 1 ) self-management behaviors and ( 2 ) health outcomes ?