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Spine (Phila Pa 1976). 2016 Jul 7. [Epub ahead of print]

Patients' Attitudes Toward Non-Physician Screening of Low Back and Low Back-Related Leg Pain Complaints Referred for Surgical Assessment.

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  • 1*Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada †Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada ‡Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada §Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada ¶Department of Surgery, Division of Orthopedic Surgery, McMaster University, Hamilton, Ontario, Canada ||Department of Surgery, Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada **Consulting Chiropractor and Advanced Practice Clinician, University Health Network, Toronto, Ontario, Canada, and Oakville Trafalgar Memorial Hospital, Oakville, Ontario, Canada ††Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada.



Questionnaire survey.


To explore patient attitudes towards screening to assess suitability for low back surgery by non-physician healthcare providers.


Canadian spine surgeons have shown support for non-physician screening to assess and triage patients with low back pain and low back-related leg pain. However, patients' attitudes towards this proposed model are largely unknown.


We administered a 19-item cross-sectional survey to adults with low back and/or low back-related leg pain who were referred for elective surgical assessment at one of five spine surgeons' clinics in Hamilton, Ontario, Canada. The survey inquired about demographics, expectations regarding wait time for surgical consultation, as well as willingness to pay, travel, and be screened by non-physician healthcare providers.


80 low back patients completed our survey, for a response rate of 86.0% (80 of 93). Most respondents (72.5%; 58 of 80) expected to be seen by a surgeon within 3 months of referral, and 88.8% (71 of 80) indicated willingness to undergo screening with a non-physician healthcare provider to establish if they were potentially a surgical candidate. Half of respondents (40 of 80) were willing to travel >50 km for assessment by a non-physician healthcare provider, and 46.2% were willing to pay out-of-pocket (25.6% were unsure). However, most respondents (70.0%; 56 of 80) would still want to see a surgeon if they were ruled out as a surgical candidate, and written comments from respondents revealed concern regarding agreement between surgeons' and non-physicians' determination of surgical candidates.


Patients referred for surgical consultation for low back or low back-related leg pain are largely willing to accept screening by non-physician healthcare providers. Future research should explore the concordance of screening results between surgeon and non-physician healthcare providers.



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