A randomized trial of a lay person-led self-management group intervention for back pain patients in primary care

Study Design. Randomized, controlled trial. Objective. To evaluate a four-session. serf-management group intervention f or patients with pain in primary care, led by trained lay persons with back pain, The intervention was designed to reduce patient worries, encourage s elf-care, and reduce activity limitations. Background Data. Randomized trials of educational interventions suggest tha t activating interventions may improve back pain outcomes, Expert opinion i ncreasingly regards effective self-management of back pain as important in achieving good outcomes, in this study, an educational intervention designe d to activate patients and support effective self-management was evaluated. Methods. Six to 8 Weeks after a primary care visit for back pain, patients were invited to participate in an educational program to improve back pain self-management. Those showing interest by returning a brief questionnaire became eligible for the study. Participants ( n = 255) randomly were assign ed to either a self-management group intervention or to a usual care contro l group. The effect of the intervention, relative to usual care, was assess ed 3, 6, and 12 months after randomization, controlling for baseline values . The intervention consisted of a four-session group applying problem-solvi ng techniques to back pain self-management, supplemented by educational mat erials (book and videos), supporting active management of back pain. The gr oups were led by lay persons trained to implement a fully structured group protocol. the control group received usual care, supplemented by a book on back pain care. Results. Participants randomly assigned to the self-management groups repor ted significantly less worry about back pain and expressed more confidence in self-care. Roland Disability Questionnaire Scores were significantly low er among participants in the self-management groups relative to the usual c are controls at 6 months (P = 0.007), and this difference was sustained at 12 months at borderline significance levels. (P = 0.09). Among self-managem ent group participants, 48% showed a 50% or greater reduction in Roland Dis ability Questionnaire Score at 6 months, compared with 33% among the usual care controls. Conclusions. Self-management groups led by trained lay persons following a structured protocol were more effective than usual care in reducing worries , producing positive attitudes toward self-care, and reducing activity limi tations among patients with back pain in primary care.