A randomized trial of a lay person-led self-management group intervention for back pain patients in primary care.
METHODS
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
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.
Von Korff
M
M
Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle, Washington, USA.
Moore
J E
JE
Lorig
K
K
Cherkin
D C
DC
Saunders
K
K
González
V M
VM
Laurent
D
D
Rutter
C
C
Comite
F
F
D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D001416:Back Pain / Q000523:psychology / Q000534:rehabilitation*; D001526:Behavioral Symptoms / Q000523:psychology; D004185:Disability Evaluation; D005260:Female; D006279:Health Maintenance Organizations; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010353:Patient Education as Topic; D011320:Primary Health Care / Q000379:methods*; D012648:Self Care; D012657:Self-Help Groups; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014861:Washington