Satisfaction with low back pain care.

BACKGROUND: By using a unique, prospective study of occupational back pain claims, we examined health-care satisfaction by provider type and its effect on return to work. PURPOSE: We estimated satisfaction differentials by provider type, decomposing overall satisfaction into two components: bedside manner and effectiveness of care. We also examined how health-care satisfaction affects the duration of jobless claims. STUDY DESIGN: The Arizona State University Healthy Back Study (HBS) is a prospective study of work-related back pain; 1,831 workers completed a baseline interview, with follow-up interviews at 1 month, 6 months, and 1 year. The HBS merged demographic and claim characteristics from the workers' compensation claim files with self-reported severity measures, measures of satisfaction, and postonset employment from worker interviews. OUTCOME MEASURES: Overall and detailed satisfaction with treatment and workers' compensation claim duration. METHODS: We performed a nonparametric descriptive analysis of satisfaction by provider type and used multivariate regressions to decompose overall satisfaction into component parts. The duration analysis links differentials in health care satisfaction to differences in claim durations. RESULTS: Workers treated by surgeons, chiropractors (DCs), or physical therapists are more satisfied with their health care than those treated by MDs. Workers are more concerned with the effectiveness of care than with the bedside manner of their provider. A one standard deviation improvement in satisfaction with the health-care provider reduces claim duration by about 25%. CONCLUSIONS: Satisfaction with health care has a significant impact on jobless spells and varies significantly between provider types.

Cost-based evaluations of the treatment of back pain: a primer for health-care professionals.

BACKGROUND CONTEXT: There is an extensive literature on the costs of back pain and on cost-based evaluations of the effectiveness of alternative modes of care for back pain. An understanding of the adequacy of a study often requires information that is not part of the experience or training of health-care professionals. The article seeks to provide clinicians with some criteria by which to judge the validity of cost-based evaluations of the treatment and consequences of back pain. PURPOSE: This article is not a comprehensive, critical review of the research literature on the costs of back pain or the relative cost-effectiveness of different methods of care for back pain. It presents, instead, a discussion of some important characteristics of cost-related studies of back pain and some criteria that can be used to evaluate the validity of cost estimates and cost-effectiveness analyses related to back pain. STUDY DESIGN: A guide for the evaluation of cost-based studies of back pain. METHODS: A summary of criteria for the evaluation of the validity of cost-based studies of back pain. RESULTS: Three sets of criteria for evaluation, ranked from most important to least important. CONCLUSIONS: Application of the suggested criteria can enhance the ability of health-care professionals to better understand the limits and relative adequacy of cost-based studies of back pain.

Comparative Effectiveness Research: A Roadmap for Physical Activity and Lifestyle.

PURPOSE: Comparative effectiveness research (CER) is designed to support informed decision making at both the individual, population, and policy levels. The American College of Sports Medicine and partners convened a conference with the focus of building an agenda for CER within the context of physical activity and nonpharmacological lifestyle approaches in the prevention and treatment of chronic disease. This report summarizes the conference content and consensus recommendations that culminated in a CER roadmap for physical activity and lifestyle approaches to reducing the risk of chronic disease. METHODS: This conference focused on presentations and discussion around the following topic areas: 1) defining CER, 2) identifying the current funding climate to support CER, 3) summarizing methods for conducting CER, and 4) identifying CER opportunities for physical activity. RESULTS: This conference resulted in consensus recommendations to adopt a CER roadmap for physical activity and lifestyle approaches to reducing the risk of chronic disease. In general, this roadmap provides a systematic framework by which CER for physical activity can move from a planning phase to a phase of engagement in CER related to lifestyle factors with particular emphasis on physical activity to a societal change phase that results in changes in policy, practice, and health. CONCLUSIONS: It is recommended that physical activity researchers and health care providers use the roadmap developed from this conference as a method to systematically engage in and apply CER to the promotion of physical activity as a key lifestyle behavior that can be effective at making an impact on a variety of health-related outcomes.

Trust evaluation in health information on the World Wide Web.

The impact of health information on the web is mounting and with the Health 2.0 revolution around the corner, online health promotion and management is becoming a reality. User-generated content is at the core of this revolution and brings to the fore the essential question of trust evaluation, a pertinent problem for health applications in particular. Evolving Web 2.0 health applications provide abundant opportunities for research. We identify these applications, discuss the challenges for trust assessment, characterize conceivable variables, list potential techniques for analysis, and provide a vision for future research.