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Clinical Trial
. 2005 Jul 9;331(7508):84.
doi: 10.1136/bmj.38495.686736.E0. Epub 2005 Jun 20.

Should treatment of (sub)acute low back pain be aimed at psychosocial prognostic factors? Cluster randomised clinical trial in general practice

Petra Jellema  1 , Daniëlle A W M van der Windt, Henriëtte E van der Horst, Jos W R Twisk, Wim A B Stalman, Lex M Bouter
Affiliations
Clinical Trial

Should treatment of (sub)acute low back pain be aimed at psychosocial prognostic factors? Cluster randomised clinical trial in general practice

Petra Jellema et al. BMJ. .

Abstract

Objective: To compare the effects of a minimal intervention strategy aimed at assessment and modification of psychosocial prognostic factors and usual care for treatment of (sub)acute low back pain in general practice.

Design: Cluster randomised clinical trial.

Setting: 60 general practitioners in 41 general practices.

Participants: 314 patients with non-specific low back pain of less than 12 weeks' duration, recruited by their general practitioner.

Interventions: In the minimal intervention strategy group the general practitioner explored the presence of psychosocial prognostic factors, discussed these factors, set specific goals for reactivation, and provided an educational booklet. The consultation took about 20 minutes. Usual care was not standardised.

Main outcome measures: Functional disability (Roland-Morris disability questionnaire), perceived recovery, and sick leave because of low back pain assessed at baseline and after 6, 13, 26, and 52 weeks.

Results: The dropout rate was 8% in the minimal intervention strategy group and 9% in the usual care group. Multilevel analyses showed no significant differences between the groups on any outcome measure during 12 months of follow-up in the whole group or in relevant subgroups (patients with high scores on psychosocial measures at baseline or a history of frequent or prolonged low back pain).

Conclusion: This study provides no evidence that (Dutch) general practitioners should adopt our new treatment strategy aimed at psychosocial prognostic factors in patients with (sub)acute low back pain. Further research should examine why our new strategy was not more effective than usual care.

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Figure 1
Figure 1
Flow of general practitioners and patients through the trial. GP=general practitioner; dropped out=cumulative number of patients who did not return all following questionnaires; missing=number of patients who did not return that specific questionnaire
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