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BMC Primary Care

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Open Access 01-12-2021 | Care | Research

Patient education booklet to support evidence-based low back pain care in primary care – a cluster randomized controlled trial

Authors: Anna S. Simula, Hazel J. Jenkins, Mark J. Hancock, Antti Malmivaara, Neill Booth, Jaro Karppinen

Published in: BMC Primary Care | Issue 1/2021

Abstract

Background

Inappropriate imaging and low-value care for low back pain (LBP) are common. A new patient-education booklet was created to overcome identified barriers to the delivery of recommended care, including the use of inappropriate imaging. Our aim was to assess the effectiveness of this booklet as part of primary care for LBP patients in comparison to usual care.

Methods

A cluster-randomized trial was performed. The intervention involved providing practitioners with the new patient-education booklet and a 30-min training session on its use. The booklet was provided during the clinical consult to all consenting LBP patients in the intervention group. Primary outcomes were the proportion of patients presenting with LBP who underwent imaging examinations during the first three months of follow-up and PROMIS PF-20 (Patient-Reported Outcomes Measurement Information System, 20-item physical functioning short form) change between baseline and three-month follow-up. Secondary outcomes, including sick leave and imaging examinations at 12 months, were investigated. Logistic regression using GEE-estimation was used for dichotomous outcomes, Poisson regression using GEE-estimation for count outcomes, and linear mixed models for continuous outcomes.

Results

Using the patient education booklet appeared to substantially reduce the proportion of LBP patients who underwent an imaging examination at three months, but the result was not statistically significant (OR 0.57, 95% confidence interval (Cl) 0.27 to 1.22). At 12 months, the effect was slightly larger and statistically significant (OR 0.50, 95%Cl 0.30 to 0.83, p = 0.008). No difference was observed in the PROMIS PF-20 T-score change between baseline and 3 months or 12 months (p = 0.365 and p = 0.923, respectively). The number of sick leave days in the intervention group was less than that in the control group at 3 months (RR 0.47, 95%Cl 0.26 to 0.83, p = 0.010) and at 12 months (RR 0.36, 95%Cl 0.18 to 0.72, p = 0.004).

Conclusions

The booklet appeared to be effective in reducing the proportion of LBP patients who underwent imaging examinations over 12 months. The intervention had no discernible effect on the PROMIS PF20 T-score change. The number of sick leave days was substantially lower in the intervention group.

Trial registration

ISRCTN, ISRCTN14389368, Registered 4 April 2019—Retrospectively registered.

Available only for authorised users

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Title: Patient education booklet to support evidence-based low back pain care in primary care – a cluster randomized controlled trial
Authors: Anna S. Simula
Hazel J. Jenkins
Mark J. Hancock
Antti Malmivaara
Neill Booth
Jaro Karppinen
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Care
Back Pain
Back Pain
Back Pain
Published in: BMC Primary Care / Issue 1/2021
Electronic ISSN: 2731-4553
DOI: https://doi.org/10.1186/s12875-021-01529-2

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Patient education booklet to support evidence-based low back pain care in primary care – a cluster randomized controlled trial

Abstract

Background

Methods

Results

Conclusions

Trial registration

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Trial registration

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