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Should we give detailed advice and information booklets to patients with back pain? A randomized controlled factorial trial of a self-management booklet and doctor advice to take exercise for back pain

Should we give detailed advice and information booklets to patients with back pain? A randomized controlled factorial trial of a self-management booklet and doctor advice to take exercise for back pain
Should we give detailed advice and information booklets to patients with back pain? A randomized controlled factorial trial of a self-management booklet and doctor advice to take exercise for back pain
Study Design: Randomized controlled factorial trial.
Objective: To assess the effectiveness of a booklet and of physician advice to take regular exercise.
Summary of Background Data: Educational booklets are one of the simplest interventions for back pain but have not been shown to alter pain and function. Although there is evidence that advice to mobilize is effective, doctors have also been advised to encourage regular exercise-but there is no evidence that such advice alone improves outcomes.
Method: Eight doctors from six practices randomized 311 patients with a new episode of back pain using sealed numbered opaque envelopes to receive a detailed self-management booklet, advice to take regular exercise, both, or neither. All groups were advised to mobilize and to use simple analgesia. Patients were telephoned during the first week after entry into the study, and after 3 weeks to assess a validated numerical pain/function score (0 = no pain normal activities to 100 = extreme pain no normal activities). Patients also returned a postal questionnaire in the first week with the Aberdeen pain and function scale, a knowledge score, and a reliable satisfaction scale (mean score of 4 items: 0 = not satisfied to 100 = extremely satisfied).
Results: Pain/function scores were obtained in 239 (77%) patients. There were interactions between exercise and booklet groups for both pain/function scores and the Aberdeen scale, which are unlikely to have been chance findings (P = 0.009 and P = 0.012, respectively). In comparison with the control group, there were reductions in the pain/function score in the first week with a booklet (-8.7, 95% CI -17.4 to -0.03) or advice to exercise (-7.9; -16.7 to 0.8) but much less effect with both together (-0.08, -9.0 to 8.9). Similarly, the Aberdeen scale was lower in the booklet group (-3.8, -7.7 to 0.07) and in the exercise advice group (-5.3; -9.3 to -1.38) but much less with both combined (-1.9, -5.8 to 2.1). There was no significant difference between groups in pain/function scores by week 3, when 58% reported being back to normal. Satisfaction was increased in booklet (7.9, 1.3 to 14.4) and exercise groups (7.4, 0.8 to 13.9)), and a booklet also increased knowledge (Kruskal-Wallis [chi]2 27.2, P = 0.001).
Conclusion: Doctors can increase satisfaction and moderately improve functional outcomes in the period immediately after the consultation when back pain is worst, by using very simple interventions: either by endorsing a self-management booklet or by giving advice to take exercise. Previous studies suggest that simple advice and the same written information provide reinforcement. This study supports evidence that it may not be helpful to provide a detailed information booklet and advice together, where the amounts or formats of information differ.
0362-2436
2065-2072
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Roberts, Lisa
0a937943-5246-4877-bd6b-4dcd172b5cd0
Blowers, Helen
529287ca-db16-4a1c-ac56-beacd53fe793
Garwood, Judit
1a173bd1-f8a0-486d-95f5-163103917303
Cantrell, Ted
0c457b2d-337e-4c67-b299-65afb306ab57
Langridge, John
0047cb1c-cf4f-4c26-b094-0299015bcea5
Chapman, Judith
0859875d-96c7-4015-b830-6f7f9783fb16
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Roberts, Lisa
0a937943-5246-4877-bd6b-4dcd172b5cd0
Blowers, Helen
529287ca-db16-4a1c-ac56-beacd53fe793
Garwood, Judit
1a173bd1-f8a0-486d-95f5-163103917303
Cantrell, Ted
0c457b2d-337e-4c67-b299-65afb306ab57
Langridge, John
0047cb1c-cf4f-4c26-b094-0299015bcea5
Chapman, Judith
0859875d-96c7-4015-b830-6f7f9783fb16

Little, Paul, Roberts, Lisa, Blowers, Helen, Garwood, Judit, Cantrell, Ted, Langridge, John and Chapman, Judith (2001) Should we give detailed advice and information booklets to patients with back pain? A randomized controlled factorial trial of a self-management booklet and doctor advice to take exercise for back pain. Spine, 26 (19), 2065-2072. (doi:10.1097/00007632-200110010-00003).

Record type: Article

Abstract

Study Design: Randomized controlled factorial trial.
Objective: To assess the effectiveness of a booklet and of physician advice to take regular exercise.
Summary of Background Data: Educational booklets are one of the simplest interventions for back pain but have not been shown to alter pain and function. Although there is evidence that advice to mobilize is effective, doctors have also been advised to encourage regular exercise-but there is no evidence that such advice alone improves outcomes.
Method: Eight doctors from six practices randomized 311 patients with a new episode of back pain using sealed numbered opaque envelopes to receive a detailed self-management booklet, advice to take regular exercise, both, or neither. All groups were advised to mobilize and to use simple analgesia. Patients were telephoned during the first week after entry into the study, and after 3 weeks to assess a validated numerical pain/function score (0 = no pain normal activities to 100 = extreme pain no normal activities). Patients also returned a postal questionnaire in the first week with the Aberdeen pain and function scale, a knowledge score, and a reliable satisfaction scale (mean score of 4 items: 0 = not satisfied to 100 = extremely satisfied).
Results: Pain/function scores were obtained in 239 (77%) patients. There were interactions between exercise and booklet groups for both pain/function scores and the Aberdeen scale, which are unlikely to have been chance findings (P = 0.009 and P = 0.012, respectively). In comparison with the control group, there were reductions in the pain/function score in the first week with a booklet (-8.7, 95% CI -17.4 to -0.03) or advice to exercise (-7.9; -16.7 to 0.8) but much less effect with both together (-0.08, -9.0 to 8.9). Similarly, the Aberdeen scale was lower in the booklet group (-3.8, -7.7 to 0.07) and in the exercise advice group (-5.3; -9.3 to -1.38) but much less with both combined (-1.9, -5.8 to 2.1). There was no significant difference between groups in pain/function scores by week 3, when 58% reported being back to normal. Satisfaction was increased in booklet (7.9, 1.3 to 14.4) and exercise groups (7.4, 0.8 to 13.9)), and a booklet also increased knowledge (Kruskal-Wallis [chi]2 27.2, P = 0.001).
Conclusion: Doctors can increase satisfaction and moderately improve functional outcomes in the period immediately after the consultation when back pain is worst, by using very simple interventions: either by endorsing a self-management booklet or by giving advice to take exercise. Previous studies suggest that simple advice and the same written information provide reinforcement. This study supports evidence that it may not be helpful to provide a detailed information booklet and advice together, where the amounts or formats of information differ.

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Published date: 1 October 2001

Identifiers

Local EPrints ID: 24388
URI: http://eprints.soton.ac.uk/id/eprint/24388
ISSN: 0362-2436
PURE UUID: 517ab1e2-9a6f-4b64-b3f4-bb3f1778aed5
ORCID for Lisa Roberts: ORCID iD orcid.org/0000-0003-2662-6696

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Date deposited: 31 Mar 2006
Last modified: 16 Mar 2024 02:54

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Contributors

Author: Paul Little
Author: Lisa Roberts ORCID iD
Author: Helen Blowers
Author: Judit Garwood
Author: Ted Cantrell
Author: John Langridge
Author: Judith Chapman

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