We thank Dr Hopayian for his interest and comments regarding our publication. Our review captured the available data on patients’ perspectives regarding health information needs related to low back pain (LBP). Synthesising patients’ reported needs and barriers to optimal care delivery enables patient-centred changes in service models to be considered. In the example of inappropriate imaging, we agree with Dr Hopayian and the existing literature that both patient-related and clinician-related factors are important and need to change, 1 whilst also considering broader organisational-level and system-level factors that influence the choice to undertake imaging. 2,3 Patients’ beliefs and expectations, one of the factors driving this practice, can be addressed in part by clinician education. While education alone may shift practice behaviours,2 empowering clinicians to better explain back pain, coupled with other practice supports (eg, referral networks, appropriate self-management resources) to reduce the role of imaging, is one of the approaches that we advocate as necessary. The perceived need for imaging (regardless of its appropriateness) to quench the desire for precise accurate LBP diagnosis in this group of patients was highlighted in our study.4 The issue of clinicians’ lack of knowledge regarding high-value LBP care has been identified as a problem internationally.1,5 Many clinicians report being inadequately trained in managing chronic musculoskeletal pain conditions.1,5 This deficiency may be reflected back to the patient, resulting in vague answers and poor explanations of non-specific LBP, leading to patients feeling ‘delegitimised’ and ‘disempowered’. 4 Lack of knowledge may also contribute to inconsistent advice from different clinicians, compounding the problem, and has also been identified as an area of health information need by patients with LBP. 4 To address these issues, clinicians require better education regarding the management of LBP along with system-level and service-level supports to enable delivery of high-value care for LBP.