Piano Leonardo [Fondazione dei Santi Lorenzo e Teobaldo, Rodello, Italy & School of Physiotherapy, University of Turin School of Medicine, Turin, Italy]
Lorenzo Benzi [School of Physiotherapy, University of Turin School of Medicine, Turin, Italy]
Paolo Audasso [School of Physiotherapy, University of Turin School of Medicine, Turin, Italy]
Adele Occhionero [School of Physiotherapy, University of Turin School of Medicine, Turin, Italy]
Marco Trucco [School of Physiotherapy, University of Turin School of Medicine, Turin, Italy]
Raymond Ostelo, Department of Health Sciences, Faculty of Science, Vrije University Amsterdam, the Netherlands & Department of Epidemiology and Data Science, Amsterdam University Medical Centre, Location Vrije Universiteit; Amsterdam, the Netherlands]
Alessandro Chiarotto [Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands]
Chronic low back pain (CLBP) is one of the most burdensome conditions with huge impact on the health systems worldwide.(1), Patient education is one of the treatment options often recommended by clinical guidelines(2,3) to improve clinical outcomes (e.g pain, disability), and psychosocial issues (e.g. self-efficacy, reassurance).
The current evidence regarding patient education remains unclear. Therefore we aimed to investigate the effectiveness on core outcomes of individual patient education in patients with CLBP, compared to no intervention, placebo, non-educational interventions, or other type of education.
We performed a systematic review with meta-analysis of randomized controlled trials (RCTs) and reported following the PRISMA guidelines.(4) We searched PubMed, CINAHL, PEDro, Embase, and Scopus from inception to 14 January 2024; citation tracking was performed in Web of Science; grey literature and reference lists of previous systematic reviews were also searched. We performed meta-analysis for clinically homogeneous RCTs using random effects. We used the Cochrane Back and Neck group criteria to assess risk of bias and the GRADE approach to evaluate the certainty of evidence for each meta-analysis.(5,6) We focused on three time points: short term (i.e. 3 months), medium term (6 months), long term (12 months) follow-ups.
We included 17 RCTs (n=1893). There was high certainty evidence that individual patient education was clinically superior to non-educational intervention on long term disability (SMD -0.23, 95%CI -0.43 to -0.03, I2=0%). There was moderate certainty evidence that individual patient education was not superior to non-educational intervention on pain (SMD -0.01, 95%CI -0.23 to 0.21, I2=42%) and disability (SMD 0.07, 95%CI -0.27 to 0.40, I2=74%), at medium-term. No between-group differences were found on the other outcomes at any follow up, regardless the type of comparison (e.g. no intervention, placebo, non-educational interventions); the certainty of evidence ranged from very low to high.
We found high certainty evidence that individual patient education was superior to non-educational intervention on long-term disability (although without a clinical relevance), and from moderate to high certainty evidence that individual patient education was not superior to non-educational intervention on pain and disability at any follow up. Our findings suggest that education should not be intended as a standalone treatment but a component of a multimodal intervention strategy aimed to definitively improve health status, patient’s attitude and coping ability to manage the condition. Future large and high quality studies are needed to elevate the certainty evidence which is suboptimal for most comparison and outcomes.
