Helping patients decide about back surgery - A randomized trial of an interactive video program

Study Design. A randomized trial of 100 patients with low back pain who wer e potential surgical candidates. Objectives. To determine whether an interactive videodisc with a booklet is superior to a booklet alone for informing patients about back surgery. Summary of Background Data. Substantial geographic variation has been obser ved in lumbar spine surgery. Informed patient preferences should play an im portant role in decisions about surgery. However, little is known about opt imal strategies for informing patients. Methods. Subjects were randomized to receive an interactive videodisc (with a booklet) or a booklet alone. A knowledge test administered at baseline a nd follow-up was used to measure improvement in knowledge about treatment o ptions for lumbar spine problems. Patients' reactions to the videodisc and booklet and preferences for treatment were also assessed. Results. The patients' knowledge improved after exposure to either interven tion. Multivariate analyses adjusted for baseline score, age, education, ge nder, and diagnosis showed a significant advantage for the videodisc with b ooklet over the booklet alone. The videodisc-booklet group showed significa ntly greater gains in knowledge among subjects with the worst baseline know ledge scores. A larger proportion of subjects in the videodisc-booklet grou p rated the materials easy to understand (93% vs. 72%, P = 0.04), containin g the right amount of information (93% vs. 80%, P = 0.3), and adequate to a ssist in choice of treatment (75% vs. 51%, P = 0.2). Those who viewed the v ideodisc expressed a somewhat lower preference for surgery than those who r eceived the booklet alone (23% vs. 42%, P = 0.4). Conclusions. Both the booklet alone and the combination of videodisc and bo oklet improved knowledge. The combination produced greater knowledge gains than the booklet alone for the subgroup with the least knowledge at baselin e. Patients preferred the combination and had a slightly lower preference f or surgery if they had viewed the videopresentation. For some patients, the video may enhance involvement in clinical decisions.