What participants did you enrol in the study?

The aim of this study was to explore clinicians’ use of reassurance for non-specific low back pain. We included 16 physiotherapists and 16 chiropractors. The participants were all practising in Australia and were diverse in age (23 to 68 years) and years of clinical experience (six months to 47 years).

What types of questions were participants asked?

We asked clinicians how they provide reassurance during consultations for patients with low back pain, if there are times when it is harder to reassure patients, if there are specific barriers to providing reassurance to patients and whether they have used strategies to overcome any difficulties in providing reassurance.

What themes did you identify?

This study identified four themes about clinicians’ use of reassurance for low back pain, as outlined below.

Giving reassurance is a core clinical skill for delivering high-quality care.

Clinicians in this study possessed comprehensive knowledge about delivering reassurance and believed that it was an important part of exceptional care.

They found that reassurance helped them to foster a positive outlook in patients, dispel fears related to underlying pathology, dispel fears related to a poor prognosis of low back pain and encourage safe activity.

It takes practice and experience to confidently deliver reassurance.

While clinicians expressed confidence in their ability to provide reassurance, they acknowledged that this confidence was developed gradually through clinical experience.

Despite feeling capable and motivated, clinicians encountered challenges in delivering reassurance.

These obstacles included patients with a higher chance of a poor prognosis, difficulties establishing patient rapport and patients’ trust barriers stemming from previous experiences with the healthcare system.

Effective reassurance requires a personalised approach.

Clinicians stressed the importance of establishing rapport and trust with the patient and tailoring reassurance by addressing individual concerns.

How might other therapists use this information to guide their own reassurance of low back pain patients?

The study highlighted the importance of an individualised approach to reassurance through understanding each patient’s specific concerns and the clinician’s own understanding of low back pain.

Clinicians can address these concerns by employing strategies to reassure patients such as individualised educational messages (cognitive reassurance) and the creation of a safe environment for patients to experience movement (experiential reassurance).

The Australian Clinical Care Standard also supports these approaches to low back pain.

To help clinicians deliver reassurance in clinical practice, our research findings on how to deliver reassurance—integrated with expert opinion and the available evidence—have been summarised in table 3 of the paper.

Where do you think research in this area needs to go next?

There is a need to explore patient experiences and reception to reassurance.

In some cases, a clinician’s attempt to reassure the patient is perceived by the patient as dismissive, as evidenced by this quote from Braeuninger-Weimer et al 2019.

‘How am I supposed to feel reassured if I feel there is something wrong with me, and they keep telling me that everything’s fine?’

Future research should focus on targeted strategies for supporting new clinicians in developing nuanced reassurance skills.

In this study, clinical experience was identified as an essential part of developing the skills needed to effectively deliver reassurance.

It is therefore important to identify and implement strategies to support new clinicians as they engage in this critical activity.

>>Annie Young is a chiropractor, an associate lecturer and a PhD candidate at Macquarie University. Her thesis, ‘Reassurance use for managing low back pain in primary care’, seeks to detail reassurance recommendations and identify the challenges clinicians face in implementing these guidelines.
 

Course of interest:

Approach to chronic low back and leg pain