Testing a model of consultation-based reassurance and back pain outcomes with psychological risk as a moderator: A prospective cohort study.

Nicola Holt, Gemma Mansell, Jonathan Hill, Tamar Pincus

Research output: Contribution to journalArticlepeer-review


Objectives: Reassurance is an essential part of treatment for low back pain (LBP), but evidence on effective methods to deliver reassurance remains scarce. The interaction between consultation-based reassurance and patients’ psychological risk is unknown. Our objective was to investigate the relationship between consultation-based reassurance and clinical outcomes at follow-up, in people with and without psychological risk.

Methods: We tested the associations between specific reassurance components (data gathering, relationship building, generic reassurance, and cognitive reassurance), patients’ psychological risk (the presence of depression, anxiety, catastrophizing, or fear-avoidance), and postconsultation outcomes including, satisfaction and enablement, disability, pain, and mood at 3-month follow-up.

Results: Adjusted linear regression models using data from patients who had recently consulted for LBP in primary care (n=142 in 43 practices) indicated that all reassurance components were strongly associated with increased satisfaction, whereas generic reassurance was significantly associated with postconsultation enablement. Generic reassurance was also associated with lower pain at 3 months, whereas cognitive reassurance was associated with increased pain. A significant interaction was observed between generic reassurance and psychological risk for depression at 3 months: high rates of generic reassurance were associated with lower depression in low-risk patients, but with higher rates of depression for high-risk groups.

Discussion: The findings support the hypothesis that different components of reassurance are associated with specific outcomes, and that psychological risk moderates this relationship for depression. Clinicians reassuring behaviors might therefore have the potential to improve outcomes in people with LBP, especially for patients with higher psychological risk profiles.
Original languageEnglish
Pages (from-to)339-348
JournalClinical Journal of Pain
Issue number4
Publication statusPublished - 1 Apr 2018

Bibliographical note

© 2017 The Author(s). Published by Wolters Kluwer Health,
Inc. This is an open access article distributed under the Creative
Commons Attribution License 4.0 (CCBY), which permits unrestricted
use, distribution, and reproduction in any medium, provided the original
work is properly cited.


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