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Self-management program helps patients with acute low back pain

The JAMA Network Journals

CHICAGO - A self-management program consisting of group classes, exercise sheet handouts and telephone follow-up may help inner-city patients with acute low back pain manage their pain and improve function, according to an article in the November 24 issue of The Archives of Internal Medicine, one of the JAMA/Archives journals.

According to the article, low back pain is highly prevalent in the United States and is extremely costly in terms of health care expenditures, lost wages and disability. Acute low back pain is defined as symptoms lasting less than three months, accounts for more than 90 percent of all back pain and nearly half of the associated cost. A recently conducted national survey indicated that compared to whites, African American men and women in the United States reported losing more workdays for greater lengths of time because of low back pain.

Teresa M. Damush, Ph.D., of Indiana University, Indianapolis, and colleagues developed a self-management program for poor, urban, primary care patients with acute low back pain that focuses on boosting confidence in order to increase the patient's motivation to incorporate suggestions for improving low back pain into their daily activities. According to the authors, programs that emphasize increasing patient confidence are consistently successful at improving and maintaining health outcomes and reducing health care use among patients with various chronic conditions.

The researchers conducted a randomized, controlled trial comparing their self-management program with usual care among 211 patients who visited a physician for acute low back pain. Patients were enrolled at university-affiliated neighborhood health centers and an emergency department of an inner-city public teaching hospital.

Patients in the self-management program attended three group sessions that emphasized treatment recommendations, behavioral changes, increased self-efficacy (confidence), and reducing negative thoughts and behaviors. They received handouts outlining exercise regimens and body mechanics. Patients who missed classes were provided with an audiotape of the class, a tape cassette player, and the accompanying handouts. Patients received follow-up telephone calls at 4, 6, and 8 weeks after the first class to reinforce the class sessions and to mark progress and address any issues or concerns. Subsequently, patients received follow-up calls once a month. Patients in the usual care group did not receive these interventions, and were advised by their physicians. Based on the physician's judgment they could get referrals to occupational or physical therapy, or other interventions such as medication or back exercise sheets.

Interviewers assessed back pain, health status, self-efficacy, and time spent in physical activity at the beginning of the study, at four months, and at 12 months.

The researchers found that after 12 months, patients in the self-management group had significantly better scores on a questionnaire assessing disability than those in the usual care group. These patients also had better mental functioning, were better able to manage their back pain, were more physically active and were less fearful of reinjuring their backs at 12 months.

The authors conclude that a "self-management program can improve and maintain functional status, mental functioning, and self-efficacy to manage future symptoms for one year among primary care patients with acute low back pain living in the urban, inner city," the authors conclude.

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(Arch Intern Med. 2003;163:2632-2638. Available post-embargo at archinternmed.com) Editor's Note: This work was supported in part by a grant from the National Institutes of Health, Bethesda, Md., and the HSR&D Department of Veterans Affairs, Research Career Scientist Program (Dr. Weinberger) and Research Career Development Program (Dr. Rao).

For more information, contact JAMA/Archives Media Relations at 312/464-JAMA (5262) or e-mail mediarelations@jama-archives.org .

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