Background
Methods
Generation of items
“reassurance ‘…removes the fears or doubts of (pain/illness); to comfort’. Reassurance always takes place within the dynamics of the interaction between the caregiver who has the intention to reduce worry, and the patient who is concerned. Ultimately, reassurance is achieved if the patient changes his/her behavior, understanding or thoughts.” ([7], pp. 5)
Testing of the new questionnaire
Participants
Inclusions
Exclusions
Materials and procedures
Demographic information
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Age
-
Gender
-
Physician gender
-
Type of physician (GP or nurse)
-
Marital status
-
Education level
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Employment status
Pain and function
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Length of current episode of LBP
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Whether or not this is the participant’s first episode of LBP
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Number of previous GP consultations for this episode
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Details of any other physician participants had seen since their consultation
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Pain intensity in the week prior to their consultation, rated on the 11-point Pain Numeric Rating Scale ranging from 0 (no pain) to 10 (worst possible pain) (NRS, [8]).
Consultation outcomes
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To measure satisfaction, the Consultation Satisfaction Questionnaire (CSQ, [11]) was used. The CSQ is a validated 9-item questionnaire in which participants respond to statements about how they felt about the consultation on a five-point scale from ‘strongly agree’ to ‘strongly disagree’.
Analysis
Item-response theory
Validity aspects to be tested
Results
Participants
Sample 1 | Sample 2 | |
---|---|---|
Average age | 56.63 (SD 16.64) | 53.52 (SD 16.08) |
Gender | 63.9 % female | 63.4 % female |
36.1 % male | 36.6 % male | |
Length of current episode | 33.8 % <1 month | 24.1 % <1 month |
23.0 % 1–3 months | 27.2 % 1–3 months | |
11.5 % 4–6 months | 11.4 % 4–6 months | |
14.2 % 7 months – 3 years | 23.4 % 7 months – 3 years | |
17.6 % >3 years | 13.9 % >3 years | |
Number of consultations for this episode | 47.9 % none | 54.4 % none |
31.9 % 1–2 | 30.9 % 1–2 | |
14.3 % 3–10 | 12.5 % 3–10 | |
5.9 % >10 | 2.2 % >10 | |
Work status | 53.9 % employed (full or part time) | 56.2 % employed (full or part time) |
35.7 % retired | 32.1 % retired | |
3.9 % looking after home/family | 3.1 % looking after home/family | |
1.9 % unemployed (health reasons) | 3.7 % unemployed (health reasons) | |
2.6 % unemployed (other) | 1.9 % unemployed (other) | |
1.9 % student | 3.1 % student | |
Education level | 49.0 % obtained higher education degree/certification | 44.0 % obtained higher education degree/certification |
18.1 % obtained A levels or equivalent | 20.7 % obtained A levels or equivalent | |
32.9 % left school at or before 16 | 35.3 % left school at or before 16 | |
Marital status | 65.8 % married/civil partnership | 57.8 % married/civil partnership |
7.7 % cohabiting | 9.9 % cohabiting | |
7.7 % single | 14.9 % single | |
9.7 % divorced | 12.4 % divorced | |
6.5 % widowed | 5.0 % widowed | |
2.6 % other | ||
Physician type | 99.3 % GP | 96.3 % GP |
0.7 % nurse practitioner | 3.8 % nurse practitioner | |
Physician gender | 52.9 % male | 50.9 % male |
47.1 % female | 49.1 % female | |
First episode? | 26.1 % yes | 27.2 % yes |
73.9 % no | 72.8 % no | |
Average pain intensity in the last week (/10) | 7.14 (SD 2.02) | 7.06 (SD 2.06) |
RMDQ score (/24) | 10.34 (SD 5.73) | 10.10 (SD 5.98) |
Structural validity: dimensionality analyses
Cluster 1 (Data-Gathering) | Cluster 2 (Relationship-Building) | Cluster 3 (Generic Reassurance) | Cluster 4 (Cognitive Reassurance) |
---|---|---|---|
1. Ask about how your symptoms affect you in your everyday life
4.10 (1.92)
|
4. Appear composed and level-headed
6.06 (1.04)
|
9. Tell you that you should not be worried
3.96 (2.05)
|
1. Explain how the treatment offered would help with your problem
4.51 (1.78)
|
2. Encourage you to voice your concerns regarding your symptoms
4.50 (1.82)
|
11. Seem friendly and approachable
5.82 (1.31)
| 16. Give a clear timescale for when your symptoms should improve 3.88 (2.15)
|
2. Give you a clear explanation for your symptoms
4.36 (1.88)
|
3. Ask you what you thought your symptoms might mean
3.54 (1.97)
|
7. Show a genuine interest in your problem
5.38 (1.61)
|
18. Tell you that everything would be fine
3.52 (2.09)
| 3. Chat with you informally 4.89 (4.47)
|
4. Listen attentively while you were talking
5.75 (1.27)
|
15. Treat you politely
6.24 (1.01)
|
20. Reassure you that he/she had no serious concerns about your back
4.38 (2.02)
| 5. Encourage you to be optimistic 4.75 (1.71)
|
5. Give you enough time to say everything you wanted to say
5.56 (1.50)
|
6. Show acceptance of your concerns
5.30 (1.56)
|
8. Give you a choice of treatment options
3.72 (2.12)
| |
6. Ask questions to make sure he/she understood what you meant
5.18 (1.72)
|
19. Put you at ease
5.13 (1.79)
| 10. Seem pleased with how you had managed your symptoms so far 4.26 (1.89)
| |
7. Summarise what you had told them
4.77 (1.86)
| 13. Check that you agreed with the treatment plan 4.85 (1.97)
|
12. Make sure you understood what your treatment plan involves
4.95 (1.94)
| |
21. Show that he/she understood your concerns
5.12 (1.80)
| 14. Assure you that you could control your problem 4.22 (2.01)
| ||
17. Explain your symptoms in relation to your concerns
4.40 (2.04)
| |||
22. Consider your lifestyle and needs in planning your treatment
4.18 (2.13)
| |||
23. Check you understood the explanation he/she gave for your symptoms
4.65 (1.96)
|
Content validity and reliability
Data-gathering
ICC Sample 1 | ICC Sample 2 | |
---|---|---|
Data gathering
| ||
Item 2 | 0.85, n = 75 (74,74) | 0.82, n = 68 (67,67) |
Item 4 | 0.83, n = 74 (73,73) | 0.70, n = 67 (66,66) |
Item 7 | 0.77, n = 74 (73,73) | 0.75, n = 68 (67,67) |
Whole subscale | 0.90, n = 76 (75,75) | 0.81, n = 68 (67,67) |
Relationship building (Subscale 1)
| ||
Item 7 | 0.87, n = 155 (154,154) | |
Item 19 | 0.84, n = 155 (154,154) | |
Item 21 | 0.88, n = 154 (153,153) | |
Whole subscale | 0.93, n = 153 (152,152) | |
Relationship-building (Subscale 2) | ||
Item 4 | 0.78, n = 156 (155,155) | |
Item 6 | 0.80, n = 156 (155,155) | |
Item 15 | 0.86, n = 156 (155,155) | |
Whole subscale | 0.88, n = 156 (155,155) | |
Generic reassurance
| ||
Item 9 | 0.87, n = 71 (70,70) | 0.82, n = 68 (67,67) |
Item 18 | 0.90, n = 68 (67,67) | 0.83, n = 66 (65,65) |
Item 20 | 0.89, n = 73 (72,72) | 0.77, n = 68 (67,67) |
Whole subscale | 0.91, n = 73 (72,72) | 0.87, n = 68 (67,67) |
Cognitive reassurance
| ||
Item 1 | 0.82, n = 72 (71,71) | 0.82, n = 65 (64,64) |
Item 12 | 0.82, n = 71 (70,70) | 0.79, n = 65 (64,64) |
Item 23 | 0.85, n = 72 (71,71) | 0.79, n = 66 (65,65) |
Whole subscale | 0.82, n = 73 (72,72) | 0.88, n = 66 (65,65) |
Relationship building
Generic reassurance
Cognitive reassurance
External validity
Total Satisfaction Score (CSQ) | Total enablement score (PEI) | |
---|---|---|
Sample 1
| ||
Data Gathering, n = 156 | 0.71a
| 0.43a
|
Generic Reassurance, n = 151 | 0.54a
| 0.42a
|
Cognitive Reassurance, n = 156 | 0.80a
| 0.48a
|
Sample 2
| ||
Data Gathering, n = 162 | 0.77a
| 0.43a
|
Generic Reassurance, n = 160 | 0.45a
| 0.46a
|
Cognitive Reassurance, n = 162 | 0.76a
| 0.52a
|
Combined Samples
| ||
Relationship-building Subscale 1, n = 312 | 0.81a
| 0.52a
|
Data-gathering subscale | Relationship-building subscale | Generic reassurance subscale | Cognitive reassurance subscale |
---|---|---|---|
To what extent did the physician …
| |||
Encourage you to voice your concerns regarding your symptoms | Show a genuine interest in your problem | Tell you that you should not be worried | Explain how the treatment offered would help with your problem |
Listen attentively while you were talking | Put you at ease | Tell you that everything would be fine | Make sure you understood what your treatment plan involves |
Summarise what you had told them | Show that he/she understood your concerns | Reassure you that he/she had no serious concerns about your back | Check you understood the explanation he/she gave for your symptoms |