Patient misconceptions concerning lumbar spondylosis diagnosis and treatment persist

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Researchers have found a surprising number of misconceptions among patients concerning lumbar spondylosis diagnosis and treatment, misconceptions that persist even in patients with a history of spine surgery.

Senior author Lynda J-S Yang, Department of Neurosurgery, University of Michigan, Ann Arbor, USA, and colleagues, suggest that patient outcome measures are becoming increasingly important in the evaluation of health care quality and physician performance. Patient expectations of treatment can directly and indirectly influence clinical outcomes, which is important given that misconceptions can lead to unmet expectations. As such, Yang et al write that the identification and addressing of these misconceptions are “critical” to providing informed and quality healthcare.

As documented by their study published in the Journal of Neurosurgery: Spine, the authors designed a short survey that was distributed to all new patients referred to a general neurosurgical spine clinic at a tertiary care centre over a period of 11 months (121 surveys in total). The authors write, “The survey consisted of questions designed to assess patient understanding of the role of radiological imaging in the diagnosis and treatment of low back and leg pain, and patient perception of the indications for surgical compared with conservative management.”

Even for those without symptoms, more than 50% of the patients surveyed indicated that they would undergo spine surgery based on abnormalities found on a magnetic resonance imaging (MRI) scan, while more than 40% of patients indicated the same for plain radiographs. Similarly, a large proportion of patients (33%) believed that back surgery was more effective than physical therapy in the treatment of back pain without leg pain. Nearly one-fifth of the survey group (17%) also believed that back injections were riskier than back surgery (no difference between the pre-and post-fungal mengitis outbreak associated with injections).

The authors note that there were no significant differences in survey responses among patients with a previous history of spine surgery compared with those without previous spine surgery. This suggests that “providing adequate information to patients remains a crucial and unresolved issue in the treatment of lumbar spondylosis”, and that “many of these repeat patients may have simply not received adequate information during prior consultations”.

Yang et al report that “Specifically, patients overemphasise the value of radiological studies and have mixed perceptions of the relative risk and effectiveness of surgical intervention compared with more conservative management. These misconceptions have the potential to alter patient expectations and decrease satisfaction, which could negatively impact patient outcomes and subjective valuations of physician performance.”

The team note that although these results are preliminary and the sources of misconceptions are “likely complex,” they highlight a need for “improved communication and patient education during surgical consultation for lumbar spondylosis”. They suggest that further research should focus on identifying the major contributors to these misconceptions.

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