The Back Home Trial

Abstract

Study Design. A single-blind randomized controlled trial of a leaflet developed for people with acute low back pain was compared with the usual general practitioner management of back pain.Objective. To test the effectiveness of a patient information leaflet on knowledge, attitude, behavior, and function.Summary of Background Data. Despite the commonality of back pain in general practice, little evidence on the effectiveness of simple interventions such as leaflets and advice on self-management has been reported. On the basis of a five-stage needs analysis, a simple leaflet was developed that considered the views of patients and health professionals.Methods. For this study, 64 patients with acute back pain were assigned to the leaflet or control group. The participants were visited at home after 2 days, 2 weeks, then 3, 6, and 12 months, where they completed a range of self-report measures. Behavioral aspects were discreetly recorded by a "blinded" researcher. Primary outcomes were knowledge, attitude, behavior, and function.Results. In all, 272 home visits were undertaken. The findings show that at 2 weeks, knowledge about sitting posture was greater in the leaflet group (P ϭ 0.006), which transferred to a behavioral difference (sitting with lumbar lordosis support) when participants were unaware that they were being observed (P ϭ 0.009). This difference remained significant at 3 months. Patients in the leaflet group also were better at maintaining a wide base of support when lifting a light object than the control subjects throughout all five assessments. There were no significant differences in the functional outcomes tested.Conclusions. This trial demonstrates that written advice for patients can be a contributory factor in the initial general practitioner consultation because it may change aspects of knowledge and behavior. This has implications for the management of acute back pain, with potential health gain.

Effect of a Simple Information Booklet on Pain Persistence after an Acute Episode of Low Back Pain: A Non-Randomized Trial in a Primary Care Setting

“…Previous studies have demonstrated a positive impact of such books for patients [7] or physicians [36] in terms of beliefs about LBP, patients' satisfaction with information [23], [24], patients' knowledge about LBP [25], and number of visits to GPs [37]. However, we failed to demonstrate any effect of the book on disability and pain level in patients reporting persistent pain and, as others, on work absenteeism [29].…”

“…Several guidelines and reviews on the management of acute LBP and cLBP in primary care practice are available [8]–[25]. They mainly concern prescriptions for X-rays and laboratory tests, treatment options, and information about physical and occupational activities.…”

“…Exercises, education about back pain, behavioural treatment and multidisciplinary treatment seem effective in preventing persistent/chronic LBP. Concerning information given to patients, evidence suggests that advice about staying active and coping with pain could decrease the rate of patients experiencing chronic pain and the impact of LBP on daily and occupational activities [23]–[25].…”

“…Among these booklets [7], [23]–[25], the “back book,” developed from evidence-based medicine by a multidisciplinary team and published to accompany the United Kingdom back-pain guidelines [26], has been shown, in a limited sample of English patients with LBP, to significantly affect fears and beliefs about and disability with LPB but not pain level [7]. Other educational booklets or pamphlets have been previously assessed, with relatively modest effects, for acute [27], chronic [28], or occupational [29] back pain.…”

Educating Adolescents About Healthy Sleep: Experimental Study of Effectiveness of Educational Leaflet

“…Educational leaflets enable dissemination of health-related information to many people in a relatively short time. Also, they have been shown to have beneficial effects on knowledge and awareness of different health-related problems, such as arthritis, oral cancer, and diabetes (19)(20)(21), and to affect changes in people's health-related behavior (22,23).…”