(P.S. Please don't tell Dave Ramsey I'm going off track of my current plan to get through a boat load of research articles - this was time sensitive and felt like a great opportunity!)
The idea that these guys have - to read more of the literature to improve their practice and knowledge - is commendable. Way to go fellas! Their goal is "to improve our ability to read research, improve our evidence appraisal skills, and read research studies that we may not have read before." They post the articles open access and they also write up a summary on the article to start conversation and get feedback.
I won't be posting about all the articles they've selected to discuss this month - but I wanted to share about the challenge in case others might want to participate - it's definitely not too late to jump on board. Also, the first article they included deserves some attention as it fits into the chronic pain theme that I've already started posting and learning about. I may do others moving forward - but since I haven't seen those topics at the time I'm writing this - it's too soon to tell. Also- I should note that I'm writing this post as I read the article with all my thoughts on it and will read their posted review of the article afterwards so it won't bias my process.
This particular article (and the entire challenge), can be found by going to the Movement Doc site and joining their members only section, is entitled, "Indviduals' Explanations for their persistent or recurrent low back pain: a cross sectional survey." It is from 2017 by Jenny Setchell et al.
Introduction: The study begins with a description of the biomedical model versus the biopsychosocial model. I've previously mentioned pain with consideration for the biopsychosocial model and the need to consider non-anatomical contributors to pain here, here, and here. If you're new here - it's the idea that psychological components such as stress, anxiety, depression, and even the word choice used to describe pathology can impact our patients and their pain. In consideration of this model, the article states, "how people think about their pain is an important predictor of severity and chronicity."
Purpose: This paper examines patients with low back pain to determine what caused their pain and where their understanding of their condition came from.
Methods: The study used a survey marketed via social media and postings in local health centers to recruit participants with low back pain. The majority lived in Australia - locale of the primary investigator - and about 75% were female. My thoughts: Whenever I see that a study was marketed in this manner, I immediately consider the fact that this means that participants had to have the time and the means to participate as well as a way to come across the study in the first place. It automatically rules out those who don't have a computer or health club membership from participation which might mean an influence of socioeconomic status of participants. I consider this important because, based on the biopsychosocial model, a person with less financial means has been excluded, but this financial status could be a significant impactor to their pain experience.
Analysis: The authors used "discourse analysis" - a statistics term I had never heard before. "Discourse analysis is based on the premise that the language we use has a role in creating or constituting reality, rather than simply reflecting it thus discourses are seen as having a real world effect." It is a way to assess how people think. This is the basis of the fear-avoidance behavior model- where, for example, if someone was told they herniated a disc in their back, they may avoid certain motions that they think are associated with that pathology. The study responses were analyzed to determine four discourses which all the participants were then categorized into. My thoughts: statistics is super hard and I'm so thankful that there are people who specialize in studying this. This concept, discourse analysis, is really interesting because in my mind, no two people will respond the same way to the same input information so to categorize responses into groups for better understanding seems sensible.
Study results: The four categories (discourses) to the question "What is your understanding of why your low back pain is persisting or recurring" were: 1) the body is a machine that has a defective part - this is the biomedical model and was most common, 2) Low back pain is permanent, 3) LBP is complex. Those who were unsure of the cause of their pain were ultimately included in this grouping. This is the biopsychosocial model. 4) LBP is negative, should be avoided, and has a poor impact on life. The second question was "Where does this understanding come from?" and 89% of the responses identified a health care provider as the supplier of these discourses as well as about 25% from the internet!!! My thoughts: WE'RE HARMING OUR PATIENTS! We need to do a better job communicating with patients as healthcare providers. Hippocratic Oath People!
Discussion: The authors summarize that most of the surveyed participants responded with biomedical responses as to the cause of their low back pain and that they learned this information from their healthcare providers and/or the internet. There was an expression of hope as some responses to where the pain came from included both an anatomical/biomedical response as well as a biopsychosocial model type response
My assessment: I thought this article was very interesting and that it aligned with the recent articles I've read on chronic back pain and the biopsychosocial model. It is clinically applicable and relevant as it is a strong reminder of the importance of the language that clinicians use with patients. Following my write up of the above information, I read the review document from the challengers and was able to recognize a few differences in how I interpreted the information versus how they did. First, in the introductory portion, I had picked up on the interests of the authors looking at the biopsychosocial model as contributing to the patient's outcomes, but I had not picked up on the idea that the authors include here that how the patients perceive their pain and what they think their outcomes will be, are also contributors here. For example, if a person thinks their back pain will never get better, this can impact their outcome. Overall, the study limitations the group found were all similar to my understanding, which was pleasing to me, and this experience of literature appraisal with someone else to compare to was overwhelmingly beneficial. I'm looking forward to the rest of the articles this month - and you should feel free to join in or check out the articles - or even the reviews being posted - because it's a fast way for you to get a lot of information!
Article referenced:
Setchell J, Costa N, Ferreira M, Makovey J, Nielsen M, Hodges PW. Individuals’ explanations for their persistent or recurrent low back pain: a cross-sectional survey. BMC Musculoskeletal Disorders. 2017;18(1). doi:10.1186/s12891-017-1831-7..
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