Should we give detailed advice and information booklets to patients with back pain? A randomized controlled factorial trial of a self-management booklet and doctor advice to take exercise for back pain

Study Design. Randomized controlled factorial trial. Objective. To assess the effectiveness of a booklet and of physician advice to take regular exercise. Summary of Background Data. Educational booklets are one of the simplest in terventions for back pain but have not been shown to alter pain and functio n. Although there is evidence that advice to mobilize is effective, doctors have also been advised to encourage regular exercise-but there is no evide nce that such advice alone improves outcomes. Method. Eight doctors from six practices randomized 311 patients with a new episode of back pain using sealed numbered opaque envelopes to receive a d etailed selfmanagement booklet, advice to take regular exercise, both, or n either. All groups were advised to mobilize and to use simple analgesia. Pa tients were telephoned during the first week after entry into the study, an d after 3 weeks to assess a validated numerical pain/function score (0 = no pain normal activities to 100 = extreme pain no normal activities). Patien ts also returned a postal questionnaire in the first week with the Aberdeen pain and function scale, a knowledge score, and a reliable satisfaction sc ale (mean score of 4 items: 0 = not satisfied to 100 = extremely satisfied) . Results. Pain/function scores were obtained in 239 (77%) patients. There we re interactions between exercise and booklet groups for both pain/function scores and the Aberdeen scale, which are unlikely to have been chance findi ngs (P = 0.009 and P = 0.012, respectively). In comparison with the control group, there were reductions in the pain/function score in the first week with a booklet (-8.7, 95% CI -17.4 to -0.03) or advice to exercise (-7.9; - 16.7 to 0.8) but much less effect with both together (-0.08, -9.0 to 8.9). Similarly, the Aberdeen scale was lower in the booklet group (-3.8, -7.7 to 0.07) and in the exercise advice group (-5.3; -9.3 to -1.38) but much less with both combined (-1.9, -5.8 to 2.1). There was no scores by week 3, whe n 58% reported being back to normal. Satisfaction was increased in booklet (7.9, 1.3 to 14.4) and exercise groups (7.4, 0.8 to 13.9)), and a booklet a lso increased knowledge (Kruskal-Wallis chi (2) 27.2, P = 0.001). Conclusion. Doctors can increase satisfaction and moderately improve functi onal outcomes in the period immediately after the consultation when back pa in is worst, by using very simple interventions: either by endorsing a self -management booklet or by giving advice to take exercise. Previous studies suggest that simple advice and the same written information provide reinfor cement. This study supports evidence that it may not be helpful to provide a detailed information booklet and advice together, where the amounts or fo rmats of information differ.