Effect of a Consumer-Focused Website for Low Back Pain on Health Literacy, Treatment Choices, and Clinical Outcomes: Randomized Controlled Trial

Abstract

Background The internet is used for information related to health conditions, including low back pain (LBP), but most LBP websites provide inaccurate information. Few studies have investigated the effectiveness of internet resources in changing health literacy or treatment choices. Objective This study aims to evaluate the effectiveness of the MyBackPain website compared with unguided internet use on health literacy, choice of treatments, and clinical outcomes in people with LBP. Methods This was a pragmatic, web-based, participant- and assessor-blinded randomized trial of individuals with LBP stratified by duration. Participants were randomly allocated to have access to the evidence-based MyBackPain website, which was designed with input from consumers and expert consensus or unguided internet use. The coprimary outcomes were two dimensions of the Health Literacy Questionnaire (dimension 2: “having sufficient information to manage my health;” dimension 3: “actively managing my health;” converted to scores 1-100) at 3 months. Secondary outcomes included additional Health Literacy Questionnaire dimensions, quality of treatment choices, and clinical outcomes. Results A total of 453 participants were recruited, and 321 (70.9%) completed the primary outcomes. Access to MyBackPain was not superior to unguided internet use on primary outcomes (dimension 2: mean difference −0.87 units, 95% CI −3.56 to 1.82; dimension 3: mean difference −0.41 units, 95% CI −2.78 to 1.96). Between-group differences in other secondary outcomes had inconsistent directions and were unlikely to be clinically important, although a small improvement of unclear importance in the quality of stated treatment choices at 1 month was found (mean difference 0.93 units, 95% CI 0.03 to 1.84). Conclusions MyBackPain was not superior to unguided internet use for health literacy, but data suggest some short-term improvement in treatment choices. Future research should investigate if greater interactivity and engagement with the website may enhance its impact. Trial Registration Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12617001292369; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372926 International Registered Report Identifier (IRRID) RR2-10.1136/bmjopen-2018-027516

Patient education materials for non-specific low back pain and sciatica: A systematic review and meta-analysis

“…Of the 6435 unique records identified, 537 full texts were reviewed, and 27 included in the review ( Fig 1 ). Most trials were conducted in the United States [ 39 – 48 ], followed by three in the United Kingdom [ 49 – 51 ], two each in Spain [ 52 , 53 ], Sweden [ 54 , 55 ], and Thailand [ 56 , 57 ], and one each in Australia [ 58 ], Croatia [ 59 ], Finland [ 60 ], Germany [ 61 ], Iran [ 62 ], the Netherlands [ 63 ], and New Zealand [ 64 ]. One trial was conducted in both Denmark and Norway [ 65 ].…”

“…One trial was conducted in both Denmark and Norway [ 65 ]. There were 21 RCTs [ 39 – 49 , 51 – 56 , 58 , 59 , 61 , 65 ] and six cluster RCTs [ 50 , 57 , 60 , 62 – 64 ], and participants were recruited largely through primary care [ 41 , 42 , 45 – 53 , 59 – 61 , 63 – 65 ]. Twelve trials included participants with acute LBP [ 39 , 41 , 49 – 51 , 54 , 55 , 57 , 60 , 61 , 63 , 64 ] and 15 with chronic LBP [ 40 , 42 – 48 , 52 , 53 , 56 , 58 , 59 , 62 , 65 ].…”

“…There were 21 RCTs [ 39 – 49 , 51 – 56 , 58 , 59 , 61 , 65 ] and six cluster RCTs [ 50 , 57 , 60 , 62 – 64 ], and participants were recruited largely through primary care [ 41 , 42 , 45 – 53 , 59 – 61 , 63 – 65 ]. Twelve trials included participants with acute LBP [ 39 , 41 , 49 – 51 , 54 , 55 , 57 , 60 , 61 , 63 , 64 ] and 15 with chronic LBP [ 40 , 42 – 48 , 52 , 53 , 56 , 58 , 59 , 62 , 65 ]. PEMs interventions were compared to usual care in 14 studies [ 39 , 48 – 51 , 53 , 55 , 58 , 60 – 65 ] and other interventions in 13 studies including Pilates [ 52 ], Yoga [ 45 –…”

“…Twelve trials included participants with acute LBP [ 39 , 41 , 49 – 51 , 54 , 55 , 57 , 60 , 61 , 63 , 64 ] and 15 with chronic LBP [ 40 , 42 – 48 , 52 , 53 , 56 , 58 , 59 , 62 , 65 ]. PEMs interventions were compared to usual care in 14 studies [ 39 , 48 – 51 , 53 , 55 , 58 , 60 – 65 ] and other interventions in 13 studies including Pilates [ 52 ], Yoga [ 45 – 47 , 59 ], exercise [ 57 ], stretching [ 40 ], proprioceptive neuromuscular facilitation [ 56 ], massage [ 42 ], walking [ 44 ], chiropractic manipulation [ 41 ], and cognitive behavioral therapy [ 43 , 54 ].…”

“…PEMs were provided by physicians [ 48 – 51 , 59 , 61 , 63 , 64 ] or researchers [ 39 – 47 , 52 – 58 , 62 , 65 ] via a hard copy booklet, leaflet or pamphlet [ 39 – 42 , 44 – 52 , 54 , 56 , 57 , 59 – 61 , 63 , 64 ] with several newer studies using digital formats [ 43 , 53 , 55 , 58 , 62 , 65 ]. PEMs content was similar across studies and included anatomy, causes of LBP, posture and movement, proper lifting techniques, exercises, how to manage flare-ups, pain management, importance of staying active, self-management strategies, and treatment options.…”