A systematic review of low back pain and sciatica patients' expectations and experiences of health care |
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| Authors: | Kevork Hopayian Caitlin Notley |
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| Affiliation: | 1. Leiston Surgery, Main Street, Leiston, Suffolk IP16 4ES, England;2. Norwich Medical School, Department of Population Health and Primary Care, University of East Anglia, Earlham Road, NR4 7TJ, Norfolk, England;1. Occupational and Industrial Orthopaedic Center (OIOC), NYU Hospital for Joint Diseases, New York University, 63 Downing St, New York, NY 10014, USA;2. Department of Internal Medicine, Horten Centre for Patient Oriented Research and Knowledge Transfer, University of Zurich, Pestalozzistrasse 24, 8032 Zurich, Switzerland;3. Department of Physical Medicine and Rheumatology, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland;4. Institute of Environmental Medicine, Karolinska Institutet, Box 210, SE-17177 Stockholm, Sweden;1. Division of Health and Social Care Research, School of Medicine, King''s College London, 7th Floor Capital House, 42 Weston St, London SE1 3QD, UK;2. Department of Psychology, Institute of Psychiatry, King''s College London, 16 De Crespigny Park, London SE5 8AF, UK;3. Department of Primary Care & Public Health Sciences, School of Medicine, King''s College London, 5th Floor Capital House, 42 Weston St, London SE1 3QD, UK;1. Swansea Centre for Health Economics, Swansea University, Swansea, UK;2. North Wales Centre for Primary Care Research, Bangor University, Wrexham, UK;3. Department of Health Sciences, Leicester University, Leicester, UK;4. Sheffield Teaching Hospitals, Sheffield, UK;5. Spinal Research Institute, University of Huddersfield, Huddersfield, UK;6. Patient representative, Betws-y-Coed, UK;1. Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire ST5 5BG, UK;2. Interdisciplinary Musculoskeletal Pain Assessment and Community Treatment Service, Haywood Hospital, High Lane, Burslem, Stoke-On-Trent ST6 7AG, UK;3. Centre for Quality, Department of Regional Health Research, University of Southern Denmark, Winsloewparken 19, 3 Odense C DK 5000, Denmark;4. Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa |
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| Abstract: | Background contextPrevious systematic reviews of patients' experience of health services have used mixed qualitative and quantitative studies. This review focused on qualitative studies, which are more suitable for capturing experience, using modern methods of synthesis of qualitative studies.PurposeTo describe the experience of health care of low back pain and sciatica patients and the sources of satisfaction or dissatisfaction with special reference to patients who do not receive a diagnosis.Study designA systematic review of qualitative studies.SamplePrimary qualitative studies identified from Medline, Embase, CINAHL, and Psychinfo databases.Outcome measuresConceptual themes of patients' experiences.MethodData collection and analysis were through thematic content analysis. Two reviewers independently screened titles and collected and analyzed data. The authors were in receipt of a Primary Care Research Bursary from National Health Service Suffolk and Norfolk Research Departments, a not-for-profit organization.ResultsTwenty-eight articles met the inclusion criteria. Most studies were of high quality. Nine themes emerged: the process and content of care, relationships and interpersonal skills, personalized care, information, the outcome of care, the importance of a diagnosis, delegitimation, recognizing the expert, and service matters. How care was given mattered greatly to patients, with importance given to receiving a perceived full assessment, consideration for the individual's context, good relationships, empathy, and the sharing of information. These aspects of care facilitated the acceptance by some of the limitations of health care and were spread across disciplines. Not having a diagnosis made coping more difficult for some but for others led to delegitimation, a feeling of not being believed. Service matters such as cost and waiting time received little mention.ConclusionsAlthough much research into the development of chronic low back pain (LBP) has focused on the patient, this review suggests that research into aspects of care also warrant research. The benefits of generic principles of care, such as personalization and communication, are important to patients with LBP and sciatica; so, practitioners may help their patients by paying as much attention to them as to specific interventions. When neither cure nor a diagnostic label is forthcoming, generic skills remain important for patient satisfaction. |
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| Keywords: | Back pain Sciatica Experience Satisfaction Delegitimation Diagnosis Personalized care Communication |
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