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The Effectiveness of a Physician-Led Web Portal on Back Pain: A Cluster Randomized Controlled Trial
Christian Schlett1, Piet van der Keylen, Andrea C Schöpf-Lazzarino
1Section of Health Care Research and Rehabilitation Research, Medical Faculty and Medical Center, University of Freiburg; Institute of General Medicine, Friedrich Alexander University Erlangen-Nuremberg, University Hospital Erlangen, and Lutheran University of Applied Sciences, Nuremberg; Careum School of Health, Zurich, Switzerland; Medical Psychology and Medical Sociology, Faculty of Medicine, Albert Ludwig University of Freiburg; IU International University of Applied Sciences, Erfurt; Department of Health Professions, Competence Centre Interprofessionalism, Bern University of Applied Sciences, Switzerland; Institute of General Practice/Family Medicine, Medical Faculty and Medical Center, University of Freiburg; Institute for Evidence in Medicine, Medical Faculty and Medical Center, University of Freiburg; Cochrane Germany, Cochrane Germany Foundation, Freiburg; Institute of Medical Biometry and Statistics, Medical Faculty and Medical Center, University of Freiburg.
Background:
It is important for patients with back pain to be well-informed. The well-informed patient is better prepared for selfmanagement and for joint decision-making with the physician. This is why we developed tala-med, a web portal providing up-to-date, evidence-based, independent information on back pain. Primary care physicians can use it in their practices and make it accessible to their patients.
Methods:
A cluster randomized controlled trial (registration number DRKS00014279) was carried out in which the primary care physicians (PCPs) in the intervention group (IG: 33 physicians) were directed to use the tala-med web portal in their consultations with patients who had back pain (180 patients). The PCPs in the control group (CG: 12 physicians) were not given access to talamed and treated their patients with back pain (136 patients) as they had done before. The patients' informedness about back pain was the primary endpoint: it was assessed by the patients themselves in terms of their subjective degree of knowledge and subjective state of informedness about back pain. Pain intensity, the second endpoint, was assessed with a visual analog scale.
Results:
Intention-to-treat analyses revealed that the patients' subjective degree of knowledge about back pain increased to a greater extent in the intervention group than in the control group (B = 0.25, 95% confidence interval [0.07; 0.43]), as did their subjective state of informedness about back pain (B = 0.51 [0.13; 0.89]). Patients in the intervention group also reported a larger reduction of pain intensity compared to patients in the control group (B = -10.46 [-18.52; -2.38]).
Conclusion:
Use of the tala-med web portal by primary care physicians and their patients made patients better informed about back pain and lessened the intensity of their pain. These improvements, although statistically significant, were not large enough to be clinically important.
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