Patient Education for Patients With Back Pain Referred to Physical Therapy

Study Overview
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Brief Summary
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The purpose of this study is to evaluate patients with low back pain who are scheduled to begin physical therapy but have not yet had their first appointment to better understand their beliefs and attitudes and to evaluate the effects of an educational session about low back pain.

Detailed Description
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The investigators will conduct a randomized trial to examine the effectiveness of a patient education session provided prior to beginning physical therapy on outcomes of usual physical therapy for acute/sub-acute low back pain patients. The study compares two groups, one group will be treated with usual physical therapy with no pre-treatment education and the other group will also receive the pre-treatment. Patients will be followed after 6 weeks and 3 months. Physical therapy care is left to the discretion of the physical therapist in conjunction with the patient. Outcomes will include pain and disability, and patients attitude and believes (pain catastrophizing, fear avoidance behavior). The overall hypothesis is that the additional educational treatment may address and improve pain, disability and fear.

Official Title
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Effect of a Patient Education Intervention for Patients With Low Back Pain Referred to Physical Therapy

Conditions
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Low Back Pain

Intervention / Treatment
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* Behavioral: Patient Education
* Other: Control


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Chief complaint of non-specific low back pain scheduled to receive outpatient physical therapy age 18-60 duration of current symptoms < 8weeks referred to physical therapy from a non-surgeon provider no treatment received for low back pain in past year other than physician office visits. Exclusion Criteria: Diagnosis provided by the referral source indicating a specific pathoanatomical source for LBP including fracture, spondylolesthesis, ankylosing spondylitis, radiculopathy any red flags in the patient's general medical screening questionnaire (i.e. tumor, metabolic diseases etc.).

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Education<br>Patients receive an educational video about low back pain based on the Consumer Reports Choosing Wisely recommendation for patients with back pain to avoid early imaging and remain as active as possible. After the video the evaluator and patient discussed key themes from the video and the patient was able to ask any questions. Previously scheduled physical therapy then began with treatment at the therapist's discretion. | Behavioral: Patient Education<br>* An educational video was watched based on Consumer Reports Choosing Wisely patient education supporting the recommendation that imaging is not helpful early for low back pain and the best strategy is to remain as active as possible. Key themes were discussed with a physical therapist and the patient's questions were answered.<br>|
| Active Comparator: Control<br>Previously scheduled physical therapy was provided with treatment at the therapist's discretion. No educational intervention was provided before beginning physical therapy | Other: Control<br>* Patients receive no additional intervention. They will begin physical therapy and receive care at the therapist's discretion.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Oswestry Disability Index | Self-report measure of low back pain-related disability | 6 weeks | 
| Pain as measured by the Numeric Pain Rating Scale | Self-report measure of pain intensity on 0-10 rating scale | 6 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Fear Avoidance beliefs Questionnaire | Self-report measure of fear avoidance beliefs about physical activity and work | baseline, 6 weeks, 3 months | 
| Pain Catastrophizing Scale | Self-report measure of pain catastrophizing beliefs | baseline, 6 weeks, 3 months | 
| Pain Beliefs Questionnaire | Self-report questionnaire used to measure patients' beliefs about the causes and consequences of pain with 2 subscales: organic (i.e, biomedical) and psychological. | baseline, 6 weeks, 3 months | 
| Global Rating of Change | Self-report global rating of improvement in condition since baseline assessed on 0-15 scale | 6 weeks, 3 months | 
| Physical Therapy Visits: Number of physical therapy episodes attended after baseline | Number of physical therapy episodes attended after baseline | 6 weeks, 3 months | 
| Treatment Self-Regulation Questionnaire | Self-report questionnaire examining motivations to attend physical therapy | baseline, 6 weeks, 3 months | 
| Hospital Anxiety and Depression Scale | Self-report questionnaire assessing anxiety and depression in separate sub-scales | baseline, 6 weeks, 3 months | 
| Oswestry Disability Scale | Self-report measure of low back pain-related disability | baseline, 3 months | 
| Numeric Pain Rating | Self-report measure of pain intensity on 0-10 scale | baseline, 3 months |