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A randomized trial of a lay person-led self-management group intervention for back pain patients in primary care.

Abstract：

STUDY DESIGN:Randomized, controlled trial. OBJECTIVE:To evaluate a four-session self-management group intervention for patients with pain in primary care, led by trained lay persons with back pain. The intervention was designed to reduce patient worries, encourage self-care, and reduce activity limitations. BACKGROUND DATA:Randomized trials of educational interventions suggest that activating interventions may improve back pain outcomes. Expert opinion increasingly regards effective self-management of back pain as important in achieving good outcomes. In this study, an educational intervention designed to activate patients and support effective self-management was evaluated. METHODS:Six to 8 weeks after a primary care visit for back pain, patients were invited to participate in an educational program to improve back pain self-management. Those showing interest by returning a brief questionnaire became eligible for the study. Participants (n = 255) randomly were assigned to either a self-management group intervention or to a usual care control group. The effect of the intervention, relative to usual care, was assessed 3, 6, and 12 months after randomization, controlling for baseline values. The intervention consisted of a four-session group applying problem-solving techniques to back pain self-management, supplemented by educational materials (book and videos) supporting active management of back pain. The groups were led by lay persons trained to implement a fully structured group protocol. The control group received usual care, supplemented by a book on back pain care. RESULTS:Participants randomly assigned to the self-management groups reported significantly less worry about back pain and expressed more confidence in self-care. Roland Disability Questionnaire Scores were significantly lower among participants in the self-management groups relative to the usual care controls at 6 months (P = 0.007), and this difference was sustained at 12 months at borderline significance levels (P = 0.09). Among self-management group participants, 48% showed a 50% or greater reduction in Roland Disability Questionnaire Score at 6 months, compared with 33% among the usual care controls. CONCLUSIONS:Self-management groups led by trained lay persons following a structured protocol were more effective than usual care in reducing worries, producing positive attitudes toward self-care, and reducing activity limitations among patients with back pain in primary care.

journal_name

Spine (Phila Pa 1976)

journal_title

Spine

authors

Von Korff M,Moore JE,Lorig K,Cherkin DC,Saunders K,González VM,Laurent D,Rutter C,Comite F

doi

10.1097/00007632-199812010-00016

subject

Has Abstract

pub_date

1998-12-01 00:00:00

pages

2608-15

issue

eissn

0362-2436

issn

1528-1159

journal_volume

pub_type

临床试验,杂志文章,多中心研究,随机对照试验

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A randomized trial of a lay person-led self-management group intervention for back pain patients in primary care.