The role of patient education materials in supporting guideline implementation and improving outcomes for patients with low back pain in primary care

Abstract

Patients lack knowledge and have unhelpful beliefs about low back pain (LBP) that are associated with worse outcomes and overuse of diagnostic imaging. Physicians report that the drivers of imaging overuse include patient expectations for imaging and not having a reliable and concise method to explain why imaging is not needed to diagnose most LBP. This dissertation explores whether patient education materials (PEMs) can support physicians in providing education to patients to improve patient outcomes and, in particular, reduce unnecessary LBP imaging in primary care. First, I conducted a systematic review and meta-analysis on the effectiveness of PEMs for LBP, but few trials measured knowledge, beliefs, imaging rates, or intervention fidelity. Furthermore, details about the tested PEMs were mostly unavailable, so this review reveals little is known about PEMs’ mechanisms of action, how their content was developed, and what this content entails. Second, patients want education about LBP treatment options, but the evidence around LBP treatments is continuously changing. Therefore, I conducted a systematic review and meta-analysis to investigate the analgesic effects of conservative treatments for LBP compared with placebo. Out of 56 treatments, none showed reliable evidence of large effects and the majority (86%) had inconclusive evidence. These findings underscore the need for better resource prioritization in this field. Third, I set out to assess the content of PEMs, but no tool had been developed to assess if PEMs contain information about patients’ needs. I created a checklist outlining 21 patient information needs (i.e., what patients want to know) and education needs (i.e., what clinicians and researchers want patients to know) about LBP. Using this checklist and other tools I assessed PEMs for their understandability, actionability, readability, quality, accuracy, comprehensiveness, and coverage of information about patients’ needs. PEMs scored poorly across most outcomes and none were actionable or comprehensive. Overall, my thesis reveals that little is known about if and how PEMs might work to help manage LBP in practice and exposes the systemic issues in their development and testing. More work is required before disregarding PEMs as an intervention for LBP.