Table 6 Summary of panel’s agreement levels concerning the patient’s beliefs/characteristics (Round 2; n = 23)
Rank | Sub-set | Statement | Mean (S.D.) | [95% CIs] | Agreement levels | Panel consensus | Percentage Disagree |
|---|---|---|---|---|---|---|---|
Patient’s beliefs and characteristics (k = 25 statements) | |||||||
1 | Patient’s treatment history | Reframing misinformed beliefs from previous healthcare experiences (e.g., 'my spine is crumbling', 'my spinal curve is abnormal', 'my back is worn out') | 4.91 (± 0.29) | [4.79, 5.04] | 91.3% Strongly Agree 8.7% Agree | Yes (100%) | 0% |
2 | Patient’s treatment history | Actively investigating patient’s needs, feelings, preferences, and previous experiences | 4.83 (± 0.39) | [4.66, 4.99] | 82.6% Strongly Agree 17.4% Agree | Yes (100%) | 0% |
3 | Patient’s treatment history | Supporting the patient in reframing negative memories (e.g., reinterpret an X-ray/scan or explain radiology reports/GP letters) | 4.78 (± 0.42) | [4.60, 4.96] | 78.3% Strongly Agree 21.7% Agree | Yes (100%) | 0% |
4.5 | Reducing negative outcomes | Allocating time for patients to ask about negative aspects of treatment to address their concerns openly and honestly | 4.70 (± 0.47) | [4.49, 4.90] | 69.6% Strongly Agree 30.4% Agree | Yes (100%) | 0% |
4.5 | Reducing negative outcomes | Anticipating and helping reduce patient’s anxiety about the treatment/procedure | 4.70 (± 0.64) | [4.42, 4.97] | 78.3% Strongly Agree 13.0% Agree | Yes (91.3%) | 8.7% (unsure) |
7* | Cognitive behavioural approach | Explaining routine activities, movement, or exercise can help 'rewire' perceived pain pathways (e.g., some pain or discomfort is normal but is not a sign their LBP is "worsening") | 4.65 (± 0.57) | [4.40, 4.90] | 69.6% Strongly Agree 26.1% Agree | Yes (95.7%) | 4.3% (unsure) |
7 | 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 a wheelchair’) | 4.65 (± 0.57) | [4.40, 4.90] | 69.6% Strongly Agree 26.1% Agree | Yes (95.7%) | 4.3% (unsure) |
7 | Cognitive behavioural approach | Developing patient’s self-confidence in performing or persisting with a new behaviour or goal | 4.65 (± 0.65) | [4.37, 4.93] | 73.9% Strongly Agree 17.4% Agree | Yes (91.3%) | 8.7% (unsure) |
10* | Patient’s treatment history | Exploring the patient’s current or pre-existing beliefs about the cause(s) of their LBP | 4.61 (± 0.50) | [4.39, 4.82] | 60.9% Strongly Agree 39.1% Agree | Yes (100%) | 0% |
10 | 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’) | 4.61 (± 0.58) | [4.36, 4.86] | 65.2% Strongly Agree 30.4% Agree | Yes (95.7%) | 4.3% (unsure) |
10 | Cognitive behavioural approach | Assisting in decreasing fear-avoidance and harm beliefs by recognising, confronting, and correcting them | 4.61 (± 0.58) | [4.36, 4.86] | 65.2% Strongly Agree 30.4% Agree | Yes (95.7%) | 4.3% (unsure) |
12.5 | Cognitive behavioural approach | Helping patients plan and monitor treatment success (e.g., explain outcome measures; co-create short-term and long-term goals or target-driven stages of improvement) | 4.57 (± 0.59) | [4.31, 4.82] | 60.9% Strongly Agree 34.8% Agree | Yes (95.7%) | 4.3% (unsure) |
12.5 | Creating positive outcomes | Communicating an intervention is likely to be effective using positive verbal instructions (e.g., 'I expect your pain will improve after treatment') | 4.57 (± 0.59) | [4.31, 4.82] | 60.9% Strongly Agree 34.8% Agree | Yes (95.7%) | 4.3% (unsure) |
14 | Cognitive behavioural approach | Reframing patient’s prior misconceptions about their anatomy/physiology (e.g., ‘your spine is flexible not fragile’) | 4.52 (± 0.67) | [4.23, 4.81] | 60.9% Strongly Agree 30.4% Agree | Yes (91.3%) | 8.7% (unsure) |
16 | Reducing negative outcomes | Reinforcing a shift in patient’s negative thoughts to positive ones (e.g., monitor outcomes to highlight progress) | 4.48 (± 0.59) | [4.22, 4.73] | 52.2% Strongly Agree 43.5% Agree | Yes (95.7%) | 4.3% (unsure) |
16 | Creating positive outcomes | Being optimistic during treatment by providing a prognosis (e.g., 'I believe you will recover and get back to your usual level of functioning') | 4.48 (± 0.67) | [4.19, 4.77] | 56.5% Strongly Agree 34.8% Agree | Yes (91.3%) | 8.7% (unsure) |
16* | Creating positive outcomes | Instilling genuine hope in patients regarding how their life can change for the better | 4.48 (± 1.08) | [4.01,4.95] | 65.2% Strongly Agree 30.4% Agree | No (95.6%) | 4.3% Not Valid |
18* | Reducing negative outcomes | Explaining that calming their stress response is a part of everyday self-care for physical pain and healing. (n = 22)a | 4.45 (± 0.91) | [4.05, 4.86] | 59.1% Strongly Agree 36.4% Agree | No (95.5%) | 4.5% Strongly Disagree |
20* | Cognitive behavioural approach | Explaining basic pain science (i.e., perceived pain is not necessarily actual physical pain from nerve or tissue damage, but whilst very real, is more of a 'learned' response to prior experiences) | 4.43 (± 0.59) | [4.18, 4.69] | 47.8% Strongly Agree 47.8% Agree | Yes (95.7%) | 4.3% (unsure) |
20 | 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 | 4.43 (± 0.79) | [4.09, 4.78] | 60.9% Strongly Agree 21.7% Agree | Yes (82.6%) | 17.4% (unsure) |
20* | Reducing negative outcomes | Using simple, everyday analogies to alter patient's negative illness perceptions (e.g., ‘rusty hinges often work well despite their appearance’) | 4.43 (± 0.79) | [4.09, 4.78] | 60.9% Strongly Agree 21.7% Agree | Yes (82.6%) | 17.4% (unsure) |
22 | Reducing negative outcomes | Avoiding negative phrases (e.g., ‘wear and tear’, ‘damage’, ‘degeneration’, 'abnormal') | 4.35 (± 0.71) | [4.04, 4.66] | 47.8% Strongly Agree 39.1% Agree | Yes (87.0%) | 13.0% (unsure) |
23.5 | Reducing negative outcomes | Rephrasing negative information (e.g., leg flexion test: ‘this procedure might be a bit uncomfortable but only temporarily’) | 4.26 (± 0.69) | [3.96, 4.56] | 39.1% Strongly Agree 47.8% Agree | Yes (87.0%) | 13.0% (unsure) |
23.5* | Reducing negative outcomes | Explaining imaging is usually unnecessary because scans may not explain the extent of their pain and/or dysfunction | 4.26 (± 0.96) | [3.84, 4.68] | 47.8% Strongly Agree 39.1% Agree | No (87.0%) | 8.7% (unsure) 4.3% Strongly Disagree |
25 | Creating positive outcomes | Emphasising positive outcomes such as overall pain-reducing effects (e.g., ‘manual or physical therapies are often as effective as painkillers’) | 4.22 (± 0.85) | [3.85, 4.59] | 47.8% Strongly Agree 26.1% Agree | No (73.9%) | 26.1% (unsure) |