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The back home trial. General practitioner-supported leaflets may change back pain behavior [with consumer summary]
Roberts L, Little P, Chapman J, Cantrell T, Pickering R, Langridge J
Spine 2002 Sep 1;27(17):1821-1828
clinical trial
6/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: No; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

STUDY DESIGN: A single-blind randomised controlled trial of a leaflet developed for people with acute low back pain was compared with the usual general practitioner management of back pain. OBJECTIVE: To test the effectiveness of a patient information leaflet on knowledge, attitude behaviour, and function. SUMMARY OF BACKGROUND DATA: Despite the commonality of back pain in general practice, little evidence on the effectiveness of simple interventions such as leaflets and advice on self-management has been reported. On the basis of a five-stage needs analysis, a simple leaflet was developed that considered the views of patiens and health professionals. METHODS: For this study, 64 patients with acute back pain were assigned to the leaflet of control group. The participants were visited at home after 2 days, 2 weeks, then 3, 6 and 12 months, where they completed a range of self-report measures. Behavioural aspects were discreetly recorded by a "blinded" researcher. Primary outcomes were knowledge, attitude, behaviour, and function. RESULTS: In all, 272 home visits were undertaken. The findings show that at 2 weeks, knowledge about sitting posture was greater in the leaflet group (p = 0.006), which transferred to a behavioural difference (sitting with lumbar lordosis support) when participants were unaware they were being observed (p = 0.009). This difference remained significant at 3 months. Patients in the leaflet group also were better at maintaining a wide base of support when lifting a light object than the control subjects throughout all five assessments. There were no significant differences in the functional outcomes tested. CONCLUSIONS: This trial demonstrates that written advice for patients can be a contributory factor in the initial general practitioner consultation because it mat change aspects of knowledge and behaviour. This has implications for the management of acute back pain, with potential health gain.
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