Low Back Pain: A Review of Social Security Data; GP, Public and Patient Beliefs in Jersey

This research aimed to investigate the attitudes and beliefs of Jersey’s general population, GPs and patients towards LBP and its management. Trends of sickness certification for LBP for the entire registered working population of Jersey were also investigated. From 1994 to 2003 Incapacity Benefit costs rose sharply (153.4% Long-term Incapacity Benefits (LTI); 76.99% Short-term Incapacity Benefits (STI) and are discussed in relation to changes seen in certification for LBP and other symptom dominated conditions. Investigation of the working population’s attitudes and beliefs revealed that educational attainment was the best single predictor of beliefs about LBP held by those currently suffering with the condition; with those reporting the lowest educational attainment also reporting the most negative beliefs. The internal consistency and test-retest reliability of the Pain Attitudes and Beliefs Scale (PABS) when used with GPs was examined. The measure was found to have adequate internal consistency, test-retest reliability and sensitivity to change. It was subsequently used alongside sickness certification data to determine if GP attitudes and beliefs about LBP influenced their decisions with regard to sick listing LBP patients. Neither PABS factor was able to add to the prediction of numbers of certificates issued; however general propensity to issue sickness certificates did. When combining patient and GP factors a clear interaction was found in relation to prediction of sick-listing for LBP. For the patient, previous absenting with LBP was a risk for future sickness certification; as was high fear avoidance of work. The biopsychosocial orientation of GPs also added to our prediction model and appeared to reduce the likelihood of sick-listing. These findings have implications for current clinical management of LBP. Finally, changes in trends of sickness certification are discussed in relation to both the research work conducted as well as specific service provision changes implemented.