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Exit Survey
 
 
Case Histories
In the following pages, you will be presented with a series of 40 cases of men suffering from chronic lower back pain (CLBP). All patients are:
• Aged between 49 and 55,
• Are married with children (aged between 10 – 16 years) ; and are
• Currently on GP certified sick-leave from work, due to a CLBP flare-up that has lasted the past 3 weeks. This flare-up is self-described as particularly bad. Self-reported pain varies from 6 to 8 on a 10-point scale.
• All patients work in supervisory roles in production settings in multi-national companies, with some duties including minor physical exertion.
On average, each patient visits their GP four times per annum due to CLBP that emerged approximately 10 years ago. No definitive cause for CLBP is apparent in any case. There was no evidence of structural problems in x-rays taken 4 years ago and earlier this year.
Each patient has been prescribed the following only: anti-inflammatories (e.g., Difene 50-100mg bd), and non-opiate analgesics (e.g., paracetamol 500-1000mg qid, Tramadol 50mg prn). Patients have been compliant with medications and have attended physiotherapy several times, though have not been consistent in exercise.
All patients previously reported worry that pain levels will increase and fear painful movement. Patients are not happy at times with medical care. All patients were previously active and are social drinkers only (i.e. no indication of abuse). Their mood is low at times, but not diagnosed as clinically depressed.
Instructions
Please put yourself in the position of the GP for these 40 consultations today. For each case, you will be asked to judge the patient’s Risk of Future Disability. Take this to refer to:
The potential for significant work disability 9 months from now, i.e. impeding the person from remaining in their current job if the job responsibilities were to remain the same as present.
Please make your judgment of future risk of disability by rating the case on a Probability Scale of 1-10 (1 = 10% chance of Disability in 9 months, through to 10 = 100% change of Disability in 9 months).
For each case, base your judgment of Risk of Future Disability on the six case factors provided. Each patient represents a unique combination of the case factors of Mobility, Sleep, Motivation, Self-Esteem, Close Relationships, and Social Activity. The definitions of each case factor below is accompanied by illustrative examples.
Low scores on a case factor represents a low problem level on that factor. High scores represent a high problem level on that factor. Assume the information in the case factors has been obtained in the consultation.