Department of Rehabilitation Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, San Antonio, TX, USA.
Uniformed Services University of the Health Sciences , Bethesda, MD, USA.
BMC Fam Pract. 2021 Oct 9;22(1):200. doi: 10.1186/s12875-021-01549-y.
Adherence to guidelines for back pain continues to be a challenge, prompting strategies focused on improving education around biopsychosocial frameworks.
Assess the influence of an interactive educational mobile app for patients on initial care decisions made for low back pain by the primary care provider. The secondary aim was to compare changes in self-reported pain and function between groups.
This was a randomized controlled trial involving patients consulting for an initial episode of low back pain. The intervention was a mobile video-based education session (Truth About Low Back Pain) compared to usual care. The app focused on addressing maladaptive beliefs typically associated with higher risk of receiving low-value care options. The primary outcome was initial medical utilization decisions made by primary care practitioners (x-rays, MRIs, opioid prescriptions, injections, procedures) and secondary outcomes included PROMIS pain interference and physical function subscales at 1 and 6 months, and total medical costs.
Of 208 participants (71.2% male; mean age 35.4 years), rates of opioid prescriptions, advanced imaging, analgesic patches, spine injections, and physical therapy use were lower in the education group, but the differences were not significant. Total back-related medical costs for 1 year (mean diff = $132; P = 0.63) and none of the 6-month PROMIS subscales were significantly different between groups. Results were no different in opioid-naïve subjects. Instead, prior opioid use and high-risk of poor prognosis on the STarT Back Screening Tool predicted 1-year back pain-related costs and healthcare utilization, regardless of intervention.
Factors that influence medical treatment decisions and guideline-concordant care are complex. This particular patient education approach directed at patients did not appear to influence healthcare decisions made by primary care providers. Future studies should focus on high-risk populations and/or the impact of including the medical provider as an active part of the educational process.
clinicaltrials.gov NCT02777983 .
坚持背痛治疗指南仍然是一个挑战，这促使人们专注于通过生物心理社会框架来改善教育策略。
评估一种用于患者的交互式教育移动应用程序对初级保健提供者为腰痛做出的初始治疗决策的影响。次要目的是比较两组之间自我报告的疼痛和功能变化。
这是一项针对首次出现腰痛的患者的随机对照试验。干预措施是移动视频教育课程（Truth About Low Back Pain）与常规护理相比。该应用程序侧重于解决与接受低价值治疗选择风险较高相关的适应性不良信念。主要结局是初级保健医生做出的初始医疗利用决策（X 光、MRI、阿片类药物处方、注射、手术），次要结局包括 PROMIS 疼痛干扰和物理功能子量表在 1 个月和 6 个月时的疼痛干扰和物理功能子量表，以及总医疗费用。
在 208 名参与者中（71.2%为男性；平均年龄 35.4 岁），教育组的阿片类药物处方、高级成像、镇痛贴片、脊柱注射和物理治疗使用率较低，但差异无统计学意义。1 年的总背部相关医疗费用（平均差异=132 美元；P=0.63）和 6 个月的 PROMIS 子量表均无统计学差异。在阿片类药物未使用的受试者中结果无差异。相反，先前使用阿片类药物和 STarT 背部筛查工具的高预后不良风险预测了 1 年的背部疼痛相关成本和医疗保健利用，无论干预措施如何。
影响医疗治疗决策和符合指南的护理的因素很复杂。这种针对患者的特定患者教育方法似乎并没有影响初级保健提供者做出的医疗决策。未来的研究应关注高危人群和/或将医疗提供者纳入教育过程的积极参与者的影响。
clinicaltrials.gov NCT02777983。
