The 130th Annual Meeting of APHA

Abstract #39280

Eric L. Hurwitz, DC, PhD, Department of Epidemiology, UCLA School of Public Health, Box 951772, Los Angeles, CA 90095-1772, 310-206-4074, ehurwitz@ucla.edu, Hal Morgenstern, PhD, Department of Epidemiology, University of California, Los Angeles, School of Public Health, Box 951772, Los Angeles, CA 90095-1772, and Fei Yu, PhD, Department of Epidemiology, UCLA, School of Public Health, 10833 Le Conte Ave., Los Angeles, CA 90095.

Recent studies of low-back-pain treatments have shown chiropractic patients to be more satisfied with their care than medical patients. However, little is known about the association between satisfaction and clinical outcomes. The purpose of this study is to estimate the effects of patient satisfaction on pain and disability among 681 low-back-pain patients followed up for 18 months in a randomized clinical trial of medical and chiropractic care. Following the initial 4-week treatment period, satisfaction was measured by telephone interview with a previously validated 10-item (0-40 points) patient satisfaction instrument. Low-back-pain intensity and frequency were assessed with 0-10 numerical rating and 6-point ordinal scales, respectively; low-back-related disability was assessed with the 24-item Roland-Morris Disability Questionnaire. Multivariable logistic and linear regression modeling with generalized estimating equations was used to estimate associations adjusted for the effects of potential confounders. For logistic modeling, the low-back scales were dichotomized at values reflecting clinically meaningful pain or disability, and a clinical remission variable created. Greater satisfaction increased the odds of remission from clinically meaningful pain and disability at 6 weeks (adjusted odds ratio [OR] for 10-point increase in satisfaction=1.61, 95% confidence interval [CI]=0.99, 2.61), but not at 6, 12, or 18 months (6 months: adjusted OR=1.02, 95% CI=0.72, 1.44; 12 months: adjusted OR=0.94, 95% CI=0.68, 1.29; 18 months: adjusted OR=1.06; 95% CI=0.78, 1.46). Type of provider did not affect the estimated associations. Patient satisfaction appears to confer short-term clinical benefits for low-back-pain patients.

Learning Objectives:

• Participants will acquire knowledge about the methods and measures used to assess patient satisfaction and clinical outcomes, as well as the statistical models used to estimate the effects of satisfaction on pain and disability outcomes in the UCLA Low-Back Pain Study. Participants will be able to describe the study design and population, discuss pertinent results, identify the study's strengths and limitations, and develop ideas for a subsequent patient satisfaction research agenda.

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.