Effects of patient--clinician disagreement in occupational low back pain: a pilot study

To determine (1) patient--physical therapist and patient--physician agreement on clinical management of LBP, (2) patient perception of agreement between physical therapist and physician, (3) association between agreement and outcome (return to work, self-perceived disability).

Thirty-five workers compensated for LBP responded to a telephone interview within 1 week of referral to physical therapy. They were asked about agreement with the physical therapist and the physician regarding the clinical management of their LBP and whether they thought the physical therapist was providing the treatment the physician would have thought appropriate. They completed a second interview upon returning to work or after 3 months. They answered questionnaires on self-perceived disability, psychological distress, coping strategies, and job satisfaction at both baseline and follow-up.

Nearly all patients (97.1%) agreed with the physical therapist and all believed the physical therapist was providing the treatment the physician would have thought appropriate. The 10 (28.6%) patients who disagreed with their physician on medical management of their LBP were less satisfied with the medical care (P=0.05), technical quality of the visit (P=0.01), and catastrophized more about their pain (P=0.03) than those who agreed. Disagreement was not associated with greater time off-work or greater self-perceived disability.

Patients who disagreed with their physician were less satisfied with their medical management, and catastrophized more about their pain than those who agreed, but disagreement was not associated with chronicity or disability. Studies with larger sample sizes should investigate the role of other factors, such as patient expectations, in the transition to chronicity.