The COPE LBP trial: Cognitive Patient Education for Low Back Pain - a cluster randomized controlled trial in primary care

Werner, Erik L.; Storheim, Kjersti; Løchting, Ida; Grotle, Margreth

doi:10.1186/1471-2474-11-33

Cited by 16 publications

(22 citation statements)

References 34 publications

(41 reference statements)

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“…One type of education that is an exception to this rule and has been widely studied focuses on improving patient understanding of the biological mechanisms that underpin pain and how best to promote recovery 14 15. This form of pain education (widely known as ‘Explain Pain’ or ‘Pain Neuroscience Education’)15–24 was developed in Australia and has been adapted in numerous Western countries, demonstrating mixed results for effectiveness for managing LBP 15 17 21 23–25. Education can be brief, around 10 min to deliver the key messages, or extended (1 hour to several hours).…”

Section: Introductionmentioning

confidence: 99%

Results of a feasibility randomised clinical trial on pain education for low back pain in Nepal: the Pain Education in Nepal-Low Back Pain (PEN-LBP) feasibility trial

et al. 2019

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ObjectivesThe aims of this study were to: (1) develop pain education materials in Nepali and (2) determine the feasibility of conducting a randomised clinical trial (RCT) of a pain education intervention using these materials in Nepal.DesignA two-arm, parallel, assessor-blinded, feasibility RCT.SettingA rehabilitation hospital in Kathmandu, Nepal.ParticipantsForty Nepalese with non-specific low back pain (mean [SD] age 41 [14] years; 12 [30%] women).InterventionsEligible participants were randomised, by concealed, 1:1 allocation, to one of two groups: (1) a pain education intervention and (2) a guideline-based physiotherapy active control group intervention. Each intervention was delivered by a physiotherapist in a single, 1-hour, individualised treatment session.Primary outcome measuresThe primary outcomes were related to feasibility: recruitment, retention and treatment adherence of participants, feasibility and blinding of outcome assessments, fidelity of treatment delivery, credibility of, and satisfaction with, treatment. Assessments were performed at baseline and at 1 week post-treatment.Secondary outcome measuresPain intensity, pain interference, pain catastrophising, sleep disturbance, resilience, global rating of change, depression and quality of life. Statistical analyses were conducted blind to group allocation.ResultsForty participants were recruited. Thirty-eight participants (95%) completed the 1-week post-treatment assessment. Most primary outcomes surpassed the a priori thresholds for feasibility. Several findings have important implications for designing a full trial. Secondary analyses suggest clinical benefit of pain education over the control intervention, with larger decrease in pain intensity (mean difference=3.56 [95% CI 0.21 to 6.91]) and pain catastrophising (mean difference=6.16 [95% CI 0.59 to 11.72]) in the pain education group. Pain intensity would seem an appropriate outcome for a full clinical trial. One minor adverse event was reported.ConclusionWe conclude that a full RCT of pain education for back pain in Nepal is feasible and warranted.Trial registration numberNCT03387228; Results.

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Section: Introductionmentioning

confidence: 99%

Results of a feasibility randomised clinical trial on pain education for low back pain in Nepal: the Pain Education in Nepal-Low Back Pain (PEN-LBP) feasibility trial

et al. 2019

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“…Only one study 18 satisfied all of the costing criteria reported by Graves et al 7 The lowest conforming study satisfied 7 of the 12 costing criteria (58%), 17 which could imply errors in costing methods. 7 In all, 14/22 (64%) of studies, however, satisfied at least 10 or more criteria.…”

Section: Quality Of Costing Methodsmentioning

confidence: 90%

“…Studies scored as "partial" for Q2 did not give an explicit statement but gave some form of justification within the introduction/methods for their approach such as discussing at length the societal burden of the MSK condition then adopting a societal perspective. All studies apart from one study 16 (and the study without a stated perspective 17 ) gave cost data that satisfied the stated perspective (Q3).…”

Section: Quality Of Costing Methodology In Included Studiesmentioning

confidence: 99%

Costing Methodology and Key Drivers of Health Care Costs Within Economic Analyses in Musculoskeletal Community and Primary Care Services: A Systematic Review of the Literature

Burgess

Hall

Bishop

et al. 2020

J Prim Care Community Health

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Background: Identifying variation in musculoskeletal service costs requires the use of specific standardized metrics. There has been a large focus on costing, efficiency, and standardized metrics within the acute musculoskeletal setting, but far less attention in primary care and community settings. Objectives: To ( a) assess the quality of costing methods used within musculoskeletal economic analyses based primarily in primary and community settings and ( b) identify which cost variables are the key drivers of musculoskeletal health care costs within these settings. Methods: Medline, AMED, EMBASE, CINAHL, HMIC, BNI, and HBE electronic databases were searched for eligible studies. Two reviewers independently extracted data and assessed quality of costing methods using an established checklist. Results: Twenty-two studies met the review inclusion criteria. The majority of studies demonstrated moderate- to high-quality costing methods. Costing issues included studies failing to fully justify the economic perspective, and not distinguishing between short- and long-run costs. Highest unit costs were hospital admissions, outpatient visits, and imaging. Highest mean utilization were the following: general practitioner (GP) visits, outpatient visits, and physiotherapy visits. Highest mean costs per patient were GP visits, outpatient visits, and physiotherapy visits. Conclusion: This review identified a number of key resource use variables that are driving musculoskeletal health care costs in the community/primary care setting. High utilization of these resources (rather than high unit cost) appears to be the predominant factor increasing mean health care costs. There is, however, need for greater detail with capturing these key cost drivers, to further improve the accuracy of costing information.

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“…Unnecessary medicine often emerges from discrepancy between clinical facts and patients’ expectations, resulting in irrelevant healthcare with a high amount of direct and indirect economic losses. A recent cluster randomised trial confirmed clinical benefit of a cognitive education programme for patients with LBP 26. In this research project, we will evaluate whether the implementation of the ICE technique can contribute to more sensible resource allocation and less unnecessary medicine in the management of acute LBP in primary care.…”

Section: Introductionmentioning

confidence: 99%

Referrals for uncomplicated lower back pain: a cluster parallel randomised trial of patient-centred communication to improve the management of acute back pain in primary care. A study protocol

et al. 2019

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IntroductionLow back pain (LBP) is one of the most frequent encounters in General Practice. Investigation and referral remain common despite the self-limiting character of episodes that are not largely attributable to specific underlying injuries. Identifying patients’ ideas, concerns and expectations (ICE) is a well-established element within consultation skills training and has been shown to improve prescribing. It can be a powerful communication tool setting the base for transferring and adjusting adequate clinical information. This study aims to evaluate whether ICE can decrease unnecessary medicine in the management of acute LBP in primary care.Methods and analysis Research question: Does ICE training intervention have an effect on doctors’ referrals of patients suffering from acute LBP? Population: Recruitment to this parallel cluster randomised trial will take place among general practitioners belonging to four independent practice networks in Northern Bavaria/Germany. Intervention: At baseline, 24 out of 48 doctors will be randomly assigned to take part in a 1-day training session covering theoretical background and clinical implementation of patient-centred communication by stimulating ICE. They will also be given access to a web-based supporting tool for reflective practice on their communication skills. Comparison: GPs in the control group will continue consultations as usual. Outcome: Outcome measures are referrals to diagnostic imaging, physiotherapy and specialists obtained from routine practice data, compared between intervention and control group. Time: Referrals of patients consulting their doctors for documented LBP will be monitored up to 3 months after the ICE training intervention.Ethics and disseminationEthical approval for the study was obtained by the Ethics Committee of the University Erlangen-Nuremberg (296_17B). Results will be disseminated by conference presentations and journal publications.Trial registration numberThe trial is registered in clinicaltrials.gov (NCT03711071).

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The COPE LBP trial: Cognitive Patient Education for Low Back Pain - a cluster randomized controlled trial in primary care

Cited by 16 publications

References 34 publications

Results of a feasibility randomised clinical trial on pain education for low back pain in Nepal: the Pain Education in Nepal-Low Back Pain (PEN-LBP) feasibility trial

Results of a feasibility randomised clinical trial on pain education for low back pain in Nepal: the Pain Education in Nepal-Low Back Pain (PEN-LBP) feasibility trial

Costing Methodology and Key Drivers of Health Care Costs Within Economic Analyses in Musculoskeletal Community and Primary Care Services: A Systematic Review of the Literature

Referrals for uncomplicated lower back pain: a cluster parallel randomised trial of patient-centred communication to improve the management of acute back pain in primary care. A study protocol

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