A Detailed Analysis of How Physiotherapists "Give" Reassurance for Patients' Concerns in Back Pain Consultations.

Abstract

Reassuring patients with low back pain to reduce their concerns is important for good clinical practice. However, guidelines provide little information on how physiotherapists should best deliver reassurance. This study explores how "reassurance" is enacted by physiotherapists and back pain patients during an initial consultation. The research setting was primary care. Twenty initial physiotherapy consultations were video-recorded and transcribed. The patient-physiotherapist interactions were analyzed using conversation analysis, a qualitative observational method. These data highlighted how some physiotherapists gave reassurance directed by what they considered to be important but not always grounded in patients' expressed concerns. We also observed examples where physiotherapists developed a better understanding of patients' concerns, which provided more patient-focused and targeted reassurance with less interactional "trouble" and greater patient affiliation. These findings suggest that physiotherapists should develop a good understanding of patients' concerns, and take them into consideration, before delivering their reassurance. This will require that physiotherapists be responsive to patients' concerns and adapt their communication to the individual needs of the patient.