Lisa Charbonneau, DO, MS
Medical Director, New England Rehabilitation Hospital of Portland
November 2014
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In this session, we will explore current state of
knowledge on patient preferences and views
on low back pain.
 The utility of patient satisfaction questionnaires –
WHY?
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Identify ways to improve your practice
Improve care delivery
Results in more satisfied, happier patients
Show staff that you are interested in quality
Marketplace now demands data on patient satisfaction
Provides quality data
Enables practice comparisons standardized
assessments on a broad scale
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We have entered the era of pay for
performance measures
Patient satisfaction scores will figure into the
equation for reimbursement for hospitals and
physicians
▪ What do patients want?
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Clear diagnosis
Information and instructions
Pain relief
A physical exam (touch the patient!)
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More diagnostic tests
Other therapeutic modalities
Referral to specialists
Certification of disability
Expert confirmation that “their pain is real”
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Understanding
Listening
Respect
Inclusion in decision making
 Reviewing the spectrum of potential outcomes
from increased function, elimination of pain to
treatment of chronic low back pain
▪ Patient expectations are more influenced by family,
friends and prior experiences
▪ Most patients with LBP expect an X-ray to identify “the
cause of pain.”
▪ Prior relationship with their physician correlates to the
degree of patient satisfaction
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Opioids +/- Cognitive Behavioral Therapy (CBT) had
no effect on improving perceptions of pain, fatigue,
level of distress in patients with chronic LBP (J. of
Pain Research Jan 2012)
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Younger patients have higher expectations
before surgery with regard to symptom relief,
mobility and reducing the impact the
condition has on current and future life.
Patients with more significant disability have
higher expectations prior to (cervical) spine
surgery.
Do we ask the right questions?
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Do we understand the scores?
Who is completing the questionnaire?
Are happy patients more or less likely to
complete the questionnaire?
Should we “teach for the test?”
Do we spend enough time listening to our
patients?
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One large center study of 422 patients found
that extent of improvement in quality of life
and disability did not correlate with patient
satisfaction scores.
Study concluded that patient satisfaction is
NOT a valid measure of overall quality or
effectiveness of surgical spine care and
should not be used as a proxy for overall
quality, safety, or effectiveness of care.
(Spine J, 2013 Sep;13(9):1006-12)
 How do we involve the public in the creation of
CPG’s?
▪ Spine (2004) “Practice guidelines should pay more
attention to the best way of discussing causes and
diagnosis with patients and should involve them in
decision making.”
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Have we included patients in the creations of
CPGs in the last decade?
▪ CPGs reviewed by AAPMR CPG committee in the area of
back pain and Agree II score:
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NASS (Spinal Stenosis)
NASS (Spondylolisthesis)
AAOS (Sympt CF)
APTA (CPG linked to ICF)
The answer is NO!!!
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We know what patients want.
We have an idea of patient expectations.
Patient satisfaction scores do not correlate
with quality of care.
We have not done a good job of including
patients (lay public) in the creation of CPGs.
We are not “satisfying” patients because we
are not creating realistic expectations and are
not asking the right questions.
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Hoffman et al. Patients expectations of acute
low back pain management. J Fam Prac
2013;14(7).
Sanderson, Kristen, et al. Investigating patient
expectations and treatment outcome in a
chronic low back pain population.J of Pain
Research Jan 2012
Verbeck J, et al. Patient expectations of
treatment for back pain; a systematic review of
qualitative and quantitative studeis. Spine 2004
Oct 15;29(20)2309-18
AAPMR website CPGs endorsed by the Academy
Godil SS et al, Determining the quality and
effectiveness of surgical spine care:patient
satisfaction is not a valid proxy.Spine J, 2013
Sep; 13(9):1006-12
 Mancuso, CA et al, Patients’ expectations of
cervical spine surgery, Spine. 2014;39(14):11571162
 Bowling A, et al, The measurement of patients’
expectations for health care: a review and
psychometric testing of a measure of patients’
expectations. Health Technol Assess, 2012
Jul:16(30):i-xii
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