Masterclass
Self-management at the core of back pain care: 10 key points for clinicians

https://doi.org/10.1016/j.bjpt.2021.05.002Get rights and content
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open access

Highlights

  • Self-management support is person-centred care reinforcing patient autonomy.

  • Avoid strong clinician control and help patients developing self-efficacy.

  • Let patients’ value-based goals and shared decisions guide management.

  • Help patients make sense of symptoms and reframe unhelpful perspectives.

    Use supervised exercises as a tool to practice problem-solving skills

Abstract

Background

A paradigm shift away from clinician-led management of people with chronic disorders to people playing a key role in their own care has been advocated. At the same time, good health is recognised as the ability to adapt to changing life circumstances and to self-manage. Under this paradigm, successful management of persistent back pain is not mainly about clinicians diagnosing and curing patients, but rather about a partnership where clinicians help individuals live good lives despite back pain.

Objective

In this paper, we discuss why there is a need for clinicians to engage in supporting self-management for people with persistent back pain and which actions clinicians can take to integrate self-management support in their care for people with back pain.

Discussion

People with low back pain (LBP) self-manage their pain most of the time. Therefore, clinicians and health systems should empower them to do it well and provide knowledge and skills to make good decisions related to LBP and general health. Self-management does not mean that people are alone and without health care, rather it empowers people to know when to consult for diagnostic assessment, symptom relief, or advice. A shift in health care paradigm and clinicians’ roles is not only challenging for individual clinicians, it requires organisational support in clinical settings and health systems. Currently, there is no clear evidence showing how exactly LBP self-management is most effectively supported in clinical practice, but core elements have been identified that involve working with cognitions related to pain, behaviour change, and patient autonomy.

Keywords

Back pain
Behavior change
Delivery of health care
Musculoskeletal disease
Patient-centred Care
Self-management

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