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Dr. Carsten Oliver Schmidt, Dipl.-Psych.
Methods of Community Medicine
Institute of Community Medicine
Walther Rathenau Str. 48
17487 Greifswald, Germany
Tel.: 03834 867768
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Risk-adapted patient information and training in non-specific back pain in the General Practitioner's practice

Carsten Oliver Schmidt, Jean-François Chenot, Michael Pfingsten, Ruth Anja Fahland, Ulf Marnitz, Gabriele Lindena, Klaus Pfeifer, Thomas Kohlmann

 

The project aims to implement information, advice and training offers for 20-60-year-old patients with acute, non-specific back pain in general practitioners' practices. Beyond medical factors, the offers are attuned to the psychosocial needs of the patients. The primary focus is on fostering the individual health competencies in dealing with back pain. This includes health-relevant knowledge, back-pain-related cognitions, appropriate assessment of risks through movement with pain, active usage of health-conducive resources in the immediate social environment as well as an improved understanding of therapeutic procedures.

 

The project is implemented as a cluster-randomised study with an intervention group and a control group at two locations (Berlin, Göttingen and surrounding area). The project was launched in April 2008 and is running until August 2011. The success of the intervention in comparison with standard therapy is examined through two postal follow-up surveys at intervals of 6 months. 27 practices in Berlin participated in the study (12 in the control arm and 15 in the intervention arm) and 15 practices in Göttingen (8 in the control arm and 7 in the intervention arm).

 

The pilot study took place in November 2008 at both locations, in 2 practices per location. In January 2009, in Berlin and Göttingen, training to elucidate the study course in practice and training of the therapists was implemented in all participating practices. The recruitment of patients took place from March 2009 to April 2010. In total, 430 patients consented to participate in the study. After checking the inclusion and exclusion criteria, 347 participants remained; 172 in the intervention group and 175 in the control group.

 

Using a short questionnaire screening carried out in the physician's practice, the participants were allocated to three groups (low, medium and high-risk group) by the physician depending on their individual risk of chronic back pain. All participants in the intervention group received an information brochure on back pain ("back book") as well as the offer of free-of-charge telephone and email consultation. Patients with a medium risk were able to participate in two training appointments, each of which lasted for 90 minutes and built on one another. In these training sessions, they received information on the emergence, progression, risk factors and protective factors of back pain. Under the guidance of a sports therapist or physiotherapist, they additionally learned different exercises for strengthening the musculoskeletal system. High-risk patients were additionally given the opportunity to participate in two psychological training appointments lasting for 90 minutes each, in which they received information on back pain-related cognitions as well as situation-based coping strategies.

 

Of the 172 participants in the intervention group, 65 (38%) showed a low risk of chronification of back pain, 60 participants (35%) a medium risk and 47 participants (27%) a high risk. For the medium- and high-risk groups, 20 physiotherapy training sessions and 8 training sessions on pain management were offered between April 2009 and April 2010. Despite the high level of commitment of the study assistants, the planning of the training sessions proved to be very difficult. In total, only approximately 30% of the possible participants in Berlin and around 50% in Göttingen took part in the training. The main reasons for the low participation rate were the patients' low interest in the training and the incompatibility with other private appointments. Instead of a planned group size of 10-15 participants per training session, an average of 3-5 participants took part in the sessions.

 

59% of the participants took part in the first follow-up survey from October 2009 to December 2010, with the response rate being comparable in the two locations (62% and 58%, respectively). To increase the response rate of the second follow-up survey from April 2010 to May 2011, gift vouchers of 20 € were used as incentives. This led to an increase of the response rate of the second follow-up survey to 71%. The survey of the dependent variables for the outcome evaluation (including functional impairment, pain intensity, utilisation of medical services) will be completed at the end of May 2011. In summer 2011, the corresponding analyses should be completed.




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