Judgement analysis of case severity and future risk of disability regarding chronic low back pain by general practitioners in Ireland

PLoS One. 2018 Mar 26;13(3):e0194387. doi: 10.1371/journal.pone.0194387. eCollection 2018.

Abstract

Chronic low back pain is a major healthcare burden that has wide ranging effects on the individual, their family, society and the workplace. However, appropriate management and treatment is often difficult, as a majority of cases are non-specific in terms of underlying pathology. As a result, there are extensive differences in both individual patient preferences for treatment and treatment decisions amongst general practitioners. The current study examined the clinical judgements of GPs in Ireland, regarding fictional patients' case severity and future risk of disability, through judgement analysis. Judgement analysis (JA) is an idiographic regression modelling technique that has been utilised in extant healthcare research for the purpose of allocating weighting to judgement criteria, or cues, observed by professionals in their clinical decision-making. The primary aim of the study was to model two critical information utilisation tasks performed by GPs with regard to CLBP-in combining information cues to form a judgement about current case severity and a judgement about the same patient's risk of future disability. It was hypothesised that the judgement weighting would differ across the two judgements and that judgements regarding future risk of disability would be less consistent among GPs than judgements about case severity. Results from the regression-based judgement analysis and subsequent follow-up statistical analysis provided support for both study hypotheses. Study findings are discussed in light of theory and research on judgement, clinical decision-making and chronic low back pain.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Chronic Pain / diagnosis*
  • Chronic Pain / therapy
  • Decision Making*
  • Female
  • General Practitioners*
  • Humans
  • Ireland
  • Judgment*
  • Low Back Pain / diagnosis*
  • Low Back Pain / therapy
  • Male
  • Middle Aged
  • Persons with Disabilities*
  • Severity of Illness Index

Grants and funding

This work was supported by the Health Research Board (IE). Reference number: ICE/2011/19 (BEM). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.