Article Figures & Data
Tables
Characteristic Adherent to CPGs Non-Adherent to CPGs P (n = 1051) (n = 68) No. % No. % Age, yr (mean ± SD) 52.9 ± 13.2 57.5 ± 11.4 0.002 Sex 0.01 Female 798 75.9 42 61.8 Male 253 24.1 26 38.2 Race 0.15 Black 181 17.2 18 26.5 Other 27 2.6 2 2.9 White 843 80.2 48 70.6 Ethnicity 0.25 Hispanic 88 8.4 3 4.4 Non-Hispanic 963 91.6 65 95.6 Educational level <0.001 High school or lower 171 16.3 28 41.2 Some post-high school 448 42.6 27 39.7 College degree or higher 432 41.1 13 19.1 Cigarette smoking status 0.03 Never or former smoker 882 83.9 50 73.5 Current smoker 169 16.1 18 26.5 Body mass index (mean ± SD) 32.4 ± 8.2 35.3 ± 11.0 0.04 Duration of low back pain 0.46 <5 years 323 30.7 18 26.5 ≥5 years 728 69.3 50 73.5 Bothersomeness of widespread pain <0.001 Not at all 375 35.7 13 19.1 A little bit 404 38.4 22 32.4 A lot 272 25.9 33 48.5 Pain catastrophizing (mean ± SD) 19.1 ± 13.1 25.4 ± 14.4 <0.001 Pain self-efficacy (mean ± SD) 33.6 ± 14.9 26.4 ± 14.3 <0.001 No. of comorbidities (mean ± SD) 1.8 ± 0.8 1.8 ± 0.7 0.62 Herniated disc 0.02 No 659 62.7 33 48.5 Yes 392 37.3 35 51.5 Sciatica 0.95 No 530 50.4 34 50.0 Yes 521 49.6 34 50.0 Osteoarthritis 0.34 No 572 54.4 33 48.5 Yes 479 45.6 35 51.5 Osteoporosis 0.02 No 907 86.3 52 76.5 Yes 144 13.7 16 23.5 Heart disease 0.05 No 944 89.8 56 82.4 Yes 107 10.2 12 17.6 Hypertension 0.003 No 612 58.2 27 39.7 Yes 439 41.8 41 60.3 Diabetes Mellitus 0.21 No 853 81.2 51 75.0 Yes 198 18.8 17 25.0 Asthma 0.11 No 773 73.5 44 64.7 Yes 278 26.5 24 35.3 Depression 0.31 No 453 43.1 25 36.8 Yes 598 56.9 43 63.2 ↵* Table entries are No. and % unless otherwise indicated. The Pain Catastrophizing Scale and the Pain Self-Efficacy Questionnaire were each used to measure the respective characteristics. CPG denotes clinical practice guideline.
Abbreviation: SD, standard deviation.
Characteristic OR 95% CI P Age (yr) 21 to 49 1 … … 50 to 59 1.38 0.68 to 2.83 0.38 ≥60 2.28 1.15 to 4.52 0.02 Sex Female 1 … … Male 1.81 1.05 to 3.12 0.03 Race White 1 … … Black 1.24 0.66 to 2.34 0.50 Other 1.65 0.35 to 7.70 0.53 Ethnicity Non-Hispanic 1 … … Hispanic 0.53 0.15 to 1.82 0.31 Educational level High school or lower 1 … … Some post-high school education 0.41 0.22 to 0.74 0.003 College degree or higher 0.26 0.12 to 0.56 <0.001 Cigarette smoking status Never or former smoker 1 … … Current smoker 1.12 0.59 to 2.14 0.72 Body mass index <30 1 … … ≥30 1.40 0.80 to 2.45 0.24 Duration of low back pain (yr) <5 1 … … ≥5 0.98 0.54 to 1.79 0.95 Bothersomeness of widespread pain Not at all 1 … … A little bit 1.24 0.59 to 2.57 0.57 A lot 2.19 1.06 to 4.52 0.03 Pain catastrophizing Low (<12) 1 … … Medium (12 to 24) 0.61 0.27 to 1.35 0.22 High (≥25) 1.04 0.47 to 2.28 0.93 Pain self-efficacy Low (<27) 1 … … Medium (27 to 41) 0.77 0.41 to 1.42 0.40 High (≥42) 0.53 0.22 to 1.27 0.15 No. of comorbidities <2 1 … … 2 to 3 1.01 0.43 to 2.34 0.99 ≥4 1.24 0.52 to 2.94 0.62 ↵* Odds ratios were adjusted for each other variable in the table. The Pain Catastrophizing Scale and the Pain Self-Efficacy Questionnaire were each used to classify participants according to tercile cutpoints on each instrument. CPG denotes clinical practice guideline.
Abbreviations: OR, odds ratio; CI, confidence interval.
Physician Interaction Adherent to CPGs Non-Adherent to CPGs P (n = 891) (n = 56) Mean 95% CI Mean 95% CI Physician communication behavior Patient participation and patient orientation 68.7 66.9 to 70.4 75.3 69.3 to 81.3 0.04 Effective and open communication 69.7 68.0 to 71.4 75.7 69.7 to 81.8 0.09 Emotionally supportive communication 74.0 72.4 to 75.6 77.1 72.4 to 81.9 0.21 Communication about personal circumstances 58.1 56.2 to 59.9 59.5 51.4 to 67.6 0.71 Physician empathy 38.7 38.0 to 39.5 39.0 36.1 to 41.9 0.86 Satisfaction with physician characteristics Technical quality 3.8 3.7 to 3.8 3.8 3.6 to 4.0 0.66 Interpersonal manner 4.1 4.1 to 4.2 4.1 3.9 to 4.3 0.80 Communications 4.0 3.9 to 4.1 3.9 3.7 to 4.1 0.65 Time spent with patient 3.6 3.6 to 3.7 3.5 3.2 to 3.8 0.28 ↵* Interactions were self-reported by participants using the Communication Behavior Questionnaire, Consultation and Relational Empathy Measure, and Patient Satisfaction Questionnaire with 18 items, respectively. Analysis includes only those participants whose low back pain onset occurred during the time period in which they were treated by their current physician. Higher scores represent better physician interaction. CPG denotes clinical practice guideline.
Abbreviations: CI, confidence interval.
Outcome Adherent to CPGs Non-Adherent to CPGs P Cohen's d 95% CI (n = 1051) (n = 68) Mean 95% CI Mean 95% CI Pain intensity 6.0 5.9.0 to 6.1 6.8 6.3 to 7.2 0.001 0.41 0.16.0 to 0.65 Back-related disability 14.3 14.0 to 14.6 17.6 16.4 to 18.9 <0.001 0.59 0.34.0 to 0.84 Pain impact on health-related quality of life 30.8 30.3 to 31.4 36.3 34.4 to 38.1 <0.001 0.62 0.38.0 to 0.87 ↵* Outcomes were measured using a numerical rating scale for low back pain intensity, the Roland-Morris Disability Questionnaire, and the National Institutes of Health pain impact measure, respectively. Higher scores represent worse outcomes. CPG denotes clinical practice guideline.
Abbreviations: CI, confidence interval.
