Can a back pain e-mail discussion group improve health status and lower health care costs? A randomized study

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. Intervention: 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. Main Outcome Measures: 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.