Traeger, A, Lee, H, Hubscher, M, Skinner, I, Moseley, GL, Nicholas, M, Henschke, N, Refshauge, K, Blyth, F, Main, C, Hush, J, Lo, S and McAuley, J (2019) Effect of Intensive Patient Education vs Placebo Patient Education on Outcomes in Patients With Acute Low Back Pain A Randomized Clinical Trial. JAMA Neurology, 76 (2). pp. 161-169.

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Abstract

IMPORTANCE:
Many patients with acute low back pain do not recover with basic first-line care (advice, reassurance, and simple analgesia, if necessary). It is unclear whether intensive patient education improves clinical outcomes for those patients already receiving first-line care.

OBJECTIVE:
To determine the effectiveness of intensive patient education for patients with acute low back pain.

DESIGN, SETTING, AND PARTICIPANTS:
This randomized, placebo-controlled clinical trial recruited patients from general practices, physiotherapy clinics, and a research center in Sydney, Australia, between September 10, 2013, and December 2, 2015. Trial follow-up was completed in December 17, 2016. Primary care practitioners invited 618 patients presenting with acute low back pain to participate. Researchers excluded 416 potential participants. All of the 202 eligible participants had low back pain of fewer than 6 weeks' duration and a high risk of developing chronic low back pain according to Predicting the Inception of Chronic Pain (PICKUP) Tool, a validated prognostic model. Participants were randomized in a 1: 1 ratio to either patient education or placebo patient education.

INTERVENTIONS:
All participants received recommended first-line care for acute low back pain from their usual practitioner. Participants received additional 2 x 1-hour sessions of patient education (information on pain and biopsychosocial contributors plus self-management techniques, such as remaining active and pacing) or placebo patient education (active listening, without information or advice).

MAIN OUTCOMES AND MEASURES:
The primary outcome was pain intensity (11-point numeric rating scale) at 3 months. Secondary outcomes included disability (24-point Roland Morris Disability Questionnaire) at 1 week, and at 3, 6, and 12 months.

RESULTS:
Of 202 participants randomized for the trial, the mean (SD) age of participants was 45 (14.5) years and 103 (51.0%) were female. Retention rates were greater than 90% at all time points. Intensive patient education was not more effective than placebo patient education at reducing pain intensity (3-month mean [SD] pain intensity: 2.1 [2.4] vs 2.4 [2.2]; mean difference at 3 months, -0.3 [95% CI, -1.0 to 0.3]). There was a small effect of intensive patient education on the secondary outcome of disability at 1 week (mean difference, -1.6 points on a 24-point scale [95% CI, -3.1 to -0.1]) and 3 months (mean difference, -1.7 points, [95% CI, -3.2 to -0.2]) but not at 6 or 12 months.

CONCLUSIONS AND RELEVANCE:
Adding 2 hours of patient education to recommended first-line care for patients with acute low back pain did not improve pain outcomes. Clinical guideline recommendations to provide complex and intensive support to high-risk patients with acute low back pain may have been premature.

Item Type: Article
Additional Information: This is the final published version of the article (version of record). It first appeared online via JAMA at https://jamanetwork.com/journals/jamaneurology/article-abstract/2712902?utm_campaign=articlePDF&utm_medium=articlePDFlink&utm_source=articlePDF&utm_content=jamaneurol.2018.3376 Please refer to any applicable terms of use of the publisher.
Uncontrolled Keywords: neurology, physical therapy, pain medicine
Subjects: R Medicine > R Medicine (General)
R Medicine > RA Public aspects of medicine
R Medicine > RC Internal medicine > RC346 Neurology. Diseases of the nervous system, including speech disorders
Divisions: Faculty of Medicine and Health Sciences > Primary Care Health Sciences
Depositing User: Symplectic
Date Deposited: 21 Jan 2019 10:09
Last Modified: 04 Mar 2019 11:47
URI: http://eprints.keele.ac.uk/id/eprint/5711

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