Low back pain (COURSE-17)

14 May 2019 13:30-17:00
Half day
HEdS Roseraie
Level of learning:
€100, fee includes all course materials and tea/coffee breaks

Half day course

Language: English

Traeger A1Hoffmann T2O'Keeffe M1Zadro J1O'Sullivan P3
1University of Sydney, School of Public Health, Sydney, Australia, 2Bond University, Faculty of Health Sciences and Medicine, Gold Coast, Australia, 3Curtin University, School of Physiotherapy, Perth, Australia

Learning objective 1: Understand the evidence base for providing advice and reassurance for acute low back pain
Learning objective 2: Develop practical skills for communicating with the distressed patient with acute low back pain
Learning objective 3: Learn ways to challenge misconceptions about low back pain early in the therapeutic relationship while maintaining patient trust


Every practice guideline recommends advice and reassurance for acute low back pain.1Unfortunately these documents contain little guidance on exactly what practitioners should communicate, or how they should communicate it. For example, guidelines recommend telling patients that low back pain is unlikely to be caused by serious illness. Suggesting that non-specific symptoms such as low back pain are not the result of serious pathology might be reassuring initially, but it can provoke increased worry in the long-term.2Guidelines also recommend that people with acute low back pain remain active and avoid bed rest. But how can practitioners convince people of this when it hurts to move and feels better to rest? Current guidelines do little to answer these questions.

Fortunately, growing evidence on patient communication is helping to provide answers. For example, we now know that advice needs to be brief,3recommend against routine imaging or complex medicines, and promote active approaches to rehabilitation and self-care. Implementing this approach is easier said than done.4Physiotherapists Dr Adrian Traeger and Dr Josh Zadro, and clinical epidemiologist Prof Tammy Hoffmann will describe the current evidence on communicating with patients about acute low back pain. All three are highly experienced clinicians who now specialise in research into evidence-based communication. They will run practical sessions on communicating about low back pain through infographics, shared decision-making and goal setting.

Despite increasing evidence on the dos and don'ts of a consultation for low back pain, bad advice is everywhere. How do you counteract misconceptions from media, health practitioners, social network without alienating the patient or undermining their trust in others? Dr Mary O'Keeffe and Prof Peter O'Sullivan have taken on bad messaging from the largest corporations, to individuals in the clinic. Along the way, they've picked up clever strategies to challenge mistaken beliefs without causing confrontation or comprising the therapeutic relationship.5

World-leading researchers and clinical experts in patient communication will challenge attendees to reconsider what good advice is through 5 acts, each combining a short presentation with a practical component:

Act 1: What do you mean, I don't need a scan? By Adrian Traeger 
Many patients are concerned about the source of their pain, risk of serious pathology, and risk of persistent pain. 

Talk 20min: Discussing 'non-specific-ness,' prognosis and risk for serious pathology in acute low back pain

Practical 20min: Risk communication and infographics 

Act 2: Bad, bad advice Part I. By Mary O'Keeffe
Bad advice is everywhere. Mary has seen some of the worst of it and responded in publications such as the BBC and Irish Independent. 

Talk 20min: Bad advice from the media, and what to do about it.

Practical 20min: Addressing misconceptions 

Act 3: How active is active? By Josh Zadro
Advising people with acute low back pain to remain active can be extremely challenging, particularly when they're distressed and in severe pain. 

Talk 20min: Activity coaching for acute low back pain

Practical 20min: Goal setting 

Act 4: Bad, bad advice Part II. By Peter O'Sullivan
Peter is one of the world's most successful and well-known physiotherapists and researchers. Peter will discuss how good advice can replace many of the low-value alternatives for acute low back pain. 

Talk 20min: Bad advice from health practitioners, and what to do about it.

Practical 20min: Addressing misconceptions 

Act 5: Shared understanding. By Tammy Hoffmann
Shared-decision making is a clinical skill that is leading the way in the battle to reduce unnecessary healthcare. 

Talk 20min: Shared-decision making. Why bother?

Practical 20min: Shared-decision making skills for acute low back pain

Implications / Conclusions:

Low back pain continues to be a leading cause of disability in both low- and high-income countries. Optimising the communication skills of practitioners managing low back pain will not only improve professional rapport, it could considerably improve patient outcomes, and ultimately impact global health.


Funding Acknowledgements: AT is supported by an NHMRC Early Career Fellowship. MOK is funded by a European Union Horizon 2020 Marie Skłodowska-Curie Global Fellowship. 
Target Audience: Clinicians interested in expanding patient communication skills and exploring how evidence can be used to navigate difficult patient interactions 
Key-Words: Low back pain; evidence-based practice; patient-practitioner communication