Patients' perceived needs for medical services for non-specific low back pain: A systematic scoping review

Abstract

Background: An improved understanding of patients' perceived needs for medical services for low back pain (LBP) will enable healthcare providers to better align service provision with patient expectations, thus improving patient and health care system outcomes. Thus, we aimed to identify the existing literature regarding patients' perceived needs for medical services for LBP.

Methods: A systematic scoping review was performed of publications identified from MEDLINE, EMBASE, CINAHL and PsycINFO (1990-2016). Descriptive data regarding each study, its design and methodology were extracted and risk of bias assessed. Aggregates of patients' perceived needs for medical services for LBP were categorised.

Results: 50 studies (35 qualitative, 14 quantitative and 1 mixed-methods study) from 1829 were relevant. Four areas of perceived need emerged: (1) Patients with LBP sought healthcare from medical practitioners to obtain a diagnosis, receive management options, sickness certification and legitimation for their LBP. However, there was dissatisfaction with the cursory and superficial approach of care. (2) Patients had concerns about pharmacotherapy, with few studies reporting on patients' preferences for medications. (3) Of the few studies which examined the patients' perceived need of invasive therapies, these found that patients avoided injections and surgeries (4) Patients desired spinal imaging for diagnostic purposes and legitimation of symptoms.

Conclusions: Across many different patient populations with data obtained from a variety of study designs, common themes emerged which highlighted areas of patient dissatisfaction with the medical management of LBP, in particular, the superficial approach to care perceived by patients and concerns regarding pharmacotherapy. Patients perceive unmet needs from medical services, including the need to obtain a diagnosis, the desire for pain control and the preference for spinal imaging. These issues need to be considered in developing approaches for the management of LBP in order to improve patient outcomes.

Fig 1. Modified PRISMA flow diagram.

Fig 2. CASP tool for qualitative studies.

¹CASP 1: Was there a clear statement of the aims of the research ²CASP 2: Is a qualitative methodology appropriate? ³CASP 3:Was the research design appropriate to address the aims of the research? ⁴CASP 4: Was the recruitment strategy appropriate to the aims of the research? ⁵CASP 5: Was the data collected in a way that addressed the research issue? ⁶CASP 6: Has the relationship between researcher and participants been adequately considered? ⁷CASP 7: Have ethical issues been taken into consideration? ⁸CASP 8: Was the data analysis sufficiently rigorous? ⁹CASP 9: Is there a clear statement of findings? ¹⁰CASP 10: How valuable is the research?

Fig 3. Hoy et al’s Risk of Bias tool for quantitative studies.

¹Criteria 1:Was the study’s target population a close representation of the national population in relation to relevant variables? ²Criteria 2: Was the sampling frame a true or close representation of the target population? ³Criteria 3: Was some form of random selection used to select the sample OR was a census taken? ⁴Criteria 4: Was the likelihood of nonresponse bias minimal? ⁵Criteria 5: Were data collected directly from the subjects? ⁶Criteria 6: Was an acceptable case definition used in the study? ⁷Criteria 7: Was the study instrument that measured the parameter of interest shown to have validity and reliability? ⁸Criteria 8: Was the same mode of data collection used for all subjects? ⁹Criteria 9: Was the length of the shortest prevalence period for the parameter of interest appropriate? ¹⁰Criteria 10: Were the numerator(s) and denominator(s) for the parameter of interest appropriate.