A quasi-randomised, controlled, feasibility trial of GLITtER (Green Light Imaging Interpretation to Enhance Recovery)—a psychoeducational intervention for adults with low back pain attending secondary care

Abstract

BackgroundAlthough it is broadly accepted that clinicians should endeavour to reassure patients with low back pain, to do so can present a significant clinical challenge. Guidance for how to provide effective reassurance is scarce and there may be a need to counter patient concerns arising from misinterpretation of spinal imaging findings. ‘GLITtER’ (Green Light Imaging Intervention to Enhance Recovery) was developed as a standardised method of communicating imaging findings in a manner that is reassuring and promotes engagement in an active recovery. This feasibility study is an important step towards definitive testing of its effect.MethodsThis feasibility study was a prospective, quasi-randomised, parallel trial with longitudinal follow-up, involving sampling of patients attending a spinal outpatient clinic at a metropolitan hospital. English speaking adults (18–75 years) presenting to the clinic with low back pain and prior spinal imaging were considered for inclusion. Eligible patients were allocated to receive a GLITtER consultation or a standard consultation (as determined by appointment scheduling and clinician availability), and were blinded to their allocation. Full details of the GLITtER intervention are described in accordance with the Tidier template.Follow-up data were collected after 1 and 3 months. The primary outcome of this study was the fulfillment of specific feasibility criteria which were established a priori. Determination of a sample size for a definitive randomised controlled trial was a secondary objective.ResultsTwo hundred seventy-six patients underwent preliminary screening and 31 patients met the final eligibility criteria for study inclusion. Seventeen participants were allocated to the intervention group and 14 were allocated to the control group. Three month follow-up data were available from 42% of the 31 enrolled participants (N = 13, six intervention, seven control). Feasibility indicators for consent, resource burden and acceptability of the GLITtER intervention were met, however participant recruitment was slower than anticipated and an acceptable follow-up rate was not achieved.Conclusions Failure to achieve pre-specified recruitment and follow-up rates were important outcomes of this feasibility study. We attribute failure to issues that are likely to be relevant for other clinical trials with this population. It is realistic to consider that these challenges can be overcome through careful strategy, ample funding and continued partnership with health care providers.Trial registrationThe trial was registered on the Australian and New Zealand Clinical Trials Registry on 28/2/2017 (ACTRN12617000317392).

Implementing high value back pain care in private physiotherapy in Australia: A qualitative evaluation of physiotherapists who participated in an “implementation to innovation” system

“…The most notable change to practice was the reported improvements and fluency in communicating and educating patients about contemporary pain science and its application within a private physiotherapy practice context. The key factors that resonated well with participants were the structured and systematic approaches (clinical pathway, MyBack) 31 ; access to, training in, and implementation of a range of practical tools (GLITtER, 34,35 Explain Pain, 32 and Explain Pain Supercharged 33 ); and experiential learning (practical application of skills, simulations, and discussion forums). Our findings are consistent with literature on effective components of quality improvement interventions; for example, skills training via simulation and observation, data feedback on performance, mentoring and peer support, and the use of structured clinical pathways and tools.…”

“…The book can be lent to patients to read through with carers/significant others Explain Pain Supercharged 33 A clinician’s guide for the content presented in the patient resource. Includes a guide to a pain assessment “cheat sheet”; planning conceptual change strategies; multiple examples of how to offer new concepts, engineer new experiences consistent with new concepts, and use resources that corroborate new concepts GLITtER patient resources 34 , 35 A 4-week patient guide that includes a framework for talking about common radiological findings in a manner that aims to reassure patients and promote activity The Explain Pain Handbook: Protectometer 36 A patient workbook integrated into care according to the cheat sheet findings BackTracker A bespoke tool to assist clinicians and patients to determine “normal” or “average” expected recovery rates. Can be used to guide reassurance and evidence-based escalation Tamethebeast.org An online resource that patients can read in their own time.…”

“…The book can be lent to patients to read through with carers/significant others Explain Pain Supercharged 33 A clinician's guide for the content presented in the patient resource. Includes a guide to a pain assessment "cheat sheet"; planning conceptual change strategies; multiple examples of how to offer new concepts, engineer new experiences consistent with new concepts, and use resources that corroborate new concepts GLITtER patient resources 34,35 A 4-week patient guide that includes a framework for talking about common radiological findings in a manner that aims to reassure patients and promote activity The Explain Pain Handbook:…”

Identifying psychosocial characteristics that predict outcome to the UPLIFT programme for people with persistent back pain: protocol for a prospective cohort study

“…People with LBP referred to specialist secondary healthcare services present with increased pain intensity, reduced function and higher rates of poor prognosis than patients presenting to primary healthcare services 15 53. Before reaching the secondary care service, the vast majority of patients with LBP have already failed a course of conservative treatment 10.…”

“…Before reaching the secondary care service, the vast majority of patients with LBP have already failed a course of conservative treatment 10. Secondary healthcare clinicians are then faced with the challenge of providing time and cost-efficient, evidence-based interventions for this population group 53. A recent review highlighted that research aiming to reveal factors that identify responders in secondary healthcare is lacking 4.…”