Feeling Reassured Does Not Help With Acute Low Back Pain – The Roles of Patient Education

Goal of the Study?

These researchers sought out to answer the question of does reassurance helps patients with acute low back pain? In this study 1, the authors looked at two hundred and two people with acute low back pain with a high risk of developing chronic low back pain. They were curious as to whether helping someone with supportive psychological language could help reduce disability outcomes.

Why are they doing this study?

The current zeitgeist and research push has emphasized reducing nocebic iatrogenic influences and steering away from the biomedical model. This has naturally led to alternative strategies like the use of emphasized reassurance tools.  However, does this strategy alone make a difference?

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What was done?

Using a randomized sham-controlled clinical trial mediation analysis, these researchers compared patient education to sham patient education. Enrolled participants listened to either: 1. two 1-hour sessions explaining the benign aspects using a biopsychosocial framework. 2. two 1-hour sessions that included active listening only, as of the sham comparison.

What did they find?

Those that did receive patient education did express improved re-assurance(compared to the sham); however, this did not lead to improved disability scores or was associated with health care use frequency. All in all, the results demonstrated there was no association with participants feeling reassured and improved outcomes.

Limitations?

The main limitation was the length of patient education in this study. This is obviously much longer than what clinicians often employed in clinical practice. The authors also suggest that less time would unlikely result in a different outcome.

Why do these findings matter?

Clinicians have been encouraged to use reassurance in the case of many clinical conditions.  The authors suggest that although patient education can be effective, overemphasis does not lead to better outcomes. Clinicians with their clinical time restraints should be selective in the time allocated to specific topics. The authors suggested that perhaps more time listening and matching appropriate treatment strategies may be a better option with time management restrictions.

Feeling reassured after a consultation does not reduce disability or healthcare use in people with acute low back pain: a mediation analysis of a randomized trial ↩

Reposted with permission from Dr. Jerome Fryer/Dynamic Disc Designs

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