title: Can a Back Pain E-mail Discussion Group improve health status and lower health care costs?: A randomized study.
abstract: BACKGROUND
  Given the high health care utilization, limited evidence for the effectiveness of back pain interventions, and the proliferation of e-mail health discussion groups, this study seeks to determine if the Internet can be used to improve health status and health care utilization for people with chronic back pain.
  
  
  METHODS
  Randomized controlled trial. Participants included 580 people from 49 states with chronic back pain having at least 1 outpatient visit in the past year, no "red-flag" symptoms, and access to e-mail. Major exclusion criteria included continuous back pain for more than 90 days causing major activity intolerance and/or receiving disability payments.
  
  
  METHODS
  Closed, moderated, e-mail discussion group. Participants also received a book and videotape about back pain. Controls received a subscription to a non-health-related magazine of their choice.
  
  
  METHODS
  Pain, disability, role function, health distress, and health care utilization.
  
  
  RESULTS
  At 1-year treatment, subjects compared with controls demonstrated improvements in pain (P =.045), disability (P =.02), role function (P =.007), and health distress (P =.001). Physician visits for the past 6 months declined by 1.5 visits for the treatment group and by 0.65 visits for the control group (P =.07). Mean hospital days declined nearly 0.20 days for the treated group vs and increased 0.04 days for the control group (P =.24).
  
  
  CONCLUSIONS
  An e-mail discussion group can positively affect health status and possibly health care utilization. It may have a place in the treatment of chronic recurrent back pain.
authors.affiliation: Stanford Patient Education Research Center, 1000 Welch Rd, Suite 204, Palo Alto, CA 94304, USA. lorig@stanford.edu
authors.forename: Kate R
authors.initials: KR
authors.lastname: Lorig
authors.forename: Diana D
authors.initials: DD
authors.lastname: Laurent
authors.forename: Richard A
authors.initials: RA
authors.lastname: Deyo
authors.forename: Margaret E
authors.initials: ME
authors.lastname: Marnell
authors.forename: Marian A
authors.initials: MA
authors.lastname: Minor
authors.forename: Philip L
authors.initials: PL
authors.lastname: Ritter
mesh_terms: D001416:Back Pain / Q000191:economics / Q000628:therapy*; D016022:Case-Control Studies; D003195:Computer Communication Networks; D005260:Female; D006266:Health Education; D006296:Health Services / Q000706:statistics & numerical data*; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D012657:Self-Help Groups; D011795:Surveys and Questionnaires; D014481:United States