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Spine (Phila Pa 1976). 2013 Mar 1. [Epub ahead of print]

Association Between Beliefs and Care-Seeking Behavior for Low Back Pain.

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  • 1Spine Center, Schulthess Klinik, Z├╝rich, Switzerland 1Winterthur Institute of Health Economics WIG, Zurich University of Applied Sciences Winterthur, Switzerland 2Department for Work and Organizational Psychology, University of Berne, Switzerland.


Study Design. Cross sectional population-based survey.Objective. To investigate the relationship between low back pain (LBP)-beliefs and care-seeking in LBP.Summary of Background Data. Not all people suffering with LBP seek care for their problem. Consistent predictors of care-seeking behavior appear to be female gender and high perceived-disability; the role of beliefs about LBP has not been investigated sufficiently.Methods. A questionnaire-booklet was mailed to a random sample of 2'860 individuals otherwise participating in an epidemiological study of musculoskeletal health. It contained the Back Beliefs Questionnaire (BBQ), the Fear-Avoidance Beliefs Questionnaire (FABQ; physical activity and work scales), and questions about sociodemographics, LBP characteristics and LBP-related care-seeking in the last month ("yes" = visit to specialist, general practitioner, physiotherapist, or other healthcare practitioner; "no" = none of these). Logistic regression was used to identify whether beliefs made a significant contribution to care-seeking behavior, beyond known predictors conceptualized in the Behavioral Model of Health Services Use.Results. 2'507/2'860 (88%) individuals completed the questionnaire; 1'071 (43%) reported current LBP, 301 (28%) of which had sought care. In univariate analyses the following were all significantly related to care-seeking (all p<0.01): female gender; increasing age; not working full time; lower income; greater LBP-frequency, LBP-intensity and limitations in activities of daily living (ADL); worse general health; higher FABQ-physical activity, FABQ-work and BBQ scores. In multiple regression, female gender (OR (95%CI) 1.731 (1.174-2.551), p = 0.006), LBP-frequency (OR 1.492 (1.249-1.783), p <0.0001), limitations in ADL (OR 1.010 (1.001-1.020), p = 0.037), and high FABQ-work scores (1.025 (1.005-1.044), p = 0.012) contributed significantly to the final model.Conclusions. That the odds of seeking care are higher in fear-avoidant individuals, even when controlling for other established predictors, emphasizes the importance of addressing such beliefs during the consultation; public health education programs may serve to underpin the delivery of positive messages, ultimately reducing healthcare demands.

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