PITFALLS OF PATIENT EDUCATION - LIMITED SUCCESS OF A PROGRAM FOR BACKPAIN IN PRIMARY-CARE

Study Design. Low back pain patients seen in primary care were allocat ed randomly to one of two educational interventions or to usual care. Objective. To evaluate educational interventions designed to improve t he outcomes of primary care for low back pain. Summary of Background D ata. Patients with back pain are frequently dissatisfied with their me dical care and identify lack of information as the most insufficient a spect. Methods. In a large Health Maintenance Organization clinic, 293 subjects were allocated randomly to receive usual care, an educationa l booklet, or a 15-minute session with a clinic nurse; including the b ooklet and a follow-up telephone call. Outcome measures included satis faction with care, perceived knowledge, participation in exercise, fun ctional status, symptom relief, and health care use. Outcomes were ass essed 1, 3, 7, and 52 weeks after the intervention. Results. The nurse intervention resulted in higher patient satisfaction than usual care (P < 0.001) and higher perceived knowledge (P < 0.001). Self-reported exercise participation was also higher in the nurse intervention group after a 1-week follow-up period (97% vs. 65% in the other groups; P < 0.0001). There were no significant differences among the three groups in worry, symptoms, functional status, or health care use at any foll ow-up interval. Differences in self-reported exercise and perceived kn owledge were no longer significant after 7 weeks. Conclusions. These f indings challenge the value of purely educational approaches in reduci ng functional impact or health care use related to back pain and also challenge the value of fitness exercise in the most acute phase of bac k pain.