Pitfalls of patient education: Limited success of a program for back pain in primary care

Study Design. Low back pain patients seen in primary care were allocated randomly to one of two educational interventions or to usual care. Objective. To evaluate educational interventions designed to improve the outcomes of primary care for low back pain. Summary of Background Data. Patients with back pain are frequently dissatisfied with their medical care and identify lack of information as the most insufficient aspect. Methods. In a large Health Maintenance Organization clinic, 293 subjects were allocated randomly to receive usual care, an educational booklet, or a 15-minute session with a clinic nurse, including the booklet and a follow-up telephone call. Outcome measures included satisfaction with care, perceived knowledge, participation in exercise, functional status, symptom relief, and health care use. Outcomes were assessed 1, 3, 7, and 52 weeks after the intervention. Results. The nurse intervention resulted in higher patient satisfaction than usual care (P < 0.001) and higher perceived knowledge (P < 0.001). Self-reported exercise participation was also higher in the nurse intervention group after a 1-week follow-up period (97% vs. 65% in the other groups; P < 0.0001). There were no significant differences among the three groups in worry, symptoms, functional status, or health care use at any follow-up interval. Differences in self- reported exercise and perceived knowledge were no longer significant after 7 weeks. Conclusions. These findings challenge the value of purely educational approaches in reducing functional impact or health care use related to back pain and also challenge the value of fitness exercise in the most acute phase of back pain.