Journal of primary health care
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Multicenter Study
Outcomes of an interdisciplinary rehabilitation programme for the management of chronic low back pain.
The health and economic costs associated with chronic low back pain (CLBP) have increased substantially over the past few decades. Despite extensive research, a consistently valid, reliable and effective diagnostic and treatment regime for CLBP is yet to be determined. ⋯ The routine measurement of symptomatic, functional and vocational outcomes throughout the rehabilitation process can assist in quantifying the effect of treatment and providing evidence of value for patients, stakeholders and funding groups.
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The 'four principle' view of medical ethics has a strong international pedigree. Despite wide acceptance, there is controversy about the meaning and use of the principles in clinical practice as a checklist for moral behaviour. Recent attempts by medical regulatory authorities to use the four principles to judge medical practitioner behaviour have not met with success in clarifying how these principles can be incorporated into a legal framework. ⋯ Difficulties with the application of the four principles (autonomy, beneficence, nonmaleficence and justice) to judge medical practitioner behaviour are highlighted. The four principles are relevant to medical practitioner behaviour, but if applied as justifications for disciplinary decisions without explanation, perverse results may ensue. Solutions are suggested to minimise ambiguities in the application of the four principles: adjudicators should acknowledge the difference between professional and common morality and the statutory requirement to give decisions with reasons.