Abstract
BackgroundNon-specific low back pain (LBP) is usually self-limiting within 4-6 weeks. Longstanding pain and disability are not predictable from clinical signs or pathoanatomical findings. Pain cognition and physical performance have been shown to improve patients with chronic LBP following neurophysiological education. The primary aim of this study is to evaluate whether a specific cognitive based education programme for patients with LBP in primary care is more effective than normal care in terms of increased function. The secondary aims of the study are to evaluate whether this intervention also results in earlier return to work, decreased pain, increased patient satisfaction, increased quality-of-life, and cost utility.Methods/DesignCluster randomised controlled trial with 20 general practitioners and 20 physiotherapists in primary care as the unit of randomisation. Each practitioner will recruit up to 10 patients, aged 20 to 55 years, with non-specific sub-acute/chronic LBP of more than four weeks but less than 1 year's duration. Practitioners in the intervention arm will provide cognitive patient education intervention in up to four weekly sessions, each lasting 30 minutes. Practitioners in the control arm will provide normal treatment, but have to make four appointments for the patients. Patients, outcome assessors, and study statistician will be blinded to group allocation.DiscussionWe present the rationale and design of an ongoing RCT study that potentially offers an easily implemented treatment strategy for LBP patients in primary care. The results will be available in 2012.Trial registrationISRCTN04323845
Highlights
Non-specific low back pain (LBP) is usually self-limiting within 4-6 weeks
We present the rationale and design of an ongoing RCT study that potentially offers an implemented treatment strategy for LBP patients in primary care
As most acute LBP is self-limiting within few weeks [1], only 10% of the patients are referred from their family doctor to specialized health care [4]
Summary
Non-specific low back pain (LBP) is usually self-limiting within 4-6 weeks. Pain cognition and physical performance have been shown to improve patients with chronic LBP following neurophysiological education. The primary aim of this study is to evaluate whether a specific cognitive based education programme for patients with LBP in primary care is more effective than normal care in terms of increased function. LBP patients are heavy health care consumers constituting 5-10% of all family doctors’ consultations [5,6], 27% of the physiotherapists’ treatment and 82% of the chiropractors’ treatment [5,6]. As most acute LBP is self-limiting within few weeks [1], only 10% of the patients are referred from their family doctor to specialized health care [4]. Specific strategies for implementing guidelines in primary care have not shown changes in patients’ sickness behaviour either [13,14]
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