Self help and the early management of acute, non-specific low back pain
Robertson, A. (2008) Self help and the early management of acute, non-specific low back pain, no. 268.
This research investigated whether there might be benefit from encouraging early self management in an episode of non-specific low back – a common and costly condition in the U.K. It aimed to address a lack of research evidence on interventions to improve current, Step 1 of primary care management for back pain. A self help, audio programme, to give information and reassurance about non-specific back pain and skills training in some components of cognitive behavioural pain management, could be used independently at home. Self help could widen access to early, cognitive behavioural based treatment, might offer an inexpensive and practicable means of intervention delivery in busy GP practices and would accord with government policy of encouraging increased self management by NHS patients. Pilot evaluation: The face validity of two, self help, audio CD programmes for use at home, “Using Relaxation Skills” and “Using Thinking Skills”, was assessed by six primary care patients with nonspecific, acute low back pain. Participants in the pilot evaluation expressed some satisfaction with both self help programmes and found them helpful. The audio CD with a focus on progressive muscular relaxation, “Using Relaxation Skills”, was more popular. Pragmatic randomised controlled trial of self help CD effectiveness: The primary objective was to demonstrate whether using a three week, self help programme at home showed benefits with respect to back pain specific functioning as measured by the Roland and Morris Disability Questionnaire (RDQ). Forty four members of the public with a current episode of back pain lasting between two and nine weeks were randomised to a CD intervention arm or a control arm. Back pain specific functioning, self reported pain intensity and general health and well being in physical and mental domains were assessed at baseline and at one and six months' follow up. Data analysis conducted using a mixed between-within subjects analysis of variance demonstrated significant improvement across all measures over time for all participants. Compared to controls, those using a self help, audio CD showed significantly improved scores on the RDQ at six months [F =6.673, p=.013], although the magnitude of the mean group difference was small (partial eta squared=.137). It is concluded that a three week, home based self help programme delivered by audio CD can improve functional outcomes in the short to medium term in early, non-specific low back pain. Interpretative Phenomenological Analysis (IPA) of self help for back pain: The study aimed to explore possible reasons for the slow uptake by the public of a free, self help CD for early back pain. Nine people with non-specific low back pain were interviewed by email to explore their experiences of using self help for managing pain. An IPA analysis revealed four, major themes: taking control, social comparisons, ongoing learning and “with hindsight”. The findings suggest that turning to self help for back pain may be a developmental process over time, related to the variable course of back pain symptoms. Interviewees wished with hindsight they had been directed towards self management in the initial stages of back pain. At the time of first consulting a GP, they had hoped for a medical “cure”. The findings indicated that slow recruitment into a self help intervention for early low back pain may reflect a lack of perceived need for any intervention in the initial phase of the condition, with implications for the likely uptake of an early, self help intervention.