Illness perceptions and healthcare use among people with low back pain in general practice

Illness perceptions, reflecting cognitive and emotional representation of a condition, may influence how people with low back pain (LBP) seek care. Evidence in this area remains limited. This study examines whether illness perceptions are associated with healthcare visits and diagnostic imaging in people seeking care for LBP.

In this prospective cohort study, patients consulting general practice for LBP completed the Brief Illness Perception Questionnaire (BIPQ; 0-80) at baseline. Two outcomes were assessed after three months: repeated healthcare visits (≥2 vs < 2 visits) and diagnostic imaging (X-ray, CT, or MRI; yes/no). Associations were analysed using logistic regression, adjusted for baseline pain intensity, disability, and episode duration.

Analysis included 214 adults (mean age, 55 years; 56% women). At three-month follow-up, 31% had ≥2 healthcare visits, and 19% had undergone diagnostic imaging. More threatening illness perceptions were associated with multiple healthcare visits (adjusted OR 1.04 per BIPQ point; 95% CI, 1.00-1.07) and diagnostic imaging (adjusted OR 1.04 per point; 95% CI, 1.00-1.08). The estimated odds corresponded to predicted probabilities increasing from 26% to 36% of healthcare visits and from 14% to 22% for imaging, comparing the highest and lowest BIPQ quartiles. For individual BIPQ items, emotional response (BIPQ8) was associated with visits, whereas recovery expectations (BIPQ2) were associated with diagnostic imaging.

Illness perceptions were associated with healthcare visits and diagnostic imaging in people with LBP, independent of pain, disability, and episode duration, and addressing these perceptions may support guideline-concordant care.