HOLES IN THE SAFETY NET: A SCOPING REVIEW OF SAFETY-NETTING ADVICE FOR PATIENTS WITH LOW BACK PAIN
Christopher Horler, V Lockley, G Leydon, L Roberts, C RyanConflicts of interest: No conflicts of interest
Sources of funding: Christopher Horler, Doctoral Clinical and Practitioner Academic Fellow, NIHR303552, is funded by Health Education England (HEE) / National Institute for Health and Care Research (NIHR) for this research project. The views expressed in this publication are those of the authors and not necessarily those of the NIHR, University of Southampton, NHS or the UK Department of Health and Social Care.
Statement of purpose of study and background
Safety-netting advice aims to empower patients to seek further medical help if their condition persists or worsens. Whilst safety-netting is recommended in national spine care pathways, limited guidance on how to communicate safety-netting advice effectively in practice may contribute to sub-optimal care and potential patient harm. Therefore, this review mapped the evidence on communicating safety-netting advice for patients with low back pain to inform best-practice guidance.
Methods
Following the Joanna Briggs Institute methodology and a published protocol, this scoping review systematically searched eight databases to identify empirical studies describing safety-netting communication for people with low back pain. Extracted data were analysed using content analysis, and nine people with lived experience of musculoskeletal care helped to interpret the findings.
Results
The fourteen studies included 1,167 participants and used qualitative interviews (n=8), interviews and focus groups (n=1), surveys (n=2), mixed methods (survey and interviews) (n=1), and data from observed practice (n=2). The findings highlight the need for clear communication of safety-netting information to help patients understand and manage their low back pain, however studies show variability and missed opportunities for providing clear safety-netting advice in practice. Furthermore, no studies explored the patients' understanding of receiving safety-netting advice, and key patient characteristics such as ethnicity were rarely reported.
Conclusion
The findings highlight the need for best-practice guidance on communicating safety-netting information for people with low back pain. Further research is needed to establish how patients interpret and ascribe meaning to safety-netting advice.