Dynamic Disc Designs

Patient education booklet to support evidence — based low back pain care in primary care — a cluster randomized controlled trial

Goal of the study?

In this study, 1 the objective was to assess the effectiveness of a patient education booklet to overcome barriers to the delivery of recommended care for patients with low back pain. 


Why are they doing this study?

Low back pain is the leading cause of disability and a major health cost worldwide. One of the reasons for this is that low back pain tends to be managed without following clinical guidelines. For example, almost half of patients undergo inappropriate imaging, which drives up healthcare costs associated with increased disability. To address the barriers to implementing clinical guidelines, Australian researchers developed a patient education booklet that educates patients and their healthcare providers, reminding practitioners of guidelines and facilitating communication. 


What did they do?

The researchers used a cluster-randomized trial design to assess the booklet’s effectiveness with low back pain patients in primary care compared to usual care. They recruited 8 clusters, 4 for the intervention (212 participants) and 4 for the control group (203 participants), with 408 participants in the sample. The practitioners in the intervention group were provided with the booklet and a 30-minute training session. The booklet was then also provided to their patients in the intervention group. The professionals only received a short training session on the study and recruitment procedure in the control group. All consenting patients received usual care but did not get the booklet.

There were two outcomes: 1) The proportion of patients presenting with low back pain who underwent imaging examinations due to low back pain during the first three months of follow-up, and 2) Change in Patient-Reported Outcomes Measurement Information System (20 items physical functioning short form) from baseline to three-month follow-up. 

They used statistical software to analyze between-group differences. 


What did they find?

The patient education booklet substantially reduced the proportion of patients with low back pain who underwent imaging at 3 months, but the result was not statistically significant. It was only statistically significant when a physician was the first contacted professional. This was compared to the findings at 12 months, which resulted in an effect that was slightly larger and statistically significant. 

The researchers did not find any differences in the Patient-Reported Outcomes Measurement Information System between baseline and 3 months or 12 months. They did find a change in the number of sick days in the intervention group was less than in the control group at 3 months and 12 months. There were no statistically significant differences between the intervention and control groups in the number of healthcare appointments or patient-reported secondary outcomes.

The use of the booklet had no impact on the patient’s pain, physical functioning, disability, or quality of life compared to usual care.


Why do these findings matter?

Patient education often matters, and how and when it is delivered should be optimized for each patient. A custom-tailored approach to each patient should be at the forefront of each clinical encounter. This study using a booklet did not show any changes in a patient’s pain score. Something needs to change in how patient education is delivered.


At Dynamic Disc Designs we believe a ‘booklet’ is a dated format and practitioners can improve their patient education through the use of accurate modelling to help patients truly understand and see the causes of their specific symptoms. Fostering the right motivational movement within patients is at the hallmark of what we do. To help in the construct of tackling biomechanical causes while addressing the fears of the unknown.