Individual Patient Education for Managing Acute and/or Subacute Low Back Pain: Little Additional Benefit for Pain and Function Compared to Placebo. A Systematic Review With Meta-analysis of Randomized Controlled Trials
Leonardo Piano, Valentina Ritorto, Irene Vigna, Marco Trucco, Hopin Lee, Alessandro Chiarotto
Abstract
Objective To evaluate the effects of individual patient education for managing acute and/or subacute low back pain (LBP), compared to no intervention/placebo education, noneducational interventions, or other type of education. Design Systematic review with meta-analysis of randomized trials. Literature Search PubMed, CINAHL, PEDro, Embase, Scopus, and CENTRAL (up to September 30, 2020); reference lists of previous systematic reviews. Study Selection Criteria Randomized controlled trials (RCTs) evaluating individual education for patients with acute and/or subacute LBP. Data Synthesis Random-effects meta-analysis for clinically homogeneous RCTs. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. Results We included 13 RCTs. There was moderate certainty evidence that individual patient education was more effective than placebo education for pain at medium term (mean difference [MD], −0.79; 95% confidence interval [CI]: −1.52, −0.07) and physical function at short term (standardized mean difference [SMD], −0.25; 95% CI: −0.47, −0.02) and medium term (SMD, −0.26; 95% CI: −0.48, −0.04), but with no clinically relevant effects. There was low-to-moderate certainty evidence that individual patient education was superior to noneducational interventions on short-term quality of life (MD, −12.00; 95% CI: −20.05, −3.95) and medium-term sick leave (odds ratio = 0.32; 95% CI: 0.11, 0.88). We found no clinically relevant between-group effects for any other comparison (low-to-high certainty of evidence) at any follow-up. Conclusion One or 2 hours of individual patient education probably makes little to no difference in pain and functional outcomes compared with placebo for patients with acute and/or subacute LBP. Considering its effects on other outcomes (eg, reassurance) and patients' desire for information about their condition, it is reasonable to retain patient education as part of a first-line approach when managing acute and subacute LBP. J Orthop Sports Phys Ther 2022;52(7):432–445. Epub: 18 May 2022. doi:10.2519/jospt.2022.10698