Practitioner self-confidence and patient outcomes in acute low back pain

Objective: To compare outcomes for patients with acute low back pain who received care from practitioners with different self-confidence scores on a 4-item scale. Design: Cross-sectional survey of practitioners. Prospective cohort study of patient outcomes. Setting: Private practices and a group model health maintenance organization. Participants: One hundred eighty-nine practitioners, including private practice traditionally trained medical physicians, chiropractors, and physicians in a group model health maintenance organization, who were randomly chosen from practices across the state of North Carolina. These practitioners enrolled 1633 patients with acute low back pain into a prospective cohort study. Methods: The practitioner survey contained 10 questionnaire items that measured aspects of practitioner confidence and attitudes in assessing and treating patients with low back pain. Patients were interviewed by telephone after the initial office visit and at 2, 4, 8, 12, and 24 weeks, or until complete recovery, whichever came first. Results: Of 189 study practitioners, 95% responded to the survey. A 4-item scale, shown by factor analysis to describe practitioners' self-confidence, demonstrated good internal consistency among physicians and chiropractors. Chiropractors had significantly stronger self-confidence scores than physicians. Among patients of primary care physicians and chiropractors, those who received care from practitioners with stronger self-confidence scores did not differ in the time to functional improvement, overall patient satisfaction, or their perception of the completeness of care. Conclusion: The level of practitioner self-confidence, as measured by a 4-item scale, did not predict patient outcomes in the treatment of acute low back pain.