Primum non nocere: shared informed decision making in low back pain--a pilot cluster randomised trial

Area of Science:

• Physiotherapy
• Health Services Research
• Clinical Decision Making

Background:

• Low back pain is a prevalent and disabling condition with significant healthcare costs.
• Effective strategies for improving patient choice in treatment selection are lacking.
• This study piloted a decision support package to aid patients in choosing low back pain treatments.

Purpose of the Study:

• To pilot a decision support package for low back pain treatments.
• To assess the impact of the package on patient satisfaction and treatment choice.
• To evaluate the feasibility and potential effectiveness of shared decision-making in physiotherapy.

Main Methods:

• A single-centered pilot cluster randomized controlled trial was conducted in a community physiotherapy service.
• Participants with non-specific low back pain received either a decision support package (booklet and enhanced shared decision-making training for physiotherapists) or usual care.
• Patient satisfaction was measured using a five-point Likert scale at four months.

Main Results:

• Patient satisfaction was lower in the intervention group (53%) compared to the control group (67%).
• The intervention showed a trend towards worse secondary outcomes, with a clinically important difference in the Roland Morris Disability Questionnaire.
• The intervention was not found to be cost-effective, with lower healthcare costs but also less favorable health outcomes (fewer QALYs).

Conclusions:

• The piloted decision support package did not improve patient satisfaction with low back pain treatment.
• The package may have had a detrimental effect on clinical outcomes, which is a significant concern.
• Decision support interventions require rigorous testing for clinical effectiveness, cost-effectiveness, and safety prior to implementation.