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Patients’ Attitudes Toward Nonphysician Screening of Low Back and Low Back Related Leg Pain Complaints Referred for Surgical Assessment

Rempel, Joshua BHSc; Busse, Jason W. DC, PhD; Drew, Brian MD, FRCSC; Reddy, Kesava MBBS, FRCSC; Cenic, Aleksa MD, FRCSC; Kachur, Edward MD, FRCSC; Murty, Naresh MD, FRCSC; Candelaria, Henry BPHE, DC; Moore, Ainsley E. MSc, MD, CCFP; Riva, John J. DC, MSc

doi: 10.1097/BRS.0000000000001764
Health Services Research

Study Design. A questionnaire survey.

Objective. The aim of this study was to explore patient attitudes toward screening to assess suitability for low back surgery by nonphysician health care providers.

Summary of Background Data. Canadian spine surgeons have shown support for nonphysician screening to assess and triage patients with low back pain and low back related leg pain. However, patients’ attitudes toward this proposed model are largely unknown.

Methods. We administered a 19-item cross-sectional survey to adults with low back and/or low back related leg pain who were referred for elective surgical assessment at one of five spine surgeons’ clinics in Hamilton, Ontario, Canada. The survey inquired about demographics, expectations regarding wait time for surgical consultation, as well as willingness to pay, travel, and be screened by nonphysician health care providers.

Results. Eighty low back patients completed our survey, for a response rate of 86.0% (80 of 93). Most respondents (72.5%; 58 of 80) expected to be seen by a surgeon within 3 months of referral, and 88.8% (71 of 80) indicated willingness to undergo screening with a nonphysician health care provider to establish whether they were potentially a surgical candidate. Half of respondents (40 of 80) were willing to travel >50 km for assessment by a nonphysician health care provider, and 46.2% were willing to pay out-of-pocket (25.6% were unsure). However, most respondents (70.0%; 56 of 80) would still want to see a surgeon if they were ruled out as a surgical candidate, and written comments from respondents revealed concern regarding agreement between surgeons’ and nonphysicians’ determination of surgical candidates.

Conclusion. Patients referred for surgical consultation for low back or low back related leg pain are largely willing to accept screening by nonphysician health care providers. Future research should explore the concordance of screening results between surgeon and nonphysician health care providers.

Level of Evidence: 3

Supplemental Digital Content is available in the text

*Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada

Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada

Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada

§Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada

Department of Surgery, Division of Orthopedic Surgery, McMaster University, Hamilton, Ontario, Canada

||Department of Surgery, Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada

**University Health Network, Toronto, Ontario, Canada

††Oakville Trafalgar Memorial Hospital, Oakville, Ontario, Canada

‡‡Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada.

Address correspondence and reprint requests to Joshua Rempel, BHSc, Michael G. DeGroote School of Medicine – Niagara Regional Campus, Cairns Family Health and Bioscience Research Complex, 1812 Sir Isaac Brock Way, St. Catharines, ON L2S 3A1. E-mail:

Received 9 February, 2016

Revised 18 April, 2016

Accepted 10 June, 2016

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: board membership, grants.

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