Key Messages for Low Back Pain

French SD et al. Essential key messages about diagnosis, imaging, and self-care for people with low back pain: a modified Delphi study of consumer and expert opinions. Pain 2019

  • People w/ lbp have difficulty finding high quality information on the internet, especially information that is consistent with clinical practice guidelines
  • This study aimed to produce robust and current non-treatment-related messages by getting both back pain experts and patients to rate their importance
  • This was a multi-stage Delphi study involving multiple rounds of questionnaires sent to a panel of experts and patients in order to obtain consensus on certain topics. 46 back pain experts were consulted and strict inclusion criteria was utilized. 22 patient representatives were chosen from a pool of individuals who previously had or were currently experiencing low back pain and had previously sought back pain information from the internet
  • Panel members ranked importance of statements based on 6-pt scale: essential, very important, moderately important, slightly important, not at all important, and undecided/not known.
  • “Consensus” was achieved if at least 70% panel members agreed that a particular statement was “important” (essential, very important, or moderately important)
  • Patient group ranked the following issues (from most to least important): red flags, principles of managing symptoms, reassurance, advice to stay active, and disease knowledge
  • Experts ranked the following from most to least important: Stay active, red flags, reassurance, unnecessary investigations, disease knowledge
  • High quality evidence indicates that imaging is not helpful in the large majority of cases of people with low back pain, but a challenge for implementation is that patients expect and want these investigations, and this has been supported by other patient surveys.
  • In general, it seemed that ppl w/ lbp placed emphasis on gaining knowledge of “what can you do for me,” while experts placed emphasis on “what can you do for yourself.”
  • Educational material needs to be evidence-based, and needs to consider the desires of patients and consumers to satisfy their needs, but the prominence of a particular message may need to be biased towards beliefs and attitudes that the material aims to influence, regardless of whether patients want to hear the information.