Face-to-Face Information Combined with a Booklet versus a Booklet Alone for Treatment of Mild Low-Back Pain: A Randomized Controlled Trial

By Rantonen, Jarmo; Vehtari, Aki et al. | Scandinavian Journal of Work, Environment & Health, March 1, 2014 | Go to article overview

Face-to-Face Information Combined with a Booklet versus a Booklet Alone for Treatment of Mild Low-Back Pain: A Randomized Controlled Trial


Rantonen, Jarmo, Vehtari, Aki, Karppinen, Jaro, Luoto, Satu, Viikari-Juntura, Eira, Hupli, Markku, Malmivaara, Antti, Taimela, Simo, Scandinavian Journal of Work, Environment & Health


Healthcare professionals deliver appropriate patient information in order to improve patients' understand- ing of the medical condition and prognosis. Patient information is also used to provide reassurance and help the patient to cope with the problem by enhancing self-management of the symptoms (1-4). Personal infor- mation is often reinforced with educational booklets. Such a combination seems to increase patients' motiva- tion for self-care (5, 6). Educational booklets are used across specialities, eg, in prevention of oral cancer (5) and type-2 diabetes (7), hypertension (4) and low-back pain (LBP) (8).

Apart from the pieces of information, patient edu- cation includes the systemic experience of either psy- chosocial or behavior modification in personal contact with the patient (1, 9). A combination of booklet and individual advice is believed to have many advantages: patients may become more aware of treatment options and make the most of consultation. Usually, they also are able to recall the verbal advice better (3).

The Back Book is an educational booklet for non- specific LBP. It is based on the biopsychosocial model and focuses on attitudes and inappropriate behavior and includes information of how to cope with LBP and avoid re-exacerbation of LBP (2, 10). It also emphasizes that one should get back to normal activities, including return- ing to work, as soon as possible (3). As the booklet is easy to deliver, inexpensive, and innocuous (11), it has become widely used and is considered to be feasible also in the treatment and promotion of self-care among LBP patients (2, 12-14). Although the Back Book was introduced more than a decade ago and there is only limited evidence on its effectiveness (3), the content of the booklet is well in line with the general LBP guidelines (15-17).

According to the Finnish Occupational Health Care Act, employers are obliged to arrange occupational health (OH) service for their employees in order to prevent work-related health risks and protect and enhance safety, work ability, and general health of the workforce. OH services typically manage prevention of general illnesses and comprehensive primary care in addition to specific occupational hazards and diseases. Already for a decade, the coverage of OH services has been almost 90% of the total Finnish workforce (about 2.2 million in 2010) and almost 1 million health check-ups are performed in OH care annually (18). Well-defined, easy, applicable and cost-effective means for (secondary) prevention of LBP and subsequent work disability are desperately needed in OH services (15). For these reasons, educational booklets may be well-suited instruments to be used in OH services either alone or as an adjunct to personal, face-to-face information. Miscellaneous information about LBP is already widely provided in the clinical practice at OH, but the effectiveness of a uniform, low-back (LB) specific self-care information for low-level symptoms is not suf- ficiently known in the OH setting.

Most prior randomized controlled trials (RCT) con- cerning LBP in an OH setting have focused on employ- ees already off-work (19-22). In their recent systematic review, Engers et al (9) concluded that at least 2.5 hours is required for the effectiveness of individual patient education concerning return to work. The studies in the review included patients who suffered from mod- erate-to-severe pain and physical impairment and were already off-work. Such a lengthy intervention would not be applicable in the OH setting for employees with only minor LBP and limitations. In addition, authors also state that "... research is also needed to evaluate what type of education is most effective or most efficient with respect to intensity and duration, and which healthcare professional can best provide patient education" (9).

We were primarily interested whether face-to-face information in addition to a patient information leaflet would be effective in improving the short- and long- term prognosis of mild LBP among employees in as pragmatic an OH setting as possible. …

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