Welcome back to SpineIQ’s Back Blog! In previous blogs we have discussed the high value of self-management, strategies to promote self-management, and how patient education can fit into self-management. There is a myth that self-management must be done without help from clinicians.1–3 In fact, clinicians can play a pivotal role in patient self-management. Many patients will not know how to self-manage, when it is appropriate, or lack the skills to progress their self-management.4 Clinicians can help patients feel more confident with self-management, develop self-management skills, and empower continued self-management. This can typically be done by patients’ education from clinicians. While patient education is a key feature in patient centered care and subsequently guideline concordant care, there is a lack of knowledge on what patient education messages will be more likely to promote self-management and what patients’ attitudes are towards these messages. Therefore, this week we summarize a study by O’Hagan et al. that evaluated patients’ attitudes towards self-management messages and whether the attitudes towards these messages were associated with intention to self-manage their low back pain.5
Methods
An online survey was created to assess the attitudes towards self-management messages and their association with intention to self-manage low back pain among people without low back pain, with acute low back pain, and with chronic low back pain. A Delphi study was conducted to develop the key messages to be tested in this study. The participants consisted of low back pain experts, which after discussion resulted in the 10 key messages that were used in this study. The themes of the self-management messages consisted of staying active, explicit self-management, professional help, and patient information.
Results
A total of 607 participants (295 without low back pain, 68 with acute low back pain, and 277 with chronic low back pain) completed the survey and their results were analyzed in this study. Overall, all participants had mostly positive attitudes toward all of the self-management messages. Certain messages were received with more positive attitudes than others and this differed by whether the patient did not have low back pain, had acute low back pain, or had chronic low back pain.
For patients without low back pain, the messages with the most positive attitude were:
- “When you have back pain, staying active is important. You need to pace yourself to return to your usual activities”,
- “Staying active helps prevent long-term back problems”
- “Persistent low back pain is influenced by a number of factors- physical, emotional, environmental; so it is important to address each of these areas”
For patients with acute low back pain, the messages with the most positive attitudes were:
- “Staying active helps prevent long-term back problems”
- “When you have low back pain it is important to take ownership of your own wellbeing”
- “Imaging, for example x-ray, CT scan, or MRI, is usually not needed in the majority of cases of low back pain, particularly when your pain has been present for less than 6 weeks, talk to your doctor about this”
For patients with chronic low back pain, the messages with the most positive attitudes were:
- “When you have back pain, staying active is important. You need to pace yourself to return to your usual activities”
- “Staying active helps prevent long-term back problems”
- “When you have low back pain it is important to take ownership of your own wellbeing”
The association between attitudes towards messages and intention to self-manage also differed by patients without low back pain, with acute low back pain, and with chronic low back pain.
For patients without low back pain, the messages that were most associated with increased likelihood of intent to self-manage were:
- “It is not necessary to know the specific cause of your back pain in order to manage the pain effectively”
- “Imaging, for example x-ray, CT scan, or MRI, is usually not needed in the majority of cases of low back pain, particularly when your pain has been present for less than 6 weeks. Talk to your doctor about this”
- “It is rare for low back pain to be caused by a more serious health problem”
For patients with acute low back pain, the messages that were most associated with increased likelihood of intent to self-manage were:
- “Your pain may not necessarily be related to the extent of damage in your back. Hurt does not necessarily mean harm”
- “It is not necessary to know the specific cause of your back pain in order to manage the pain effectively”
For patients with chronic low back pain, the messages that were most associated with increased likelihood of intent to self-manage were:
- “It is not necessary to know the specific cause of your back pain in order to manage the pain effectively”
- “It is rare for low back pain to be caused by a more serious health problem”
- “Imaging, for example x-ray, CT scan, or MRI, is usually not needed in the majority of cases of low back pain, particularly when your pain has been present for less than 6 weeks. Talk to your doctor about this”
Conclusion
The results of this study have several clinically relevant findings. First, patients tend to have positive feelings overall towards evidence-based messages about self-management and low back pain. Second, there are some messages that depending on the length of low back pain are received with more positive attitude. Third, there are some messages that depending on the length of low back pain are more likely to increase intention to self-manage. It is imperative to remember that low back pain self-management does not have to be done alone by patients and clinicians can play a key role in teaching self-management skills, reinforcing and empowering patients. Finally, the messages used in this study are not a strict guideline, they better represent a theme and potential conversation starters to discuss these topics. For example, clinicians may want to discuss topics with a patient experiencing chronic low back pain that they are likely to have a more positive attitude towards such as: theme of staying active. This conversation may lead to topic with the intent of empowering the patient with chronic low back pain to increase their intent to self-manage their low back pain such as: theme of patient information especially the rarity of serious disease and lack of need for imaging. These findings play a key role in informing clinicians what messages may be better suited for certain patient populations.
Reference
- Barlow J, Wright C, Sheasby J, Turner A, Hainsworth J. Self-management approaches for people with chronic conditions: a review. Patient Educ Couns. 2002;48(2):177-187. doi:10.1016/S0738-3991(02)00032-0
- Caiata Zufferey M, Schulz PJ. Self-management of chronic low back pain: an exploration of the impact of a patient-centered website. Patient Educ Couns. 2009;77(1):27-32. doi:10.1016/j.pec.2009.01.016
- Devan H, Hale L, Hempel D, Saipe B, Perry MA. What Works and Does Not Work in a Self-Management Intervention for People With Chronic Pain? Qualitative Systematic Review and Meta-Synthesis. Phys Ther. 2018;98(5):381-397. doi:10.1093/ptj/pzy029
- Bair MJ, Matthias MS, Nyland KA, et al. Barriers and facilitators to chronic pain self-management: a qualitative study of primary care patients with comorbid musculoskeletal pain and depression. Pain Med Malden Mass. 2009;10(7):1280-1290. doi:10.1111/j.1526-4637.2009.00707.x
- O’Hagan ET, Di Pietro F, Traeger AC, et al. What messages predict intention to self-manage low back pain? A study of attitudes towards patient education. Pain. 2022;163(8):1489-1496. doi:10.1097/j.pain.0000000000002530
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