The Associations between Physician-Patient Encounter Characteristics and Chronic Low Back Pain Outcomes

PURPOSE Low back pain is the leading cause of disability, affecting 577 million persons worldwide. As there are relevant clinical practice guidelines from the Centers for Disease Control and Prevention and the American College of Physicians that have been widely implemented in the United States, factors other than treatment may have an important impact on clinical outcomes. This study aimed to determine if aspects of the physician-patient encounter affect long-term outcomes among patients with chronic low back pain (CLBP). METHODS Participants in this retrospective cohort study were recruited from the PRECISION Pain Research Registry from April 2016 through December 2021. Eligible participants reported CLBP according to criteria established by the National Institutes of Health, were 21-79 years of age, and had a physician who regularly treated their low back pain. Characteristics of the physician-patient encounter were measured with the Communication Behavior Questionnaire, Consultation and Relational Empathy Measure, and the Patient Satisfaction Questionnaire (PSQ) and classified according to tercile cut points. The PSQ measure included the five scales most closely related to physician behavior during medical care (general satisfaction, technical quality, interpersonal manner, communication, and time spent with patient). Outcomes were measured at quarterly encounters over 12 months using a numerical rating scale (NRS) for pain intensity, the Roland-Morris Disability Questionnaire (RMDQ), and the SPADE cluster (sleep disturbance, pain interference, anxiety, depression, and low energy/fatigue) derived from the Patient-Reported Outcomes Measurement Information System. The latter measures health-related quality of life. Higher scores represent worse outcomes on each measure. Longitudinal outcomes were assessed using repeated measures analysis of variance. RESULTS Patient satisfaction most consistently and strongly predicted outcomes (P< 0.001). Health-related quality of life was strongly associated with each aspect of the physician-patient encounter. Participants who rated their physicians in the highest tercile for satisfaction reported lower scores for NRS (mean, 5.77; 95% CI, 5.56-5.98 vs mean, 6.11; 95% CI, 5.91-6.32 for reference category), RMDQ (mean, 13.22; 95% CI, 12.50-13.94 vs mean, 15.33 95% CI, 14.63-16.02), and SPADE (mean, 56.06; 95% CI, 55.25-56.87 vs mean, 59.22; 95% CI, 58.44-60.00). Similarly, participants who rated their physicians in the highest tercile for empathy reported lower scores for SPADE (mean, 56.30; 95% CI, 55.45-57.15 vs mean, 58.75; 95% CI, 57.95-59.55). CONCLUSIONS Various aspects of the physician-patient encounter may impact long-term outcomes of patients with CLBP. Most notably, patient satisfaction was consistently and strongly associated with all outcomes. The PSQ, a composite measure including satisfaction with such factors as physician communication and interpersonal manner, appears to be a stronger predictor of clinical outcomes than two other instruments that each focused specifically on physician communication or empathy. These findings have potentially important public health implications because CLBP management in the United States is driven by widely accepted clinical practice guidelines. Thus, it appears that the physician-patient encounter offers a mechanism for augmenting the effects of recommended CLBP treatments.