PRACTITIONER SELF-CONFIDENCE AND PATIENT OUTCOMES IN ACUTE LOW-BACK-PAIN

Objective: To compare outcomes for patients with acute low back pain w ho received care from practitioners with different self-confidence sco res on a 4-item scale. Design: Cross-sectional survey of practitioners . Prospective cohort study of patient outcomes. Setting: Private pract ices and a group model health maintenance organization. Participants: One hundred eighty-nine practitioners, including private practice trad itionally trained medical physicians, chiropractors, and physicians in a group model health maintenance organization, who were randomly chos en from practices across the state of North Carolina. These practition ers enrolled 1633 patients with acute low back pain into a prospective cohort study. Methods: The practitioner survey contained 10 questionn aire items that measured aspects of practitioner confidence and attitu des in assessing and treating patients with low back pain. Patients we re interviewed by telephone after the initial office visit and at 2, 4 , 8, 12, and 24 weeks, or until complete recovery, whichever came firs t. Results: Of 189 study practitioners, 95% responded to the survey. A 4-item scale, shown by factor analysis to describe practitioners' sel f-confidence, demonstrated good internal consistency among physicians and chiropractors. Chiropractors had significantly stronger self-confi dence scores than physicians. Among patients of primary care physician s and chiropractors, those who received care from practitioners with s tronger self-confidence scores did not differ in the time to functiona l improvement, overall patient satisfaction, or their perception of th e completeness of care. Conclusion: The level of practitioner self-con fidence, as measured by a 4-item scale, did not predict patient outcom es in the treatment of acute low back pain.