What messages predict intention to self-manage low back pain? A study of attitudes towards patient education

Abstract

This observational study evaluated people's attitudes towards educational statements and tested whether this predicted intention to self-manage low back pain (LBP). People with or without LBP who were older than 18 years and fluent in written English were recruited. Participants completed an online survey asking demographic questions and questions on the presence or absence of LBP, its duration, and intensity. We assessed attitude toward educational statements and conducted linear regression analyses to investigate the relationship between attitude toward each statement and intention to self-manage. We recruited 656 participants, n 5 345 (53.6%), with LBP of varying duration. On average, participants had a positive attitude toward all statements except one; participants with chronic LBP had a negative attitude toward a statement relating to the cause of LBP. The effect of attitude on intention to self-manage was dependent on whether someone had LBP and for how long. For example, increased intention to selfmanage was predicted by a positive attitude toward educational statements related to staying active (b 5 0.22 ) in participants without pain, statements about reassurance (b 5 0.33 [CI 0.16-0.49]) for participants with acute or subacute LBP, and statements about the severity of back pain (b 5 0.25 [CI 0.18-0.33]) for participants with chronic LBP. We noted differences in attitude toward educational messages and individuals' intention to self-manage LBP depending on pain duration. Self-management could be encouraged with specific reassurance in people with acute or subacute LBP and education about severity in people with chronic LBP.

Challenges, Concerns, and Experiences of Community-Dwelling Older Women with Chronic Low Back Pain—A Qualitative Study in Hong Kong, China

“…For example, the misconception that pain-provoking activities can cause injury or recurrent back pain may result in the adoption of fear avoidance behavior and deconditioning. Likewise, the common belief that pain is a natural part of aging may discourage older people from self-managing CLBP [ 58 , 59 ].…”

Development and measurement properties of the AxEL (attitude toward education and advice for low-back-pain) questionnaire

“…We conducted a separate analysis to understand if any of the 10 statements that were included in the questionnaire draft were predictive of self-managing low back pain in people with low back pain of different durations. Our findings indicate that people’s attitude toward certain key messages was predictive of their intention to self-manage, but which message and the size of the effect was dependent on whether someone had low back pain and for how long [ 48 ].…”

Reassurance regarding educational messages in people with non‐specific low back pain: A cross‐sectional study

“…Please rate on the 0–10 scale below whether each statement in the educational messages has hindered or reassured you about your LBP (i.e., 0 the statement hindered you, 10 the statement reassured you). If this is not the scenario for you right now, imagine that scenario (i.e., that you have LBP)’ (O'Hagan et al., 2021). All the educational messages were merged into one section in the questionnaire to avoid confusion and bias.…”

“…The higher the score, the more the participants were reassured; the lower the score, the more they were hindered regarding LBP. We interpreted a score of 6–10 out of 10 to indicate a reassuring educational message, 5 as a neutral response, and 0–4 to suggest a hindering educational message (O'Hagan et al., 2021).…”