The evidence based management of low back pain (LBP) in primary health care has improved; however, there are still gaps related to risks, prognosis and treatment for this condition. This thesis contributes to the understanding of these gaps and provides insights into the influence of patient-clinician interaction in treatment outcomes.
The case-control twin study presented in Chapter 2 was designed to identify new and important risks for LBP using twins’ perceptions of the contribution of various factors in the development of their own or their twins’ LBP. Patients’ reported sense of social isolation was investigated as a prognostic factor for LBP, and reported in Chapter 3. Effectiveness of self-management of LBP was investigated in a systematic review, reported in Chapter 4. The influence of the patient-clinician interaction on treatment outcomes was investigated in two systematic reviews, reported in Chapters 5 and 6, and in a cohort study, reported in Chapter 7.
Overall, the studies presented in this thesis contributed new knowledge about risks, prognosis and treatment of LBP. Physical loading of the spine and lifestyle factors were perceived to be important risks for LBP, patients’ reported sense of social isolation may inform prognosis, and self-management of LBP appears to have limited benefit. This thesis also provided new knowledge about the influence of patient-clinician interaction on treatment outcomes. Firstly, modifiable communication factors during the patient-clinician interaction that predicted treatment outcomes over time were not identified. Secondly, clinicians simply facilitating further clarification of patients’ expressed emotions were insufficient to optimise treatment outcomes in LBP. Thirdly, communication training for clinicians has small benefits in terms of treatment outcomes and needs to be better understood and maximised to be useful in LBP.