Information and low back pain management: a systematic review.
METHODS
A systematic search of three electronic databases was done to identify randomized controlled trials on the effect of written or audiovisual information in low back pain.


OBJECTIVE
To determine whether information is an effective preventive action and/or therapy for low back pain and which type of information is most effective.


BACKGROUND
Information is commonly used in the primary care of low back pain and mostly delivered by booklets.


METHODS
A systematic computer-aided search of the Medline, PsyclInfo, and Embase database. A rating system was used to assess the strength of the evidence, based on the methodologic quality of the randomized controlled trials, the relevance of the outcome measures, and the consistency of the results.


RESULTS
Eleven randomized controlled trials were selected, including seven trials of high methodologic quality, as well as one parallel group controlled survey and one longitudinal study. Only three of the seven high-quality studies showed favorable results for information. There is strong evidence that a booklet increases knowledge and moderate evidence that physician-related cues increase the confidence in a booklet and adherence to exercises. There is limited evidence that a biopsychosocial booklet is more efficient than a biomedical booklet to shift patient's beliefs about physical activity, pain, and consequences of low back trouble. There is strong evidence that booklets are not efficient on absenteeism and conflicting evidence that they are efficient on healthcare use. There is no evidence that e-mail discussion or video programs alone are effective to reduce low back pain, disability, and healthcare costs.


CONCLUSIONS
Information based on a biopsychosocial model is recommended in primary care to shift patient beliefs on low back pain. Nevertheless, information delivery alone is not sufficient to prevent absenteeism and reduce healthcare costs.
Henrotin
Yves Edgard
YE
Bone and Cartilage Research Unit, Department of Physical Medicine, Institute of Pathology, University of Liège, Belgium.
Cedraschi
Christine
C
Duplan
Bernard
B
Bazin
Thierry
T
Duquesnoy
Bernard
B