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

doi:10.1016/j.bjpt.2021.05.002

Table 1

Actions to place self-management at the core of back pain care.

Clinical process Self-management component How? Why?
Planning Let patient value-based goals guide management. Discuss specific patient value-based goals using for example the SMART framework. To help patients identify their motivation for change and what facilitates and hinders engaging in valued activities.
To reduce focus on pain-goals.

Make shared decisions about the plan. Exchange information about treatment options.
Include patients’ values and preferences.
Affirm the decision. To enhance patient-centred care and increase patients’ satisfaction, engagement, and adherence.

Define readiness to change. Identify resources and knowledge to make a lasting change successfully.
Identify barriers to change.
Identify challenges to maintain new behaviour. To understand elements of change, the stages of change, and ways to address each stage to achieve goals.

Delivery Help patients make sense of their symptoms. Deliver knowledge to reduce fear and address misconceptions.
Direct patients to useful sources of information. To avoid restrictions in patient-valued activities and low sense of control due to misbeliefs and fears.
Teach skills to solve everyday problems. Use exercises as a tool to train problem-solving skills by patients exploring movement instead of being told what to do.
Encourage patients to try out a variety of movements and activities.
Help patients come up with solutions to everyday problems. To avoid dependency on the clinician, as being the one knowing what correct movement/posture is.
To enable patients to cope with everyday situations on their own
To increase self-efficacy by using operant conditioning, positive reinforcement and positive experiences.
Set patients up for successful experiences Use exposure to new/feared activities to provide the experience of success.
Discuss alternative perspectives on feared activities or movements. To help patients reframe their perspectives on low back pain.
To challenge overly negative beliefs.
To change thoughts or emotions related to an activity.
Provide tools for management of pain and emotions Teach pain strategies as distraction, breathing exercises, or mindfulness. To support planning of active behaviour with relapses and flare ups.
To enhance feeling of control.

Evaluation Evaluate and discuss adjustments of goals Ask if the patient-valued goals have been achieved:
Partly: “What went well?”
Not at all: “What are the barriers?” To keep focusing on value-based goals and motivate for maintained engagement.
Evaluate patients’ understanding of back pain Ask questions about patients’ beliefs related to pain and what forms those beliefs: “What do you think happens when your back hurts?” To raise awareness of more appropriate back pain beliefs.
Assist patients in action planning Discuss active tools to maintain self-managing of back problems.
Prompt detailed planning of actions to take when perusing goals is challenged “How will you react when you back relapses/has flare ups?”
“When will you need help from health care and why?” To help patients sustain good habits and prepare for relapses.

Clinical process	Self-management component	How?	Why?
Planning	Let patient value-based goals guide management.	Discuss specific patient value-based goals using for example the SMART framework.	To help patients identify their motivation for change and what facilitates and hinders engaging in valued activities. To reduce focus on pain-goals.
	Make shared decisions about the plan.	Exchange information about treatment options. Include patients’ values and preferences. Affirm the decision.	To enhance patient-centred care and increase patients’ satisfaction, engagement, and adherence.
	Define readiness to change.	Identify resources and knowledge to make a lasting change successfully. Identify barriers to change. Identify challenges to maintain new behaviour.	To understand elements of change, the stages of change, and ways to address each stage to achieve goals.

Delivery	Help patients make sense of their symptoms.	Deliver knowledge to reduce fear and address misconceptions. Direct patients to useful sources of information.	To avoid restrictions in patient-valued activities and low sense of control due to misbeliefs and fears.
	Teach skills to solve everyday problems.	Use exercises as a tool to train problem-solving skills by patients exploring movement instead of being told what to do. Encourage patients to try out a variety of movements and activities. Help patients come up with solutions to everyday problems.	To avoid dependency on the clinician, as being the one knowing what correct movement/posture is. To enable patients to cope with everyday situations on their own To increase self-efficacy by using operant conditioning, positive reinforcement and positive experiences.
	Set patients up for successful experiences	Use exposure to new/feared activities to provide the experience of success. Discuss alternative perspectives on feared activities or movements.	To help patients reframe their perspectives on low back pain. To challenge overly negative beliefs. To change thoughts or emotions related to an activity.
	Provide tools for management of pain and emotions	Teach pain strategies as distraction, breathing exercises, or mindfulness.	To support planning of active behaviour with relapses and flare ups. To enhance feeling of control.

Evaluation	Evaluate and discuss adjustments of goals	Ask if the patient-valued goals have been achieved: Partly: “What went well?” Not at all: “What are the barriers?”	To keep focusing on value-based goals and motivate for maintained engagement.
	Evaluate patients’ understanding of back pain	Ask questions about patients’ beliefs related to pain and what forms those beliefs: “What do you think happens when your back hurts?”	To raise awareness of more appropriate back pain beliefs.
	Assist patients in action planning	Discuss active tools to maintain self-managing of back problems. Prompt detailed planning of actions to take when perusing goals is challenged “How will you react when you back relapses/has flare ups?” “When will you need help from health care and why?”	To help patients sustain good habits and prepare for relapses.