Take Home Messages:

1. An individual oral educational intervention of 2.5 hours is useful to hasten return to work outcomes in workers with acute or subacute low back pain.
2. Simple patient education sessions of shorter duration or written information do not seem to be as effective as a single intensive 2.5 hour session. They do not do harm if they are evidence based and up-to-date, there is no reason not to use oral and written education to support treatment.
3. For patients with chronic low back pain the effectiveness of individual education is still unclear and there is a lack of research in this area.
4. Trials are needed in which the effect of patient education is evaluated for patient subgroups, eg. high versus low level fear of pain.
5. Research is needed to evaluate what type of education is most effective and efficient, with respect to intensity and duration, and which health care professional can best provide patient education.

Why the research matters:

Low back pain is a common condition. It can cause great pain and lost activity and is a cause of significant disability in industrialised countries.

Increasingly, patient education is being provided to assist in treatment and the return to work outcome, but the effect of individual patient education for low back pain has not been systematically reviewed.

Patient education can mean discussions with a health professional, a special back education class, written information, such as a booklet to take home, or other formats such as a video.

Health professionals use patient education to help people learn about low back pain and how to manage it, with advice commonly including:

• Staying active and returning to normal activities as soon as possible.
• Avoiding worry and coping with having a sore back.
• Minimizing dependency on health care providers.
• Ways to avoid strain and avoid future back injuries.

What the research involved:

This study reviewed and summarised the findings of 24 relevant studies on this topic.

The review analysed pain, function and return-to-work outcomes in these studies, comparing people with low back pain who received in-person patient education sessions, with those who received written or visual information and those who received no health education at all.

Summary of research findings:

The review found:

• For patients with acute or subacute low back pain there is strong evidence that an individual 2.5 hour oral educational session is more effective in short-term and long-term return to work than no intervention;
• Educational interventions that were less intensive were not more effective than no intervention;
• Individual education for patients with acute or sub acute low back pain is as effective as non-educational interventions, eg. Physiotherapy, on long-term pain and global improvement;
• For chronic patients, individual education is less effective for back pain-specific function when compared to more intensive interventions, such as cognitive behavioural group therapy, work-site visits, x-rays, acupuncture, chiropractic, physiotherapy, massage, manual therapy, heat-wrap therapy, interferential therapy, spinal stabilisation, yoga or Swedish back school.

Original Research:

Individual patient education for low back pain.
Engers A, Jellema P, Wensing M, van der Windt DAWM, Grol R, van Tulder MW.

Cochrane Database of Systematic Reviews 2008:CD004057.

Link to PubMed abstract