Research On The Construction Of Background Factors In TCM Clinical Research On Chronic Low Back Pai

Background:Chronic low back pain is a global multiple disease,which causes a serious burden on the physical,psychological and social life of patients,and has a very important clinical and economic impact.Studies have shown that in chronic diseases,when pain persists beyond the normal healing time,patients are simultaneously exposed to different physical,psychological and social factors,known as "background factors",and when patients respond positively to background factors,they can trigger expectations,memories and emotions,which in turn affect health-related outcomes,resulting in placebo or nocebo effects.As a disease with multidimensional characteristics,chronic low back pain is in great need of a comprehensive and personalized treatment,and the study of background factors and their conscious use and integration in clinical practice may be a new way to manage chronic low back pain.Objective:This study aims to explore and summarize the non-interventional factors(Contextual Factors)affecting the treatment of chronic low back pain,and construct a framework of background factors for chronic low back pain in clinical practice.Method:This study adopts the method of hybrid research,which includes the following three aspects:1)Based on the qualitative research of the background factor framework of chronic low back pain,the non-intervention factors affecting the treatment of chronic low back pain are explored,and the corresponding background factor concept is summarized.The databases PubMed,EMbase,Web of Science,SINOMED,China Journals Full-text Database(CNKI),Weipu Chinese Scientific and Technical Journals Database(VIP),WanFang Database(WanFang Data)were searched from January 2001 to December 2021,after literature quality evaluation using the criteria for qualitative research quality evaluation of the JBI Center for Evidence-Based Health Care in Australia.The thematic synthesis method was used to analyze the research results and construct a framework of background factors.2)In order to have a more direct understanding of the background factors affecting the clinical treatment of chronic low back pain,this study conducted semi-structured interviews with patients based on the interview outline,understood the patient’s treatment process and life experience and experience after the appearance of symptoms,and improved the background factor framework of chronic low back pain centered on the patient’s perspective based on the framework of inductive background factors,3)Based on the literature research of chronic low back pain in the previous period,combined with the results of semi-structured interviews of the research group,this study formed a background factor framework entry pool,collected the views of clinical experts in the field of chronic low back pain on non-interventional factors through the Delphi questionnaire,clarified the non-intervention factors affecting the treatment of chronic low back pain,and summarized them into the corresponding concept of background factors,and finally constructed a framework of background factors affecting chronic low back pain.Results:1)A total of 32 articles were included,and 5 themes and 33 sub-themes were summarized:social factors(social background,medical and health policies,family factors,medical resources),situational factors(environmental factors,doctor-patient relationship,time cost),doctor factors(whether the doctor’s diagnosis and treatment skills are superb,whether the doctor’s attitude is amiable,whether the doctor’s clothes are clean and tidy,whether the doctor can carry out psychological intervention on the patient,the doctor’s expectation of the treatment of the disease,Whether doctors can effectively educate patients and doctors’ clinical experience),patient factors(psychological factors,health literacy,basic information)and disease factors(risk factors,length of disease).2)Patient interview includes 5 main categories and 13 sub-categories:doctor factors(doctor technology,doctor attitude,psychological intervention),patient factors(psychological factors),situational factors(treatment environment,doctor-patient relationship,time cost),social factors(medical system,social background,economic factors,family relationships,medical resources)and disease factors(risk factors).3)After two rounds of consultation,the Delphi expert meeting finally constructed the background factor framework of chronic low back pain from the three dimensions of "environment","person" and "disease",including 5 first-level items,14 second-level items and 9 third-level items:social factors(economic factors,family relationships,medical resources),situational factors(doctor-patient relationship),doctor’s factors(whether the doctor’s diagnosis and treatment skills are superb,whether the doctor’s attitude is amiable,whether the doctor’s treatment is attentive to excellence,Whether doctors can provide psychological intervention to patients,doctors’ expectations for the treatment of diseases,whether doctors can effectively educate patients and doctors’ clinical experience),patient factors(psychological factors,health literacy)and disease factors(risk factors,length of disease).Among them,15 items were judged to be "very important",namely,economic factors,medical resources,doctor-patient relationship,whether the doctor’s diagnosis and treatment skills are superb,whether the doctor is dedicated to improving in treatment,whether the doctor can carry out psychological intervention on the patient,the doctor’s expectation of the treatment of the disease,whether the doctor can effectively educate the patient,the doctor’s clinical experience,patient factors,disease factors,risk factors(obesity,heavy lifting,abnormal posture);The eight items judged to be "important" were family factors(family relationships),whether the doctor’s attitude was amiable,psychological factors,health literacy,length of illness,sedentary time,and appropriate exercise;No entry was judged to be"extremely important".Conclusion:The Contextual Factors of chronic low back pain include 5 major influencing factors and 23 specific items,namely doctor factors,patient factors,situational factors,social factors and disease factors.There are differences in the focus of doctors and patients on background factors,with doctors placing more emphasis on disease factors and patients paying more attention to situational and social factors.However,both sides emphasized the main role of doctors in the treatment process,as well as doctor-patient communication,psychological factors,etc.Under the premise of protecting the doctor’s technology,if the patient’s experience can be improved,it will be more conducive to the relief of symptoms of patients with chronic low back pain.