Programme no. 555-P
COPE – A Cognitive Patient Education trial for Low Back Pain in Primary Care
Erik L. Werner*1, Kjersti Storheim2, Ida Løchting3, Margreth Grotle4
1Department of General Practice,University of Oslo,Oslo,Norway, 2Communication and Research Unit for Musculoskeletal Disorders (FORMI),Oslo University Hospital,Oslo,Norway, 3Communication and Research Unit for Musculoskeletal Disorders (FORMI),Oslo University Hospital,Oslo,Norway, 4Communication and Research Unit for Musculoskeletal Disorders (FORMI),Oslo University Hospital,Oslo,Norway
* = Presenting author
Objectives: The aim of the study was to explore the effect of the model on function and sick leave in normal clinical settings of general practitioners (GPs) and physiotherapists (PTs) in Norwegian primary care.
Background: Cognitive treatment is endorsed by guidelines for the treatment of longstanding low back pain LBP. In this study we have modified an ”Explain Pain” model, into a communication tool for primary care. The model was originally developed in Australia for specialist care. We adapted the model to fit into the daily routine in Norwegian GP and PT practices. The basic idea was to provide the LBP patients with accurat knowledge of the back pain neurophysiology in order to understand the mechanisms and thereby improve their health behavior.
Results: 109 patients were recruited in both groups. There were no statistical differences of the four groups at baseline. There was a significant drop in Roland Morris Disability Questionnaire in the intervention group from baseline mean 9.0 to 3.7 at 12 months follow-up, and an accordingly reduction in number of patients on sick leave of 66%. This was also seen in the control group, with a drop on RMDQ from mean 9.8 to 3.0, and a 73% reduction on sick leave.
Material/Methods: The protocol and design have been presented previously (Werner et al, BMC Musculoskeletal Disorders 2010). 16 GPs and 20 PTs were cluster randomized to intervention or control group. The patients had LBP lasting for more than four weeks and less than one year. All patients (in all groups) received four sessions of 30 minutes individually with their health care provider. In the intervention groups these sessions followed a detailed manual. In the control group the patientes received normal care. In all groups the health care providers were allowed to add any additional treatment they found indicated.
Conclusion: In this study, there were no statistical differences between the groups. We suggest that the substantial increase in function and reduction in sick leave in all groups may be an effect of the attention paid by the health care provider regardless of the specific content of the sessions.
Points for discussion: The study suggests that the time spent with the health care provider in it self may be reassuring and beneficial in order for the patient to restore normal activities and routines. Possibly the providers in the control groups were more updated on the guidelines than average and therefore were more concerned about the delivery of these recommendations. GPs and PTs should be updated and adhere to the guidelines in their daily practices and spend sufficient time with longstanding LBP patients.