Effect of Reassuring Information on Danish Workers Who Experience Low Back Pain in the Following Year.
Condition: Non-specific Low Back Pain
MeSH terms: Back Pain; Low Back Pain
Study type: Interventional

Summary: 
      RCT study of the effect of an educational-based intervention on low back pain-related
      outcomes concerning beliefs and behaviour.
    

Detailed description: 
      Previous studies have strongly implied that information is a valuable means for people
      suffering from LBP in terms of coping appropriately. Most studies have tested the effect of
      information as part of a multimodal intervention.

      Four Nordic studies testing the effect of 'reassuring information' based on the 'Functional
      Disturbance'-model (proposed by Indahl et al. 1999 - also called the 'non-injury'-model) have
      all been effective at positively altering the functional level and/or days of sickness
      absence - when provided in combination with other elements to people with subacute/chronic
      back pain. The present study set out to test the effect of this kind of resassuring
      information alone.

      Between November 2012 and September 2013, we included app. 500 municipal workers perfoming
      either manual work, administrative work or a combination of the two. Participants worked in 5
      different municipal workplaces. These workplaces were characterized by being devided into
      'natural working unit', which had no or very little daily contact. All 5 workplaces
      participated with at least 2 units. Thus 11 units contributed to the data. Baseline
      assessment took place during right upon recruitment prior to randomization.

      We cluster-randomized the 11 units into an intervention and a control group using a simple
      stepwise randomization-metod.

      The intervention group received two 45-minute lectures at the workplace with an interval of 2
      weeks. The lectures were coherent allthough different. They consisted of information on the
      scientific knowledge on the etiology of LBP, basic anatomy, common myths about LBP, a theory
      of non-specific LBP being caused by muscular functional disturbances (Indahl 1999), pain
      physiology, and scientific knowledge on seemingly appropriate coping strategies to prevent a
      prolonged course. Emphasis was made to reduce pain-related fear of movement and
      catastrophizing thoughts and beliefs. Instead, activity during pain episodes was promoted as
      well as a natural use of the back despite pain. A non-directive approach was used
      (non-imperativ wording and absence of giving advice). The purpose was to provide information
      but let the participant make their own conclusions on how and if to use the information in
      present/future coping with pain.

      In addition to the lecture, the intervention group participants were provided with a leaflet
      showing various relevenat stretching exercises (back and related muscles) and they were
      offered the option to make a call to the primary investigator in case any questions would
      arise subsequently.

      The control group was untreated by us. Both groups had access to all 'usual' help (workplace,
      general practitioner etc).

      Upon completion of the lectures, twelve monthly assessments were conducted using Text
      Messaging (SMS). During each assessment, participants answered questions on no. of LBP days,
      no. of LBP-related cutdown days, no. of LBP-related sick days, no. of LBP-related healthcare
      visits, overall workability, bothersomeness last week, restricted activity last week, and use
      of pain medicine or degree of sadness/depression.

      In addition, a separate assessment was performed at app. 5.5 monts to obtain responses on
      back beliefs.

      The data collection was completed in 2014. Analysis are nearly finished. The sicentific paper
      on the study is anticipated to take place in the beginning of 2016.
    

Intervention name(s): Talks about what science says about LBP
Intervention type(s): Behavioral
Intervention description(s): Two talks, a folder with general stretching exercises and possibility to contact health professional by telephone
Allocation: Randomized
Intervention model: Factorial Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Prevention