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Panel findings and recommendations: 
Patients with low back problems should be given accurate information about the following (Strength of Evidence = B)
  -   Expectations for both rapid recovery and recurrence of symptoms based on natural history of low back symptoms. 
  -   Safe and effective methods of symptom control. 
  -   Safe and reasonable activity modifications. 
  -   Best means of limiting recurrent low back problems. 
  -   The lack of need for special investigations unless Red Flags are present. 
  -   Effectiveness and risks of commonly available diagnostic and further treatment measures to be considered should symptoms persist.   
  Patient education as defined here includes all forms of patient-oriented education about low back problems except for "back schools" (formally structured, classroom-style back education programs).  Under this  definition, patient education includes printed and audiovisual materials, information given by health care providers, and educational programs that are less formal than back schools. 
Patient Education 
Literature Reviewed  Evidence on Efficacy   Potential Harms and Costs    Summary of Findings          Author's Example 
Patient Education 
  Literature Reviewed.  Of 14 articles screened for this topic, 2 met the criteria for review.67,68  Other articles contained information used by the panel, but did not meet article selection criteria.69,70,71 
  Neither of the studies meeting the criteria focused solely on patients with acute low back problems.  Both evaluated patients with low back problems of unspecified duration.  Interventions evaluated included giving patients booklets on back pain68 and holding a brief individual educational session during an emergency room visit or by phone after the visit. 67 
  Evidence on Efficacy.    Jones, Jones, and Katz67 evaluated educational intervention for patients with low back problems who came to a hospital emergency department and were referred for followup care.  Patients receiving an educational intervention in the emergency department and/or a followup phone call were more likely than control patients to schedule and keep their followup appointment. 
  Roland and Dixon68 conducted a randomized controlled trial (RCT) in which patients presenting with low back problems were assigned either to a group receiving an educational booklet on back problems or to a control group receiving no educational materials.  In the first 2 weeks after the intervention, no differences were found between the education and control groups in number of consultations for back pain.  However, in the period from 2 weeks to 1 year after the intervention, significantly fewer patients in the group receiving the booklet consulted physicians for back pain. 
  The importance of providing information to the patient is indicated in a study by Deyo and Diehl.70  Failure to receive an explanation of the problem was the most frequently cited source of patient dissatisfaction among 140 patients with low back problems.  Patients who felt they did not receive an adequate explanation wanted more diagnostic tests, were less satisfied with their visit, and were less likely to want the same doctor again, compared with patients who reported an adequate explanation. 
  Thomas71 randomly assigned patients with symptoms (including low back pain), but no definite diagnosis, to one of four consultations: either one of two positive consultations, with and without treatment, or one of two negative consultations, with and without treatment.  In the positive consultations, patients were given a firm diagnosis and told confidently that they would be better in a few days.  The negative consultations were devised so that no firm assurance was given.  Two weeks later the difference in recovery was significant between the positive and negative groups, but not between the treated and untreated groups. 
  A study of patients visiting family physicians for common symptoms, including back or neck pain, found that gaining patient agreement about the nature of the problem led to earlier resolution.69 
  Potential Harms and Costs.  The potential risks, harms, and costs of educating patients are considered to be low. 
  Summary of Findings.  Evidence indicates that educating patients about back problems may reduce use of medical resources, decrease patient apprehension, and speed recovery. The importance of gaining the patient's confidence through by providing information after history and examination has since been found prospectively by UCLA Low Back Study (Goldstein`02). 
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