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GPs continue to sign off back pain patients

09 November 2009 Breaking News

Over a quarter of GPs and physiotherapists continue to recommend that patients with low back pain stay off work, despite national guidelines to the contrary, according to new research.

The findings have implications for employers and insurers facing a rising number of income protection and private medical insurance claims for musculoskeletal problems.

While healthcare professionals (HCPs) surveyed for the study claim to "strictly" or "broadly" give advice in line with guidelines recommendations that patients remain active rather than staying in bed, they are more likely to report non-adherence to guidelines regarding work. The authors of the study speculate that this finding may be linked to previous studies showing that GPs see sickness certification as a potential threat to the doctor-patient relationship.  

Healthcare professionals who believe that disability and pain are the result of physical problems were more likely to recommend that patients remain off work, compared to those who believe that pain can be influenced by social and psychological factors (the "biopsychosocial model" adopted by disability insurers such as Unum when devising underwriting and claims management systems).

The authors write: "By restricting activities and work, HCPs may reinforce patient's unhelpful illness perceptions and increase spinal vigilance. Alternatively, they may over-direct the patient by providing strict advice to perform only specific activities and exclude others, encouraging an over-reliance on the HCP, which may make it difficult to foster the patients' self-management skills, something recommended as part of best practice for patients with lower back pain."

Low back pain affects 38% of adults in any one year, of whom one in four experience significant disability. Only 25% of patients consulting in primary care will be symptom free 12 months later. The last two decades have also seen dramatic rises in work loss and sickness benefit payments, attributed to recurrent and persistent low back pain.

National guidelines state that GPs should recommend that patients stay at work or make an early return, as the longer someone is off work the likelihood of them returning steadily diminishes, with a 20% risk of long term disability for those off work for four to six weeks.

Insurers have sought to adopt more sophisticated approaches to managing claims for private medical insurance treatment and income protection driven by musculoskeletal problems, emphasising the importance of self-management and limited clinical intervention.

The research, from Keele University, is based on a survey of 442 GPs and 580 physiotherapists. It is published in the journal Pain.

Health Insurance held a seminar on musculoskeletal conditions and their impact on absence and productivity earlier this year. The full report is available here.

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