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Can a patient educational book change behavior and reduce pain in chronic low back pain patients?*1

Background contextThis study was prompted by 1) the almost universal use of patient education as an initial or at least an ancillary step in the treatment of patients presenting with low back pain, 2) the relative dearth of studies evaluating the effectiveness of patient education and 3) the complete lack of support in the few existing studies for the efficacy of education in improving patients' long-term health status.PurposeA feasibility study to evaluate the efficacy of an individualized biomechanical treatment educational booklet to effect improvement in health status.Study designA prospective, longitudinal cohort study.Patient sampleSixty-two subjects (35 female, 27 male), average age 42.4 years, reported a mean duration of back pain before inclusion of 10.4 years. However, because of attrition, only 48 subjects had complete data across the 18-month follow-up period.Outcome measuresOutcome measures included pain status, number of back pain episodes, subject compliance with self-care behaviors, knowledge and opinion of booklet content.MethodsVolunteers with chronic low back pain were provided a copy of an individualized biomechanical treatment educational book and told they would undergo a written survey of its content 1 week after reading the book. Subjects' health status at 9 and 18 months was evaluated using a structured telephone interview.ResultsOne week after the 62 subjects, with an average of 10.4 years of symptoms and extensive use of the medical system, finished reading the index book, 51.62% reported noticeable improvement in their pain, their content comprehension was good and opinions about the text were generally positive. At 9-month follow-up, there was statistically significant and clinically relevant improvement in reported pain magnitude (p<.03), number of episodes (p<.0001) and perceived benefit (p<.04). At 18-month follow-up, these gains held or demonstrated even further improvement.ConclusionThis study's results suggest that the Treat Your Own Back book may have considerable efficacy in helping readers decrease their own low back pain and reduce the frequency of, or even eliminate, their recurrent episodes. These findings also justify conducting a randomized controlled clinical trial to assess this book's efficacy in improving health status in subjects with low back pain with the study design including internal controls to minimize bias issues and a wider range of outcomes, including measures of pain, function, disability, patient satisfaction, utilization of health care services and psychosocial measures.

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