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Information and Low Back Pain Management: A Systematic Review

Henrotin, Yves Edgard, PhD*; Cedraschi, Christine, PhD; Duplan, Bernard, MD; Bazin, Thierry, MD; Duquesnoy, Bernard, MD, PhD

doi: 10.1097/01.brs.0000217620.85893.32
Literature Review

Study Design. 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.

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

Summary of Background Data. 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.

Information is commonly used in the primary care of low back pain and mostly delivered by booklets. Booklets, particularly those based on a biopsychosocial model, are efficient to improve knowledge and positively modify beliefs of patients with low back pain.

From the *Bone and Cartilage Research Unit, Department of Physical Medicine, Institute of Pathology, University of Liège, Belgium; †Multidisciplinary Pain Center, Service of Clinical Pharmacology and Toxicology & Service of Internal Medicine for Rehabilitation, University Hospitals, Geneva, Switzerland; ‡Hôpital Reine Hortense, Centre hospitalier d'Aix les Bains, Aix les Bains, France; §Centre Medical Dupic, Lyon, France; and ∥Service de Rhumatologie, Hôpital Roger Salengro, Lille, France.

Acknowledgment date: June 15, 2005. First revision date: September 9, 2005. Second revision date: October 28, 2005. Acceptance date: October 31, 2005.

Supported by the Section Rachis France and by the Belgian Back Society.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Yves Edgard Henrotin, PhD, Bone and Cartilage Research Unit, Institute of Pathology, Level 5, CHU Sart-Tilman, 4000 Liège, Belgium; E-mail:

© 2006 Lippincott Williams & Wilkins, Inc.