Oral Presentation Sydney Spinal Symposium 2023

Adding pain science or ergonomics messages to guideline advice does not increase feelings of reassurance in people with acute low back pain: a randomised experiment (#4)

Giovanni Ferreira 1 , Joshua Zadro 1 , Adrian Traeger 1 , Caitlin Jones 1 , Courtney West 1 , Mary O'Keeffe 1 , Hazel Jenkins 2 , James McAuley 3 , Christopher Maher 1
  1. Institute for Musculoskeletal Health, Institute for Musculoskeletal Health, Sydney Local Health District & The University of Sydney, Sydney, NSW, Australia
  2. Department of Health Professions, Department of Health Professions, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
  3. Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia

Background: Standard guideline advice includes messages on the importance of staying active, returning to work as early as possible, and to avoid bed rest. There are several popular approaches to providing advice to people with acute low back pain in addition to guideline advice, such as messages based on pain science of ergonomics principles. It is unknown whether adding those messages to standard guideline advice is more effective at reassuring patients than providing guideline advice only.  

Objective: To investigate the effects of adding pain science or ergonomics messages to guideline advice on feelings of reassurance and management intentions among people with acute low back pain (LBP).

Design: Three-arm parallel-group randomised experiment.

Methods:  We recruited people with acute LBP (pain for ≤ 6 weeks) who were randomised at a 1:1:1 ratio to guideline advice alone (adapted from the Australian LBP clinical care standard), or with the addition of brief pain science or ergonomics messages. Reassurance that (i) no serious condition is causing LBP and (ii) continuing with daily activities is safe were co-primary outcomes. Secondary outcomes were perceived risk of developing chronic pain, management intentions (bed rest, see a health professional, see a specialist, and imaging), credibility, and relevance of the advice in addressing the participant’s concerns.

Results: Data from 2,297 participants (99.3% of 2,313 randomised) were analysed. Adding brief pain science or ergonomics messages to guideline advice did not change reassurance that LBP was not caused by serious disease. The addition of ergonomics advice provided worse reassurance that it is safe to continue with daily activities compared to guideline advice (mean difference [MD]: -0.33, 95% CI 0.13 to 0.53). There was no difference between groups on management intentions.

Conclusion: Adding pain science or ergonomics messages to guideline advice did not increase reassurance or change management intentions in people with acute LBP. Ergonomics messages may lead to reduced feelings of reassurance.