P28S02: Acute low-back
pain
Bottom line: Information on acute low-back
pain was used to
justify the management of a patient (use the right management for acute mechanical
back pain). It contributed to increase patient knowledge, to avoid inappropriate
procedures, to prevent health deterioration and to improve health.
Level 1 outcome (situational relevance): On December 15, 2008, P28 did a search at work, by themselves, and
during an encounter with a patient. P28 left the examination room, retrieved
two information hits about acute low-back
pain, and went back to the room. The reported search objective was: to address a clinical question.He [the patient, a man in his forties] came in, I
think he had bent over or done something funny with his back. So I wanted to
look up [
] things [
] regarding the appropriate management [
] of low-back pain, [
] because I
didnt want to just give him some Tylenol or Advil and send him home. I wanted
to kind of get a diagnosis. So I went to e-Therapeutics and I found the table
that was really helpful because it helped guide my history and physical
examination, and then, I used the green [highlight] for my management. According to P28, e-Therapeutics+ was in agreement with and equally
relevant as the information from another electronic resource (Up-to-Date).
Level 2 outcome (cognitive impact): Two hit were associated with a report of
positive cognitive impact (see table). Regarding practice improvement and learning, P28 stated: I feel more comfortable after reading that,
about how to approach a low-back pain. I have certain questions in mind or
certain kind of red flag symptoms that make me more or less worried of a
patient with back pain. [
] Before reading the article, I just kind of
lumped back pain into back pain. I didnt really have much of a differential
for it or what to look out for, but after reading the article I think I learned
a bit about how to approach it. Regarding motivation, confirmation, reassurance and reminder, P28
stated: I later did a
presentation on lower back pain for some colleagues [
] where we do a
presentation on something clinical. [
] The search triggered my [motivation to
learn more about low back pain to do my] presentation. [
] I knew previously that for acute mechanical
back pain, bed rest is not favorable to [get] good outcomes. [
] Its always
reassuring to see something that you know [
] in writing. [
] That was just something that I had learned previously
during medical school.
Retrieved
information hits:
1)
e-Therapeutics+ (CIRT): eTherapeutics Tab Keyword: Back pain Low back pain Acute low-back
pain Table 1 (P28S02H01)
2)
e-Therapeutics+ (CIRT): eTherapeutics Tab Keyword: Back pain Low back pain Acute low-back
pain Highlight (P28S02H02)
Level 3 outcome
(information use): Information on acute low-back pain was retrieved, and used to better
understand a specific issue with respect to the management of the patient, and to
justify the management of a patient (information used as presented in
e-Therapeutics+). After I reviewed Table 1, I went back and did
a more thorough examination of the patient to look for any red flags and also
ask some trigger questions like did he have a fever, previous history of
cancer, etc. When he replied no to all of those, I made the diagnosis of acute
mechanical back pain, because I was reassured that there wasnt anything more
serious going on. I gave him some analgesics as well as told him to try and
stay active, and I think I made a referral for physiotherapy. [
] So, I guess
the particular issue that I tried to understand was whether it was acute
mechanical low-back pain versus something more serious like nerve entrapment,
sciatica, etc. [
] I had already a grasp on how to manage acute
mechanical low-back pain, [
] the green highlight[justified
that] I was doing the right thing.
Level 4 outcome (patient health): Regarding patient
health, P28 reported that the information contributed to increase patient
knowledge, to avoid inappropriate procedures, to prevent health deterioration
and to improve health. I essentially told the patient that I was
comfortable sending him home with analgesia and physiotherapy, because I didnt
feel that he had anything more serious going on. I explained my reasoning and
the other diagnoses that were presented in Table 1, and he [
] comply with my
suggestions. [
] I wouldnt have run him through X-rays, MRIs
you know
there are different things that you do by getting a good history and
physical guided through the information that e-Therapeutics provided, they
would save him that, and just reassure him. [
] By telling him to remain active versus just
going with bed rest I think it made it less likely to develop into a chronic
back pain patient. [
] I improved his functioning by applying the
therapeutic option which was to remain active with physiotherapy and analgesia.
[
] I did have a follow-up with him actually and
his back pain was still present, but improved. He was managing well with the
pain medications that I gave him.
Levels of outcome of information-seeking
|
Situational relevance |
Positive cognitive
impact |
Information use |
Patient health |
|
Address a clinical question Fulfill educational objective |
Practice improved Learned something Reminded something Motivated to learn Confirmed Reassured |
Justify choice Understand issue |
Improve Prevent Avoid Patient knowledge |