A comparison of two short education programs for improving low back pain-related disability in the elderly - A cluster randomized controlled trial

Study Design. Cluster randomized clinical trial. Objectives. To assess the effectiveness of 2 minimal education programs for improving low back pain (LBP)-related disability in the elderly. Summary of Background Data. No education program has shown effectiveness on low back pain ( LBP)-related disability in the elderly. Methods. A total of 129 nursing homes ( 6389 residents) in northern Spain were invited to participate in the study. The actual participants were 12 nursing homes randomly assigned to 3 groups and 661 subjects. An independent physician gave a 20-minute talk with slide projections summarizing the content of the Back Book ( active management group), the Back Guide ( postural hygiene group), and a pamphlet on cardiovascular health ( controls). Disability was measured with the Roland-Morris questionnaire (RMQ). Blind assessments were performed before the intervention, and 30 and 180 days later. The effect of the intervention on disability was estimated by generalized mixed linear random effects models. Results. Mean age of participants ranged between 79.9 and 81.2 years. Disability improved in all groups, but at the 30-day assessment the postural education group showed an additional improvement of 1.1 (95% confidence interval, 0.2-1.9), RMQ points and at the 180-day assessment the active education group an additional improvement of 2.0 ( 95% confidence interval, 0.6-3.4). In the subset of subjects with LBP when entering the study, postural education had no advantages over controls, while an additional improvement of 3.0 ( 95% confidence interval, 1.5-4.5) RMQ points at the 180-day assessment was observed in the active education group. Conclusion. In institutionalized elderly, the handing out of the Back Book supported by a 20-minute group talk improves disability 6 months later, and is even more effective in those subjects with LBP.