Health Literacy and Health Outcomes in Patients with Back Pain – A Scoping Review

Abstract

BACKGROUND: The World Health Organisation highlights back pain as a leading and growing cause of disability worldwide. In the field of chronic pain, higher health literacy is linked to lower pain intensity and better pain control. However, there remains a paucity of evidence, with a recent systematic review finding only three studies meeting its inclusion criteria. OBJECTIVES: This scoping review had two objectives in exploring research in chronic pain, which were to identify:1) The health literacy measures currently employed. 2) The back-pain health outcomes included in such work and the extent to which these reflect the core outcome set for clinical trials in non-specific low back pain.METHODS: The search broadened the search strategy used in the systematic review. It was conducted using thirteen bibliographic databases, employing medical subject heading (MeSH) terms for back pain and health literacy, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. A thematic framework approach was used for analysis.RESULTS: The search yielded ten relevant studies for inclusion, amongst which a total of nine health literacy measures and 50 health outcome measures were used. The health outcomes assessed by the included studies could be broadly categorised into: Pain, Disability, Behaviour, Knowledge and Beliefs, and Resource Utilisation. Most outcome measures employed (36 out of 50) were not directly relevant to addressing the core outcome set for clinical trials in non-specific low back pain.CONCLUSIONS: A dearth of studies in this field of research was noted, especially in Asia and low-middle income countries. Methodological limitations were identified, including in study design and outcome measures. To allow for comparison across findings and the development of a rigorous evidence base, future work should include the core outcome set for clinical trials in non-specific low back pain. Furthermore, research thus far has focused on a narrow range of populations and there is an urgent need to broaden the evidence-base to include those with characteristics known to be moderators in health outcomes. Such work demands the incorporation of comprehensive measures of health literacy that have both generic and culturally sensitive components.