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123 results on '"Main, Chris J."'

1. On 'Fragility and Back Pain: Lessons From the Frontiers of Biopsychosocial Practice.' Nicholls DA. Phys Ther. 2023; 103:pzad040. https://doi.org/10.1093/ptj/pzad040

Author

Beneciuk, Jason M., George, Steven Z., Simon, Corey B., Ballengee, Lindsay A., Lentz, Trevor A., Greco, Carol M., Main, Chris J., and Keefe, Francis J.

Abstract

Psychologically Informed Practice: Let's Not Throw the Baby Out With the Bath Water Nicholls (1) offers an interesting lens on psychologically informed practice (PiP) and back pain using cardiac disease [...]

Published
2024
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2. The Psychologically Informed Practice Consultation Roadmap: A Clinical Implementation Strategy

Author

Main, Chris J., Psychol, C., Simon, Corey B., Beneciuk, Jason M., Greco, Carol M., George, Steven Z., and Ballengee, Lindsay A.

Subjects
Company business management, Patients -- Care and treatment, Medical consultation -- Management, Pain -- Care and treatment, Informed consent (Medical law) -- Psychological aspects -- Social aspects
Abstract

Psychologically informed practice (PiP) includes a special focus on psychosocial obstacles to recovery, but research trials have revealed significant difficulties in implementing PiP outside of research environments. Qualitative studies have identified problems of both competence and confidence in tackling the psychosocial aspects of care, with a tendency to prefer dealing with the more mechanical aspects of care. In PiP, the distinction between assessment and management is not clear-cut. Analysis of the problem is part of the intervention, and guided self-management begins with the initial detective work by the patient, who is encouraged to develop successful and relevant behavior change. This requires a different style and focus of communication that some clinicians find difficult to enact. In this Perspective, the PiP Consultation Roadmap is offered as a guide for clinical implementation to establish a therapeutic relationship, develop patient-centered communication, and guide effective pain self-management. These strategies are illustrated through the metaphor of the patient learning to drive, with the therapist as a driving instructor and the patient as a student driver. For convenience, the Roadmap is depicted in 7 stages. Each stage represents aspects of the clinical consultation in a recommended order, although the Roadmap should be viewed as a general guide with a degree of flexibility to accommodate individual differences and optimize PiP interventions. It is anticipated that the experienced PiP clinician will find it progressively easier to implement the Roadmap as the building blocks and style of consultation become more familiar. Keywords: Psychologically Informed Practice, Pain, Communication, Introduction A detailed description of psychologically informed practice (PiP) and its origins (1) is presented in the accompanying paper in this issue. (2) In brief, PiP's most distinctive features are [...]

Published
2023
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3. Psychologically Informed Practice: The Importance of Communication in Clinical Implementation

Author

Main, Chris J., Psychol, C., Ballengee, Lindsay A., George, Steven Z., Beneciuk, Jason M., Greco, Carol M., and Simon, Corey B.

Subjects
Patients -- Care and treatment, Chronic pain -- Risk factors -- Prevention -- Psychological aspects, Informed consent (Medical law) -- Psychological aspects -- Health aspects
Abstract

There has been increasing interest in the secondary prevention of chronic pain and pain-associated disability over the past 3 decades. In 2011, psychologically informed practice (PiP) was suggested as a framework for managing persistent and recurrent pain, and, since then, it has underpinned the development of stratified care linking risk identification (screening). Although PiP research trials have demonstrated clinical and economic advantage over usual care, pragmatic studies have been less successful, and qualitative studies have identified implementation difficulties in both system delivery and individual clinical management. Effort has been put into the development of screening tools, the development of training, and the assessment of outcomes; however, the nature of the consultation has remained relatively unexplored. In this Perspective, a review of the nature of clinical consultations and the clinician--patient relationship is followed by reflections on the nature of communication and the outcome of training courses. Consideration is given to the optimization of communication, including the use of standardized patient-reported measures and the role of the therapist in facilitating adaptive behavior change. Several challenges in implementing a PiP approach in day-to-day practice are then considered. Following brief consideration of the impact of recent developments in health care, the Perspective concludes with a brief introduction to the PiP Consultation Roadmap (the subject of a companion paper), the use of which is suggested as a way of structuring the consultation with the flexibility required for a patient-centered approach to guided self-management of chronic pain conditions. Keywords: Psychologically Informed Practice, Pain, Communication, Introduction This Perspective is centered on the nature of the clinical consultation in Psychologically Informed Practice (PiP) and focuses on how the use of communication skills can be used to [...]

Published
2023
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12. Implementation Science and Employer Disability Practices: Embedding Implementation Factors in Research Designs

Author

Main, Chris J., Nicholas, Michael K., Shaw, William S., Tetrick, Lois E., Ehrhart, Mark G., Pransky, Glenn, Amick, III, Benjamin C., Anema, Johannes R., Besen, Elyssa, Blanck, Peter, Boot, Cécile R. L., Bültmann, Ute, Chan, Chetwyn C. H., Delclos, George L., Ekberg, Kerstin, Ehrhart, Mark G., Fassier, Jean-Baptiste, Feuerstein, Michael, Gimeno, David, Kristman, Vicki L., Linton, Steven J., Main, Chris J., Munir, Fehmidah, Nicholas, Michael K., Pransky, Glenn, Shaw, William S., Sullivan, Michael J., Tetrick, Lois E., Tveito, Torill H., Viikari-Juntura, Eira, Williams-Whitt, Kelly, Young, Amanda E., and the Hopkinton Conference Working Group on Workplace Disability Prevention

Published
2016
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13. Employer Policies and Practices to Manage and Prevent Disability: Conclusion to the Special Issue

Author

Main, Chris J., Shaw, William S., Amick, III, Benjamin C., Anema, Johannes R., Besen, Elyssa, Blanck, Peter, Boot, Cécile R. L., Bültmann, Ute, Chan, Chetwyn C. H., Delclos, George L., Ekberg, Kerstin, Ehrhart, Mark G., Fassier, Jean-Baptiste, Feuerstein, Michael, Gimeno, David, Kristman, Vicki L., Linton, Steven J., Main, Chris J., Munir, Fehmidah, Nicholas, Michael K., Pransky, Glenn, Shaw, William S., Sullivan, Michael J., Tetrick, Lois E., Tveito, Torill H., Viikari-Juntura, Eira, Williams-Whitt, Kelly, Young, Amanda E., and the Hopkinton Conference Working Group on Workplace Disability Prevention

Published
2016
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14. Employer Policies and Practices to Manage and Prevent Disability: Foreword to the Special Issue

Author

Shaw, William S., Main, Chris J., Pransky, Glenn, Nicholas, Michael K., Anema, Johannes R., Linton, Steven J., Young, Amanda E., Amick, III, Benjamin C., Boot, Cécile R. L., Chan, Chetwyn C. H., Main, Chris J., Gimeno, David, Viikari-Juntura, Eira, Besen, Elyssa, Munir, Fehmidah, Delclos, George L., Pransky, Glenn, Fassier, Jean-Baptiste, Anema, Johannes R., Williams-Whitt, Kelly, Ekberg, Kerstin, Tetrick, Lois E., Ehrhart, Mark G., Feuerstein, Michael, Sullivan, Michael J., Nicholas, Michael K., Blanck, Peter, Linton, Steven J., Tveito, Torill H., Bültmann, Ute, Kristman, Vicki L., Shaw, William S., and the Hopkinton Conference Working Group on Workplace Disability Prevention

Published
2016
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24. Advancing Psychologically Informed Practice for Patients With Persistent Musculoskeletal Pain: Promise, Pitfalls, and Solutions

Author

Keefe, Francis J., Main, Chris J., and George, Steven Z.

Subjects
Back pain -- Prognosis -- Patient outcomes -- Development and progression, Health screening -- Usage, Musculoskeletal diseases -- Research, Pain management -- Psychological aspects -- Research, Health
Abstract

There has been growing interest in psychologically oriented pain management over the past 3 to 4 decades, including a 2011 description of psychologically informed practice (PIP) for low back pain. PIP requires a broader focus than traditional biomechanical and pathology-based approaches that have been traditionally used to manage musculoskeletal pain. A major focus of PIP is addressing the behavioral aspects of pain (ie, peoples' responses to pain) by identifying individual expectations, beliefs, and feelings as prognostic factors for clinical and occupational outcomes indicating progression to chronicity. Since 2011, the interest in PIP seems to be growing, as evidenced by its use in large trials, inclusion in scientific conferences, increasing evidence base, and expansion to other musculoskeletal pain conditions. Primary care physicians and physical therapists have delivered PIP as part of a stratified care approach involving screening and targeting of treatment for people at high risk for continued pain-associated disability. Furthermore, PIP is consistent with recent national priorities emphasizing nonpharmacological pain management options. In this perspective, PIP techniques that range in complexity are described, considerations for implementation in clinical practice are offered, and future directions that will advance the understanding of PIP are outlined., Substantial promise and important new opportunities come about when health care providers integrate biopsychosocial management into their clinical practice. One such approach has been termed psychologically informed practice (PIP), (1) [...]

Published
2018
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25. Sustaining Work Participation Across the Life Course

Author

Pransky, Glenn S., Fassier, Jean-Baptise, Besen, Elyssa, Blanck, Peter, Ekberg, Kerstin, Feuerstein, Michael, Munir, Fehmidah, Amick, III, Benjamin C., Anema, Johannes R., Besen, Elyssa, Blanck, Peter, Boot, Cécile R. L., Bültmann, Ute, Chan, Chetwyn C. H., Delclos, George L., Ekberg, Kerstin, Ehrhart, Mark G., Fassier, Jean-Baptiste, Feuerstein, Michael, Gimeno, David, Kristman, Vicki L., Linton, Steven J., Main, Chris J., Munir, Fehmidah, Nicholas, Michael K., Pransky, Glenn, Shaw, William S., Sullivan, Michael J., Tetrick, Lois E., Tveito, Torill H., Viikari-Juntura, Eira, Williams-Whitt, Kelly, Young, Amanda E., and the Hopkinton Conference Working Group on Workplace Disability Prevention

Published
2016
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26. New Business Structures Creating Organizational Opportunities and Challenges for Work Disability Prevention

Author

Ekberg, Kerstin, Pransky, Glenn S., Besen, Elyssa, Fassier, Jean-Baptise, Feuerstein, Michael, Munir, Fehmidah, Blanck, Peter, Amick, III, Benjamin C., Anema, Johannes R., Besen, Elyssa, Blanck, Peter, Boot, Cécile R. L., Bültmann, Ute, Chan, Chetwyn C. H., Delclos, George L., Ekberg, Kerstin, Ehrhart, Mark G., Fassier, Jean-Baptiste, Feuerstein, Michael, Gimeno, David, Kristman, Vicki L., Linton, Steven J., Main, Chris J., Munir, Fehmidah, Nicholas, Michael K., Pransky, Glenn, Shaw, William S., Sullivan, Michael J., Tetrick, Lois E., Tveito, Torill H., Viikari-Juntura, Eira, Williams-Whitt, Kelly, Young, Amanda E., and Hopkinton Conference Working Group on Workplace Disability Prevention

Published
2016
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27. Workplace Interventions to Prevent Disability from Both the Scientific and Practice Perspectives: A Comparison of Scientific Literature, Grey Literature and Stakeholder Observations

Author

Williams-Whitt, Kelly, Bültmann, Ute, Amick, III, Benjamin, Munir, Fehmidah, Tveito, Torill H., Anema, Johannes R., Amick, III, Benjamin C., Anema, Johannes R., Besen, Elyssa, Blanck, Peter, Boot, Cécile R. L., Bültmann, Ute, Chan, Chetwyn C. H., Delclos, George L., Ekberg, Kerstin, Ehrhart, Mark G., Fassier, Jean-Baptiste, Feuerstein, Michael, Gimeno, David, Kristman, Vicki L., Linton, Steven J., Main, Chris J., Munir, Fehmidah, Nicholas, Michael K., Pransky, Glenn, Shaw, William S., Sullivan, Michael J., Tetrick, Lois E., Tveito, Torill H., Viikari-Juntura, Eira, Williams-Whitt, Kelly, Young, Amanda E., and the Hopkinton Conference Working Group on Workplace Disability Prevention

Published
2016
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28. Workplace Outcomes in Work-Disability Prevention Research: A Review with Recommendations for Future Research

Author

Young, Amanda E., Viikari-Juntura, Eira, Boot, Cécile R. L., Chan, Chetwyn, de Porras, David Gimeno Ruiz, Linton, Steven J., Amick, III, Benjamin C., Anema, Johannes R., Besen, Elyssa, Blanck, Peter, Boot, Cécile R. L., Bültmann, Ute, Chan, Chetwyn C. H., Delclos, George L., Ekberg, Kerstin, Ehrhart, Mark G., Fassier, Jean-Baptiste, Feuerstein, Michael, Gimeno, David, Kristman, Vicki L., Linton, Steven J., Main, Chris J., Munir, Fehmidah, Nicholas, Michael K., Pransky, Glenn, Shaw, William S., Sullivan, Michael J., Tetrick, Lois E., Tveito, Torill H., Viikari-Juntura, Eira, Williams-Whitt, Kelly, Young, Amanda E., and The Hopkinton Conference Working Group on Workplace Disability Prevention

Published
2016
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29. Researching Complex and Multi-Level Workplace Factors Affecting Disability and Prolonged Sickness Absence

Author

Kristman, Vicki L., Shaw, William S., Boot, Cécile R. L., Delclos, George L., Sullivan, Michael J., Ehrhart, Mark G., Amick, III, Benjamin C., Anema, Johannes R., Besen, Elyssa, Blanck, Peter, Boot, Cécile R. L., Bültmann, Ute, Chan, Chetwyn C. H., Delclos, George L., Ekberg, Kerstin, Ehrhart, Mark G., Fassier, Jean Baptiste, Feuerstein, Michael, Gimeno, David, Kristman, Vicki L., Linton, Steven J., Main, Chris J., Munir, Fehmidah, Nicholas, Michael K., Pransky, Glenn, Shaw, William S., Sullivan, Michael J., Tetrick, Lois E., Tveito, Torill H., Viikari-Juntura, Eira, Williams-Whitt, Kelly, Young, Amanda E., and the Hopkinton Conference Working Group on Workplace Disability Prevention

Published
2016
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30. System-level efforts to address pain-related workplace challenges

Author

Main, Chris J., Shaw, William S., Nicholas, Michael K., Linton, Steven J., Main, Chris J., Shaw, William S., Nicholas, Michael K., and Linton, Steven J.

Abstract

Funding agencies:Center for the Promotion of Health in the New England Workplace 1 U19 OH012299United States Department of Health & Human ServicesCenters for Disease Control & Prevention - USANational Institute for Occupational Safety & Health (NIOSH)

Published
2022
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35. Pain psychology in the 21st century : lessons learned and moving forward

Author

Flink, Ida, Reme, Silje, Jacobsen, Henrik Børsting, Glombiewski, Julia, Vlaeyen, Johan W. S., Nicholas, Michael K., Main, Chris J., Peters, Madelon, Williams, Amanda C. de C., Schrooten, Martien G. S., Shaw, William, Boersma, Katja, Flink, Ida, Reme, Silje, Jacobsen, Henrik Børsting, Glombiewski, Julia, Vlaeyen, Johan W. S., Nicholas, Michael K., Main, Chris J., Peters, Madelon, Williams, Amanda C. de C., Schrooten, Martien G. S., Shaw, William, and Boersma, Katja

Abstract

Background and aims: In the spring of 2019, Professor Steven J. Linton, the founder of the Center for Health and Medical Psychology (CHAMP) at Örebro University, Sweden, formally retired. As a tribute to his scholarly work covering decades of influence and inspiration to the field of pain psychology, the research center organized a topical conference titled "Pain in the 21st century: Where do we come from and where are we going?", which resulted in this state-of the-art synthesis. The aim of this declaration is to highlight lessons learned but not in the least is meant to inspire and guide our continued journey forward, developing pain psychology into the 21st century. Methods: Several collaborators of Professor Linton have summarized and reflected on the current state-of-the-art of pain psychology from the perspective of his input to the field, as well as on developments from the last years of advancements in pain psychology. Results: The topics have been divided into six themed sections covering the fear avoidance model, transdiagnostics, secondary prevention, risk- and protective factors, communication and contextual factors. The sections cover a broad spectrum, from basic experimental studies, integrating emotion and motivational theories into current theoretical models, to applied research on the effect of early interventions as well as sophisticated emotion-focused treatment models for pain patients with concurrent emotional ill-health. Conclusions: There have been major advancements within pain psychology research during the last decades, moving the field towards a more comprehensive picture, taking emotional and motivational aspects into account to understand pain sufferers. Although psychologically informed interventions in general mainly focus on the individual, it has been put forward that pain management is highly influenced by the surrounding environment, including communication with health care providers, and the occupational and social context. Implic

Published
2020
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37. Pain psychology in the 21st century: lessons learned and moving forward

Author

Flink, Ida K., primary, Reme, Silje, additional, Jacobsen, Henrik Børsting, additional, Glombiewski, Julia, additional, Vlaeyen, Johan W.S., additional, Nicholas, Michael K., additional, Main, Chris J., additional, Peters, Madelon, additional, Williams, Amanda C. de C., additional, Schrooten, Martien G.S., additional, Shaw, William, additional, and Boersma, Katja, additional

Published
2020
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38. Effects of Biopsychosocial Education on the Clinical Judgments of Medical Students and GP Trainees Regarding Future Risk of Disability in Chronic Lower Back Pain: A Randomized Control Trial

Author

Dwyer, Christopher P, primary, MacNeela, Pádraig, primary, Durand, Hannah, primary, O’Connor, Laura L, primary, Main, Chris J, primary, McKenna-Plumley, Phoebe E, primary, Hamm, Robert M, primary, Reynolds, Bronagh, primary, Conneely, Sinéad, primary, Slattery, Brian W, primary, Taheny, Darragh, primary, NicGabhainn, Saoirse, primary, Murphy, Andrew W, primary, Kropmans, Thomas, primary, and McGuire, Brian E, primary

Published
2019
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40. Effect of Intensive Patient Education vs Placebo Patient Education on Outcomes in Patients With Acute Low Back Pain

Author

Traeger, Adrian C., primary, Lee, Hopin, additional, Hübscher, Markus, additional, Skinner, Ian W., additional, Moseley, G. Lorimer, additional, Nicholas, Michael K., additional, Henschke, Nicholas, additional, Refshauge, Kathryn M., additional, Blyth, Fiona M., additional, Main, Chris J., additional, Hush, Julia M., additional, Lo, Serigne, additional, and McAuley, James H., additional

Published
2019
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42. Mediators of Treatment Effect in the Back In Action Trial:Using Latent Growth Modeling to Take Change Over Time Into Account

Author

Mansell, Gemma, Hill, Jonathan C., Main, Chris J., Von Korff, Michael, and Van Der Windt, Daniëlle

Abstract

Objectives: To test whether change in fear-avoidance beliefs was a mediator of the effect of treatment on disability outcome, and to test an analytical approach, latent growth modeling, not often applied to mediation analysis. Methods: Secondary analysis was carried out on a randomized controlled trial designed to compare an intervention addressing fear-avoidance beliefs (n=119) with treatment as usual (n=121) for patients with low back pain, which found the intervention to be effective. Latent growth modelling was used to perform a mediation analysis on the trial data to assess the role of change in fear-avoidance beliefs on disability outcome. The product of coefficients with bias-corrected bootstrapped confidence intervals was used to calculate the mediating effect. Results: A statistically significant mediating effect of fear-avoidance beliefs on the effect of treatment on disability outcome was found (standardized indirect effect −0.35; bias-corrected 95% CI, −0.47 to −0.24). Poor fit of the model to the data suggested that other factors not accounted for in this model are likely to be part of the same mediating pathway. Discussion: Fear-avoidance beliefs were found to mediate the effect of treatment on disability outcome. Measurement of all potential mediator variables in future studies would help to more strongly identify which factors explain observed treatment effects. Latent growth modelling was found to be a useful technique to apply to studies of treatment mediation, suggesting that future studies could use this approach.

Published
2017

43. Effects of Biopsychosocial Education on the Clinical Judgments of Medical Students and GP Trainees Regarding Future Risk of Disability in Chronic Lower Back Pain: A Randomized Control Trial.

Author

Dwyer, Christopher P, MacNeela, Pádraig, Durand, Hannah, O'Connor, Laura L, Main, Chris J, McKenna-Plumley, Phoebe E, Hamm, Robert M, Reynolds, Bronagh, Conneely, Sinéad, Slattery, Brian W, Taheny, Darragh, NicGabhainn, Saoirse, Murphy, Andrew W, Kropmans, Thomas, and McGuire, Brian E

Subjects
ACADEMIC medical centers, ATTITUDE (Psychology), CHRONIC diseases, COMPARATIVE studies, EMPATHY, FAMILY medicine, HEALTH attitudes, HOSPITAL medical staff, INTELLECT, JUDGMENT (Psychology), MEDICAL education, MEDICAL personnel, PSYCHOLOGY of medical students, PEOPLE with disabilities, RISK assessment, STATISTICAL sampling, SCHOOL environment, STUDENT attitudes, DECISION making in clinical medicine, RANDOMIZED controlled trials, PRE-tests & post-tests, PATIENTS' attitudes, LUMBAR pain, DISEASE complications
Abstract

Background Chronic lower back pain (CLBP) is a major health care burden and often results in workplace absenteeism. It is a priority for appropriate management of CLBP to get individuals back to work as early as possible. Interventions informed by the flags approach, which integrates cognitive and behavioral approaches via identification of biopsychosocial barriers to recovery, have resulted in reduced pain-related work absences and increased return to work for individuals with CLBP. However, research indicates that physicians' adherence to biopsychosocial guidelines is low. Objective The current study examined the effects of a flags approach–based educational intervention on clinical judgments of medical students and general practitioner (GP) trainees regarding the risk of future disability of CLBP patients. Design Randomized controlled trial (trial registration number: ISRCTN53670726). Setting University classroom. Subjects Medical students and GP trainees. Methods Using 40 fictional CLBP cases, differences in clinical judgment accuracy, weighting, and speed (experimental N = 32) were examined pre- and postintervention, as were flags approach knowledge, pain attitudes and beliefs, and empathy, in comparison with a no-intervention control group (control N = 31). Results Results revealed positive effects of the educational intervention on flags approach knowledge, pain-related attitudes and beliefs, and judgment weighting of psychologically based cues; results are discussed in light of existing theory and research. Conclusions Short flags approach–based educational video interventions on clinical judgment-making regarding the risk of future disability of CLBP patients may provide opportunities to gain biopsychosocial knowledge, overcome associated attitude barriers, and facilitate development of clinical judgment-making more aligned with psychological cues. [ABSTRACT FROM AUTHOR]

Published
2020
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44. In memoriam: Professor Stephen J. Morley (1950-2017)

Author

Vlaeyen, Johan W, Vlaeyen, Johan W, Keefe, Francis J, Main, Chris J, Eccleston, Christopher, de C Williams, Amanda C, Vlaeyen, Johan W, Vlaeyen, Johan W, Keefe, Francis J, Main, Chris J, Eccleston, Christopher, and de C Williams, Amanda C

Published
2017

50. Effect of Intensive Patient Education vs Placebo Patient Education on Outcomes in Patients With Acute Low Back Pain A Randomized Clinical Trial

Author

Michael K. Nicholas, James H. McAuley, Hopin Lee, Markus Hübscher, G. Lorimer Moseley, Chris J. Main, Ian W Skinner, Julia M. Hush, Nicholas Henschke, Adrian C Traeger, Fiona M. Blyth, Kathryn M. Refshauge, Serigne Lo, Traeger, Adrian C, Lee, Hopin, Hübscher, Markus, Skinner, Ian W, Moseley, G Lorimer, Nicholas, Michael K, Henschke, Nicholas, Refshauge, Kathryn M, Blyth, Fiona M, Main, Chris J, Hush, Julia M, Lo, Serigne, and McAuley, James H

Subjects
Adult, Male, pain medicine, medicine.medical_specialty, Placebo, law.invention, Placebos, 03 medical and health sciences, 0302 clinical medicine, Patient Education as Topic, Randomized controlled trial, law, Outcome Assessment, Health Care, Humans, Medicine, Single-Blind Method, physical therapy, 030212 general & internal medicine, Aged, business.industry, neurology, Chronic pain, Guideline, Middle Aged, RC346, medicine.disease, Acute Pain, Low back pain, R1, Clinical trial, Roland Morris Disability Questionnaire, Physical therapy, Female, Neurology (clinical), New South Wales, medicine.symptom, business, Low Back Pain, RA, 030217 neurology & neurosurgery, Patient education
Abstract

© 2018 2018 American Medical Association. All rights reserved. Importance: Many patients with acute low back pain do not recover with basic first-line care (advice, reassurance, and simple analgesia, if necessary). It is unclear whether intensive patient education improves clinical outcomes for those patients already receiving first-line care. Objective: To determine the effectiveness of intensive patient education for patients with acute low back pain. Design, Setting, and Participants: This randomized, placebo-controlled clinical trial recruited patients from general practices, physiotherapy clinics, and a research center in Sydney, Australia, between September 10, 2013, and December 2, 2015. Trial follow-up was completed in December 17, 2016. Primary care practitioners invited 618 patients presenting with acute low back pain to participate. Researchers excluded 416 potential participants. All of the 202 eligible participants had low back pain of fewer than 6 weeks' duration and a high risk of developing chronic low back pain according to Predicting the Inception of Chronic Pain (PICKUP) Tool, a validated prognostic model. Participants were randomized in a 1:1 ratio to either patient education or placebo patient education. Interventions: All participants received recommended first-line care for acute low back pain from their usual practitioner. Participants received additional 2 × 1-hour sessions of patient education (information on pain and biopsychosocial contributors plus self-management techniques, such as remaining active and pacing) or placebo patient education (active listening, without information or advice). Main Outcomes and Measures: The primary outcome was pain intensity (11-point numeric rating scale) at 3 months. Secondary outcomes included disability (24-point Roland Morris Disability Questionnaire) at 1 week, and at 3, 6, and 12 months. Results: Of 202 participants randomized for the trial, the mean (SD) age of participants was 45 (14.5) years and 103 (51.0%) were female. Retention rates were greater than 90% at all time points. Intensive patient education was not more effective than placebo patient education at reducing pain intensity (3-month mean [SD] pain intensity: 2.1 [2.4] vs 2.4 [2.2]; mean difference at 3 months, -0.3 [95% CI, -1.0 to 0.3]). There was a small effect of intensive patient education on the secondary outcome of disability at 1 week (mean difference, -1.6 points on a 24-point scale [95% CI, -3.1 to -0.1]) and 3 months (mean difference, -1.7 points, [95% CI, -3.2 to -0.2]) but not at 6 or 12 months. Conclusions and Relevance: Adding 2 hours of patient education to recommended first-line care for patients with acute low back pain did not improve pain outcomes. Clinical guideline recommendations to provide complex and intensive support to high-risk patients with acute low back pain may have been premature. Trial Registration: Australian Clinical Trial Registration Number: 12612001180808.

Published
2019

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