{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T01:03:29Z","timestamp":1785805409898,"version":"3.56.0"},"reference-count":40,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2021,9,16]],"date-time":"2021-09-16T00:00:00Z","timestamp":1631750400000},"content-version":"unspecified","delay-in-days":15,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100011713","name":"EUROSPINE","doi-asserted-by":"publisher","award":["TFR2019-2"],"award-info":[{"award-number":["TFR2019-2"]}],"id":[{"id":"10.13039\/501100011713","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2021,9,2]]},"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aimed to explore the perceptions of orthopaedic clinicians about consultations for people with persistent musculoskeletal low back pain (PMLBP) in which surgery is not recommended. Surgery is not recommended for the majority of PMLBP consulting in secondary care settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Secondary care sector in the UK.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Semi-structured qualitative interviews were conducted with 24 orthopaedic team clinicians from 17 different hospitals in the UK and Ireland. Interviews explored clinicians\u2019 perceptions of the challenges in consultations where surgery is not indicated. Interviews were transcribed verbatim and analysed using thematic analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Two meta-themes, Difficulties and Enablers, each consisting of several subthemes were identified. Difficulties included challenges around the choice of appropriate terminology and labels for PMLBP, managing patients\u2019 expectations, working with mentally vulnerable patients and explaining imaging findings. Enablers included early management of expectations, use of routine imaging, triaging, access to direct referral elsewhere, including other non-surgical practitioners in the team, training to improve communication skills and understanding of psychological issues.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The findings highlight clinicians\u2019 perceived need for concordance in messages delivered across the care pathway and training of orthopaedic clinicians to deliver effective reassurance and address patients\u2019 needs in circumstances where surgery is not indicated.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2021-052938","type":"journal-article","created":{"date-parts":[[2021,9,16]],"date-time":"2021-09-16T12:57:11Z","timestamp":1631797031000},"page":"e052938","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Taking patients to the ice cream shop but telling them that they cannot have ice cream: a qualitative study of orthopaedic spine clinicians\u2019 perceptions of persistent low back pain consultations"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9880-8686","authenticated-orcid":false,"given":"Kathrin Louise","family":"Braeuninger-Weimer","sequence":"first","affiliation":[{"name":"Psychology, Royal Holloway University of London, Egham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naffis","family":"Anjarwalla","sequence":"additional","affiliation":[{"name":"Orthopaedic, Wexham Park Hospital, Slough, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alison H","family":"McGregor","sequence":"additional","affiliation":[{"name":"Department of Surgery and Cancer, Imperial College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2662-6696","authenticated-orcid":false,"given":"Lisa","family":"Roberts","sequence":"additional","affiliation":[{"name":"Health Sciences, University of Southampton, Southampton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip","family":"Sell","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Leicester University Hospitals, Leicester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamar","family":"Pincus","sequence":"additional","affiliation":[{"name":"Department of Psychology, University of London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,9,16]]},"reference":[{"key":"2025120523345828000_11.9.e052938.1","doi-asserted-by":"crossref","first-page":"2368","DOI":"10.1016\/S0140-6736(18)30489-6","article-title":"Prevention and treatment of low back pain: evidence, challenges, and promising directions","volume":"391","author":"Foster","year":"2018","journal-title":"The Lancet"},{"key":"2025120523345828000_11.9.e052938.2","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1007\/s00586-002-0493-8","article-title":"Complications in lumbar fusion surgery for chronic low back pain: comparison of three surgical techniques used in a prospective randomized study. 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