Change in Healthcare Use After a Self-Management Supportive Intervention for Low Back Pain-A Quasi-Experimental Study
Søren Grøn1, Melker Johansson1,2, Kim Rose Olsen3
1Center for Muscle and Joint Health, Departments of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark.
Background:
Individuals with low back pain (LBP) have high healthcare use (HCU). It is currently unclear whether self-management supportive interventions can decrease HCU among patients with LBP. The aim of this study was to investigate changes in visits to primary care and redeemed prescriptions of analgesics after enrolment in a self-management supportive programme compared to usual care.
Methods:
This quasi-experimental study included adults with LBP who enrolled in the Danish GLA:D Back programme between 2018 and 2022. GLA:D Back is a structured 10-week programme of group-based patient education and supervised exercises aiming to enhance self-management skills. HCU was obtained from national registries as the total quarterly visits to primary care (general practitioner, physiotherapists or chiropractor) or quarterly total redeemed defined daily doses (DDD) of analgesics (paracetamol, non-steroidal anti-inflammatory drugs or opioids).
Results:
We included 4205 individuals. From 2 to 14 quarters post-enrolment, the additional quarterly reduction in HCU after the programme compared to the control group was -1.1 (95% CI -1.5 to -0.8) visits to primary care and -5.3 (95% CI -9.2 to -2.2) DDDs of redeemed analgesics. Sensitivity analyses questioned the statistical significance of the reduction in analgesic use, but results for people with LBP duration > 1 year were robust for both outcomes. The largest reductions were observed in those with high HCU at baseline.
Conclusion:
Participation in a structured self-management programme led to a sustained reduction in primary care visits and analgesic use over a 3-year period, although regression to the mean may partly explain these reductions.
Significance Statement:
This quasi-experimental study demonstrated that a structured self-management supportive programme for low back pain reduced future healthcare use, especially among individuals with long-lasting pain or high initial healthcare use. These findings suggest a potential to alter healthcare use through structured interventions to support self-management.
