Table 5 Panel’s self-reported use, perceived clinical validity, and confidence addressing patient’s beliefs/characteristics (Round 1; n = 39)
Rank | Sub-set | Statement | Self-reported use (%) | Valid (%) | Confidence (%) |
|---|---|---|---|---|---|
Patient’s beliefs and characteristics (k = 23 statements) | |||||
1.5 | Patient’s treatment history | Actively investigating patient’s needs, feelings, preferences, and previous experiences | 100 (n = 39) | 89.7 (n = 35) | 74.4 (n = 29) |
1.5 | Patient’s treatment history | Supporting the patient in reframing negative memories (e.g., reinterpret an X-ray/scan or explain radiological reports/GP letters) | 100 (n = 39) | 89.7 (n = 35) | 64.1 (n = 25) |
3.5* | Cognitive behavioural approach | Reframing patient’s prior misconceptions about low back pain (e.g., ‘pain is not always a sign of physical tissue damage,’ ‘your spine is flexible not fragile’) | 97.4 (n = 38) | 87.2 (n = 34) | 71.8 (n = 28) |
3.5* | Patient’s treatment history | Taking note of inaccurate knowledge from previous treatment experiences (e.g., ‘my spine is crumbling’ or ‘my back is worn out’) | 97.4 (n = 38) | 89.7 (n = 35) | 69.2 (n = 27) |
6.5 | Cognitive behavioural approach | Reframing patient’s prior misconceptions about treatment (e.g., ‘bed rest does not usually help patients recover faster but modified activity can’) | 94.9 (n = 37) | 84.6 (n = 33) | 71.8 (n = 28) |
6.5 | Reducing negative outcomes | Reinforcing a shift in patient’s negative thoughts to positive ones (e.g., outcomes to highlight progress) | 94.9 (n = 37) | 87.2 (n = 34) | 59.0 (n = 23) |
6.5 | Cognitive behavioural approach | Clarifying maladaptive perceptions (e.g., catastrophising: ‘My vertebrae are out of line. I stopped gardening, so I won’t end up in wheelchair’) | 94.9 (n = 37) | 84.6 (n = 33) | 59.0 (n = 23) |
6.5* | Cognitive behavioural approach | Assisting in decreasing fear-avoidance and harm beliefs along with avoidant behaviours | 94.9 (n = 37) | 87.2 (n = 34) | 59.0 (n = 23) |
9 | Creating positive outcomes | Communicating to patients an intervention is likely to be effective (e.g., ‘this treatment usually works for most people with low back pain’) | 92.3 (n = 36) | 89.7 (n = 35) | 74.4 (n = 29) |
11.5 | Creating positive outcomes | Being optimistic during the consultation and regarding their dysfunction (e.g., ‘I believe you will get back to your usual level of functioning again’) | 89.7 (n = 35) | 89.7 (n = 35) | 76.9 (n = 30) |
11.5 | Reducing negative outcomes | Allocating time for patients to ask about negative aspects of treatment | 89.7 (n = 35) | 89.7 (n = 35) | 66.7 (n = 26) |
11.5 | Cognitive behavioural approach | Explaining the multi-dimensional nature (biopsychosocial aspects) of pain (i.e., beliefs, emotions, and behaviours (movement and lifestyle)) via suitable educational materials | 89.7(n = 35) | 87.2 (n = 34) | 61.5 (n = 24) |
11.5 | Cognitive behavioural approach | Developing patient’s self-confidence in performing and persisting with a new behaviour to pursue a goal | 89.7 (n = 35) | 89.7 (n = 35) | 51.3 (n = 20) |
14 | Reducing negative outcomes | Anticipating and helping reduce patient’s anxiety about the treatment/procedure | 87.2 (n = 34) | 92.3 (n = 36) | 56.4 (n = 22) |
15.5 | Creating positive outcomes | Emphasising positive outcomes such as overall pain-reducing effects (e.g., ‘manual or physical therapies are often as effective as painkillers’) | 82.1 (n = 32) | 79.5 (n = 31) | 66.7 (n = 26) |
15.5* | Sociocultural contexta | Displaying a balanced attitude to patient’s alternative or cultural beliefs if not harmful (e.g., acupuncture) | 82.1 (n = 32) | 82.1 (n = 32) | 53.8 (n = 21) |
17 | Reducing negative outcomes | Avoiding negative phrases (e.g., ‘wear and tear,’ ‘damage’, ‘degeneration’, ‘ongoing’ instead of ‘chronic’ pain, ‘plan activities’ instead of ‘do exercise’) | 79.5 (n = 31) | 87.2 (n = 34) | 56.4 (n = 22) |
18 | Reducing negative outcomes | Rephrasing negative information (e.g., during leg flexion test: ‘this procedure may lead to a slight increase in pain’ rather say instead: ‘this procedure might be a bit uncomfortable but only temporarily’) | 76.9 (n = 30) | 89.7 (n = 35) | 59.0 (n = 23) |
19.5* | Cognitive behavioural approach | Helping patients plan and monitor treatment success (e.g., SMART goals, motivational interviewing) | 71.8 (n = 28) | 87.2 (n = 34) | 35.9 (n = 14) |
19.5* | Cognitive behavioural approach | Empowering patients to self-care and anticipate barriers (e.g., reminders, implementation intentions, journal/logbook, NHS online self-care resources) | 71.8 (n = 28) | 89.7 (n = 35) | 33.3 (n = 13) |
21* | Sociocultural contexta | Involving significant others and/or primary carers in treatment | 69.2 (n = 27) | 79.5 (n = 31) | 46.2 (n = 18) |
22.5* | Creating positive outcomes | Helping patients associate hands on techniques with positive outcomes using positive verbal instructions (e.g., ‘I expect your pain will improve after this manipulation’) | 51.3 (n = 20) | 61.5 (n = 24) | 51.3 (n = 20) |
22.5* | Reducing negative outcomes | Describing how (un)common side effects are numerically (e.g., 1 in 100 people) | 51.3 (n = 20) | 76.9 (n = 30) | 38.5 (n = 15) |