Abstract of paper presented at the International Society for the Study of the Lumbar Spine, Adelaide - April 2000

CAN AN EDUCATIONAL BOOKLET (Treat Your Own Back By Robin McKenzie is the book used) CHANGE BEHAVIOUR AND PAIN IN CHRONIC LOW BACK PAIN PATIENTS?

*Udermann B. **Tillotson J, -Donelson R, *Mayer J. *Graves J: *Dept of Exercise Science, **Dept of Science Teaching, Syracuse University; -Institute for Spine Care, State University of New York Health Science Center, Syracuse, NY.

INTRODUCTION:

Patient education is considered valuable in treating low back pain (LBP) yet educational booklets have been ineffective in outcome studies. Educational content of booklets has never been evaluated however. This is a dissertation-based investigation of the impact of reading a specific booklet on the LBP and self- treatment behaviour of volunteer chronic symptomatic subjects. The book provided instruction in the self- analysis using symptomatic responses to test movements/positions to identify effective exercises and posture changes.

METHODS:

62 recruited volunteers with current chronic LBP read the educational booklet, knowing they would be tested as to its content. A 50-question written survey was completed one-week later. 48 subjects (81 %) were available for a telephone survey at 9 months. Survey questions covered demographics, back pain history, retention of content, and changes in their pain, beliefs, and spinal care behaviour as a result of reading the book. Besides descriptive statistics, ANCOVA and ANOVA were used to analyse the dependent measures at p<0.05.

RESULTS:

Those patients with 9-month follow-up had a mean age of 42.4 yrs, mean pain duration of 10.4 yrs, mean number of episodes per year of 4. 1, and had seen an average of 2.5 health care providers previously. The average pain intensity was 1.3 on a 0-4 scale. One week after reading the book, 86% felt confident they could effectively self-treat their back pain. 85% stated they would use the book, both as a reference to self-treat an acute episode, and to prevent future pain. 52% reported they had already decreased their pain during the first week, 94% using specific directional spinal exercises described in the book and 92% were now more aware of correct posture.
At 9 months 87% were still exercising regularly. 91% were still focusing on using good posture. 82% noted less LBP since reading the book and 60% were pain free. 95% attributed their improvement to the exercises and posture changes learned from the book. Mean pain severity had dropped from 1.3 to 0 .44 and number of episodes from 4. 1 to 1.0 per annum (p<0.000 1). Worst-case scenario for those lost to follow-up was still significant at p< 0.01.

DISCUSSION:

With 10.4 years duration of LBP being far beyond any expectation of any improvement by natural history, this chronic sample served as its own control. Such a high rate of change in exercise and postural behaviour maintained over 9 months as a result of reading an educational booklet matches the high rate of improvement in pain and decrease in number of episodes. Subjects reporting of a perceived direct relationship between their pain decrease and the continued use of specific exercises and posture changes further supports a relationship between these specific self-treatment interventions learned from the book and the favourable outcomes. Further research needs to compare outcomes after reading this book vs. other books and to obtain better functional baseline and follow-up data.

CONCLUSION:

In chronic LBP volunteers, a significant decrease in pain intensity (60% pain free) and number of painful episodes occurred after reading a specific educational booklet focused on the self-treatment of LBP. Such improvement may be related to the long-term changes in patient self-treatment efforts and strategies.