Provider-patient communication: an illustrative case report of how provider language can influence patient prognosis

Kelsey Pierce; Alyssa Troutner; Lindsay Rae; Janet Austin

Table 1

Case management over six chiropractic visits at one-week intervals.

Visit Manual Therapy Patient Education/ Home Care Advice VAS (out of 100mm) PROMIS Pain Interference 6b T-score Functional Improvements
Initial Evaluation — Reviewed past imaging findings and educated patient on unlikely correlation between these findings and his symptoms
Provided reassurance surrounding the absence of red flags or progressive neurological deficits
Educated patient on the nature of chronic low back pain
Prescribed repeated end range loading exercises 57mm 66.4
2^nd visit Spinal manipulation – due to limited response to home care Reviewed hurt versus harm concepts
Education surrounding pacing activity — — Increased tolerance to installing docks and performing work duties
3^rd visit Spinal manipulation Advice to stay active — — Increased tolerance to installing docks and performing work duties
4^th visit Spinal Manipulation Education surrounding graded activity 34mm 65.5 Increased tolerance to hunting and performing work duties
5^th visit Spinal Manipulation Patient presented wearing a lumbar support brace recently given by physiatrist, we advised limiting its use — — Successfully used pacing methods during his weekend activities
6^th visit Spinal Manipulation Education on sleep hygiene practices 15mm 56.1 Required assistance donning socks only 1 day of the week
Felt he did not need the lumbar brace between visits

VAS = Visual analog scale,
PROMIS= Patient Reported Outcomes Measurement Information System

Visit	Manual Therapy	Patient Education/ Home Care Advice	VAS (out of 100mm)	PROMIS Pain Interference 6b T-score	Functional Improvements
Initial Evaluation	—	Reviewed past imaging findings and educated patient on unlikely correlation between these findings and his symptoms Provided reassurance surrounding the absence of red flags or progressive neurological deficits Educated patient on the nature of chronic low back pain Prescribed repeated end range loading exercises	57mm	66.4
2^nd visit	Spinal manipulation – due to limited response to home care	Reviewed hurt versus harm concepts Education surrounding pacing activity	—	—	Increased tolerance to installing docks and performing work duties
3^rd visit	Spinal manipulation	Advice to stay active	—	—	Increased tolerance to installing docks and performing work duties
4^th visit	Spinal Manipulation	Education surrounding graded activity	34mm	65.5	Increased tolerance to hunting and performing work duties
5^th visit	Spinal Manipulation	Patient presented wearing a lumbar support brace recently given by physiatrist, we advised limiting its use	—	—	Successfully used pacing methods during his weekend activities
6^th visit	Spinal Manipulation	Education on sleep hygiene practices	15mm	56.1	Required assistance donning socks only 1 day of the week Felt he did not need the lumbar brace between visits