Journal
JOURNAL OF PHYSIOTHERAPY
Volume 67, Issue 3, Pages 197-200Publisher
AUSTRALIAN PHYSIOTHERAPY ASSOC
DOI: 10.1016/j.jphys.2021.06.007
Keywords
Mediation analysis; Reassurance; Low back pain; Patient education; Physical therapy
Categories
Funding
- Australian National Health and Medical Research Council [1047827]
- University of New South Wales Prince of Wales Clinical School Postgraduate Research Scholarship
- NeuRA PhD Candidature Supplementary Scholarship
- National Health and Medical Research Council
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care Oxford at Oxford Health NHS Foundation Trust
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Feeling reassured after a consultation does not reduce disability or healthcare use in patients with acute low back pain, despite an increase in this feeling through patient education intervention. Clinicians should consider reallocating time spent on reassuring patients to other aspects of consultation.
Question: Does feeling reassured after a consultation reduce future disability or healthcare use in people with acute low back pain (LBP)? Design: Mediation analysis of a randomised, sham-controlled trial. Participants: Two hundred and two people with acute LBP at above average risk (high risk) of developing chronic LBP. Intervention: All participants received guideline-based care from their usual clinician. Participants received two additional 1-hour sessions of patient education focused on emphasising the benign nature of LBP or sham patient education that included active listening only. Outcome measures: The two primary outcomes for this study were self-reported disability and healthcare use. The mediator was feeling reassured that LBP was not caused by serious illness. Results: Data from 194 (96%) participants and 178 (88%) participants were included in the analysis for disability and healthcare use outcome models, respectively. Feeling reassured did not mediate the effect of the intervention on disability (indirect effect -0.23, 95% CI -0.71 to 0.18) or healthcare use (indirect effect 0.00, 95% CI -0.04 to 0.04). Patient education intervention increased feeling reassured (1.14 points, 95% CI 0.43 to 1.85) compared with sham patient education. However, the mediator (ie, feeling reassured) did not reduce disability ( -0.20 points, 95% CI -0.58 to 0.19) or healthcare use (OR 1.09, 95% CI 0.98 to 1.21). Conclusion: Feeling reassured after a consultation did not lead to improvements in disability and healthcare use for people with acute LBP. Clinicians should reflect on the time that they allocate to reassuring their patients and consider reallocating time to other aspects of the consultation that could reduce disability and future healthcare use. (C) 2021 Australian Physiotherapy Association. Published by Elsevier B.V.
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