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Einstellungen und Überzeugungen von Behandlern bei älteren Patienten mit Rückenschmerzen

Eine Analyse der Erhebungsinstrumente und Forschungslücken

Health care professionals’ attitudes and beliefs towards older back pain patients

Analysis of the assessment methods and research gaps

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Zusammenfassung

In den letzten Jahren wurde der Einfluss von Einstellungen und Überzeugungen von Ärzten und Therapeuten auf die Behandlung von chronischen Rückenschmerzpatienten vermehrt untersucht. Für ein leitliniengerechtes aktivierendes therapeutisches Vorgehen wurden dabei die Einstellungen von Behandlern als bedeutsam erkannt und verschiedene Fragebogen zur Einstellungserhebung entwickelt. Es liegen inzwischen Reviews zur Güte mehrerer dieser Messinstrumente sowie zu den Auswirkungen der Einstellungen hinsichtlich der Therapie- und Aktivitätsempfehlungen gegenüber Patienten vor. Der vorliegende Beitrag fasst diese Ergebnisse zusammen und beleuchtet die Übertragbarkeit auf ältere Rückenschmerzpatienten. Eine Literatursichtung zeigt, dass die meisten Untersuchungen die Berufsgruppen der Physiotherapeuten und Ärzte für Allgemeinmedizin einbeziehen. Der psychometrisch am stärksten überprüfte Fragebogen ist derzeit die Pain Attitudes and Beliefs Scale (PABS), die durch eher altersneutrale Itemformulierungen auch für Einstellungsuntersuchungen gegenüber älteren Schmerzpatienten genutzt werden könnte. Die Literatursichtung zeigt, dass Fallvignetten als weiterer methodischer Zugang in Anlehnung an vorliegende Untersuchungen aus England für die Situation in Deutschland übersetzt und kulturell adaptiert werden sollten. Insgesamt muss davon ausgegangen werden, dass auch in der Versorgung älterer Schmerzpatienten Einstellungen und Überzeugungen von Behandlern bedeutsam sind. Hinsichtlich der Aktivitätsempfehlungen müssen hierbei auch Altersstereotype sowie die besondere Situation von älteren Menschen mit möglicher Sturzgefahr, Multimorbidität, Polypharmazie und kognitiver Einschränkung berücksichtigt werden. Adaptierte oder neu entwickelte Fragebogen sollten diese Themenfelder bei den Einstellungen von Ärzten und anderen Therapeuten mit berücksichtigen.

Abstract

In recent years, the influence of doctors and therapist’s attitudes and beliefs for the treatment of chronic low back pain patients has been increasingly investigated. Attitudes and beliefs of health care providers have been identified as important contributors for an activity based, guideline-oriented therapeutic approach and different questionnaires were developed to evaluate this interaction. Recent reviews discuss the quality of those questionnaires as well as the impact of attitudes towards therapeutic choices and activity recommendations by health care professionals. This article summarizes these results and illuminates transferability of existing questionnaires to older patients with back pain. A literature review shows that most studies were conducted with physiotherapists and general practitioners. At present the most thoroughly investigated tool for its psychometric validity is the Pain Attitudes and Beliefs Scale (PABS). The PABS could be a suitable instrument for examinations regarding therapist attitudes towards older pain patients by using more age-neutral wording. Concluding from the literature, an additional methodological assessment tool could be the utilization of case vignettes. However, those case vignettes, which had been used in studies in England, should be translated and culturally adapted before its application in Germany. Overall, it must be assumed that attitudes and beliefs of clinicians are also important in the care of older patients in pain. With regards to activity recommendations, ageism and the special situation of older people should also be taken into account including possible risk of falling, multimorbidity, polypharmacy, and cognitive impairment. These topics should all be considered in adapted or newly developed questionnaires for the evaluation of attitudes and beliefs of health care providers regarding back pain in older persons.

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Authors and Affiliations

  1. PhD Studentin, Department für Pflegewissenschaft, Fakultät für Gesundheit, Universität Witten/Herdecke, Stockumerstr. 12, 58453, Witten, Deutschland

    M. Laekeman

  2. Marburg, Deutschland

    C. Leonhardt

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  1. M. Laekeman
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  2. C. Leonhardt
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Correspondence to M. Laekeman.

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M. Laekeman und C. Leonhardt geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Laekeman, M., Leonhardt, C. Einstellungen und Überzeugungen von Behandlern bei älteren Patienten mit Rückenschmerzen. Schmerz 29, 362–370 (2015). https://doi.org/10.1007/s00482-015-0025-1

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