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

doi:10.1016/j.bjpt.2021.05.002

Table 2

Turning clinical activities and treatment into self-management support.

Do… Don't…
Planning Defining success Support and guide patients towards their individual value-based goals. Communicate that cure of symptoms is the ultimate goal of treatment.
Clinical assessment Assess (pain) behaviours, impairments, thoughts, and feelings that facilitate and hinder valued goals. Emphasize a structural diagnosis that does not inform choice of treatment and prognosis, or understanding of pain.
Intervention plan Provide evidence-based knowledge to help patients make informed decisions about their care. Decide what is best for a patient or make them believe that their pain will be cured and never return.

Delivery Patient education Focus on the benign aspect of low back pain. Focus on structural injury as an explanation of non-specific low back pain.
Manual therapy Include manual therapy in symptom management if valued by patients and helpful for achieving patient-valued goals. Tell patients that their back pain cannot improve without manual therapy, that something is out of place or that manual treatment corrects spinal abnormalities.
Exercise supervision Use exercises to help people become confident with natural and varied movements and use exercises to develop problem-solving skills. Tell patients that their back pain cannot improve without specific exercises, and don't make movement difficult by correcting them to achieve a ‘neutral posture’, ‘alignment’, or other clinician determined criteria for moving correctly.

Evaluation Define success of intervention Use patient-centred goals to define results of the intervention. Use pain measurements to define results of the intervention.

		Do…	Don't…
Planning	Defining success	Support and guide patients towards their individual value-based goals.	Communicate that cure of symptoms is the ultimate goal of treatment.
	Clinical assessment	Assess (pain) behaviours, impairments, thoughts, and feelings that facilitate and hinder valued goals.	Emphasize a structural diagnosis that does not inform choice of treatment and prognosis, or understanding of pain.
	Intervention plan	Provide evidence-based knowledge to help patients make informed decisions about their care.	Decide what is best for a patient or make them believe that their pain will be cured and never return.

Delivery	Patient education	Focus on the benign aspect of low back pain.	Focus on structural injury as an explanation of non-specific low back pain.
	Manual therapy	Include manual therapy in symptom management if valued by patients and helpful for achieving patient-valued goals.	Tell patients that their back pain cannot improve without manual therapy, that something is out of place or that manual treatment corrects spinal abnormalities.
	Exercise supervision	Use exercises to help people become confident with natural and varied movements and use exercises to develop problem-solving skills.	Tell patients that their back pain cannot improve without specific exercises, and don't make movement difficult by correcting them to achieve a ‘neutral posture’, ‘alignment’, or other clinician determined criteria for moving correctly.

Evaluation	Define success of intervention	Use patient-centred goals to define results of the intervention.	Use pain measurements to define results of the intervention.