Use of Patient Education Material Back Book Has Positive Effect on Lower Back Pain Among Elderly

Low back pain is a common injury among many people in Western society, regardless of age. Low back pain during adulthood can result in lost work time and diminished quality of life, but among the elderly, it can reduce their ability to participate in daily activities and to care adequately for themselves, resulting in a drastically reduced quality of life.

Previous studies in France and Britain used the Back Book as an educational tool for working-age adults who had lower back pain. The study findings showed that adding the book to education programs appeared to affect the patients in a positive manner when compared with those who did not receive the book. A third study using the book took place in the Netherlands but the researchers there found that the Back Book, combined with a 20-minute discussion regarding back care, did not show a higher level of improvement over those who didn't receive the book.

In this clustered, randomized, controlled trial, researchers recruited 661 patients who were residents from 10 nursing homes in Spain. The patients were randomized per nursing home: four nursing homes to active education program, receiving Back Manual, a culturally adapted Spanish version of the Back Book; three to postural intervention with a Back Guide that discussed how to promote healthy posture; and three to the control group, receiving a book discussing general cardiovascular health. All participants received a talk from a physician how discussed the information available in the booklet.

The average age of the patients was 80 years old and the majority of the patients (64 percent) were women. Sixty five percent of the patients complained of lower back pain at the start of the study and the pain was chronic in 35 percent of the cases. More than half the patients were taking medications for chronic illnesses and around 55 percent were taking medications for lower back pain.

Before the study, the patients were assessed for their pain levels, functional disability and fear avoidance beliefs. Using a point system, the researchers found that after six months, all patients experienced some improvement, including those in the control group. Patients in the postural education group improved more than those in the control group, but not as much as the patients in the active education program. Also, patients who had lower back pain at the start of the study improved if they were in the active education group, but not if they were in either of the two others.

Although some improvements may not be considered statistically significant, the authors point out that there are relatively few low-cost treatments available for the prevention of lower back pain, so this type of intervention may still be useful.

The authors concluded that the addition of the Back Book to patient education does have merit and can improve the quality of life among elderly patients, particularly those who have lower back pain already.

Francisco Kovacs MD, PhD, et al. A Comparison of Two short Education programs for Improving Low Back Pain-Related Disability in the Elderly. A Clustered Randomized Controlled Trial. In Spine. May 2007. Vol. 32. No. 10. Pp. 1053-1059.

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