Evaluation of a risk tailored intervention among low back pain patients in primary care

ISRCTN ISRCTN68205910
DOI https://doi.org/10.1186/ISRCTN68205910
Secondary identifying numbers N/A
Submission date
10/03/2009
Registration date
29/05/2009
Last edited
07/01/2010
Recruitment status
No longer recruiting
Overall study status
Completed
Condition category
Musculoskeletal Diseases
Prospectively registered
Protocol
Statistical analysis plan
Results
Individual participant data
Record updated in last year

Plain English summary of protocol

Not provided at time of registration

Contact information

Prof Thomas Kohlmann
Scientific

Walther Rathenau Str. 48
Greifswald
17475
Germany

Email thomas.kohlmann@uni-greifswald.de

Study information

Study designCluster randomised controlled trial, two treatment arms
Primary study designInterventional
Secondary study designRandomised controlled trial
Study setting(s)GP practice
Study typeTreatment
Participant information sheet Not available in web format, please use the contact details below to request a patient information sheet
Scientific titleEvaluation of a risk tailored intervention among low back pain patients in primary care: a cluster randomised controlled trial
Study objectivesTo assess the effectiveness of a risk tailored intervention among low back pain patients in primary care in improving patient outcomes.

Primary hypothesis:
The risk tailored intervention is more effective in reducing disability compared to treatment as usual.
Ethics approval(s)1. Ethics Committee of the Medical Faculty, University of Greifswald approved on the 2nd October 2008
2. Ethics Committee of the Medical Faculty, University of Göttingen approved on the 21st January 2009
Health condition(s) or problem(s) studiedLow back pain without specific origin
InterventionThe intervention consists of two elements:
1. A risk-factor screening and risk tailored educational intervention including information and counselling
2. A telephone/email consulting service concerning back pain related problems independent of risk group assignment

Both elements will be described subsequently:

Risk screening:
All patients fill out a brief risk screening inventory concerning yellow flags that are predictive of chronic back pain. Based on the results patients will be assigned to one of three risk groups (low/intermediate/high).

The tailored interventions are based on the risk factor assignment as follows:
1. Low level risk: patients receive advice on staying active by the general practitioner and will be handed an educational booklet. This booklet aims at reducing erroneous back related beliefs and fosters active health related behaviours. It argues against a biomechanical model by emphasising psychological and social aspects of back problems. Patients receive information regarding local health activities promoting physical exercise, sports, relaxation.
2. Physical risk group: in addition to the physicians' advices and the back book patients in will be offered participation in a guideline based intervention group that consists of two meetings of 120 minutes duration each. The main focus of these manualised meetings will be: education on "back myths" and risk factors, relaxation techniques, and motivation to stay active. Training selected physical exercises is a key element of these meetings. The groups will be conducted by experienced physiotherapists, and exercise therapists. The group size is limited to ten patients.
3. Psychological risk group: patients will receive physicians' advice and the back book. In addition, they will be invited to participate in a psychosocial risk factor group that comprises two additional meetings of 120 minutes duration each. These meetings will be conducted by psychologists with a specialisation in pain treatment. Patients receive a manualised cognitive-behavioural intervention that focusses on pain and strain prone situations as well as on catastrophising, depressive, and fear-avoidant cognitions. The group size is limited to five patients.
4. Combined physical and psychological risk group: patients will receive physicians' advice, the back book and an invitation to particiapte in both intervention groups as described above.

An attendance list will be taken for every course to monitor compliance. Patients receive an illustrated handbook designed specifically for the purpose of this trial with information on all covered topics. All therapeutic sessions will be structured based on a written manual. All participating therapists will have attended a training session of four hours.

Telephone, email counselling:
It is the aim of this counseling offer to answer back pain related questions that usually cannot be handled during a normal consultation. Local study coordinators (usually physiotherapists) will take on enquiries and pass them on to the collaborating MDs, psychologists, and sport scientists, as best suited. No diagnoses will be made during these contacts, neither will there be concrete therapeutic recommendations. A manual will be authored to standardise responses given during the telephone/email counselling.

This trial is carried out in cooperation with:
Gabriele Lindena
Clara Institut
Clara Zetkin Str. 34
14532 Kleinmachnow

Michael Pfingsten
Schmerzambulanz
Universitätsklinikum Göttingen
Robert-Koch Str. 40
37075 Göttingen

Ulf Marnitz
Rückenzentrum am Markgrafenpark
Markgrafenstr. 19
10969 Berlin

Jean-Francois Chenot
Abtlg. Allgemeinmedizin
Universität Göttingen
Humboltallee 38
37073 Göttingen

Ulrich Schwantes
Institut f. Allgemeinmedizin Charite
Schumannstr. 20/21
101177 Berlin

Klaus Pfeifer
Institut für Sportwissenschaft
Universität Erlangen
Gebertstr. 123 b
91508 Erlangen
Intervention typeOther
Primary outcome measure1. Functional disability as measured with the Hanover Functional Ability Questionnaire
2. Days of sick leave (over a 3-month recall period)
Secondary outcome measuresPatients' characteristics as measured by a questionnaire:
1. Graded chronic pain (Graded Chronic Pain Scale [GCPS])
2. Depression (Patient Health Questionnaire, German version [PHQ-D])
3. Quality of life (PHQ-D, 12-item short form [SF-12])
4. Fear Avoidance Beliefs Questionnaire (FABQ)
5. Physical activity
6. Catastrophising (Fatigue Severity Scale [FSS])
7. Health services utilisation

All measures will be assessed at baseline and, 6 and 12 months after inclusion in the study. Additionally, participation in the counselling groups and telephone/email contacts will be documented.
Overall study start date16/03/2009
Completion date30/03/2011

Eligibility

Participant type(s)Patient
Age groupAdult
SexBoth
Target number of participants40 GPs, 1200 patients
Key inclusion criteriaGeneral Practitioners (GPs) in Göttingen and within 20 minutes driving distance of the study centre and Berlin (less than 15 km distance from the study centre) are invited to take part in the trial by letter. Addresses were obtained from the local health boards. In case of non-response to the letter, GPs are contacted by telephone or personally.

The GPs recruit patients according to the following inclusion criteria:
1. Men and women aged 20 - 60 years
2. Consultation for low back pain
3. Written informed consent
Key exclusion criteriaPatient:
1. Severe comorbidities (e.g. congestive heart failure, tumour)
2. Back pain of specific origin
3. Insufficient German language proficiency
4. Ongoing juridical proceedings due to pension claims
5. Prior spine surgery
6. Ongoing specialised pain treatment
7. Rehabilitation because of back pain in the past five years
Date of first enrolment16/03/2009
Date of final enrolment30/03/2011

Locations

Countries of recruitment

  • Germany

Study participating centre

Walther Rathenau Str. 48
Greifswald
17475
Germany

Sponsor information

German Federal Ministry of Education and Research (Bundesministerium Fur Bildung und Forschung [BMBF]) (Germany)
Government

Hannoversche Strasse 28-30
Berlin
10115
Germany

Email pt-info@dlr.de
Website http://www.bmbf.de
ROR logo "ROR" https://ror.org/04pz7b180

Funders

Funder type

Government

German Federal Ministry of Education and Research (Bundesministerium Fur Bildung und Forschung [BMBF]) (Germany) (ref: 01EM0113)

No information available

Results and Publications

Intention to publish date
Individual participant data (IPD) Intention to shareNo
IPD sharing plan summaryNot provided at time of registration
Publication and dissemination planNot provided at time of registration
IPD sharing plan

Study outputs

Output type Details Date created Date added Peer reviewed? Patient-facing?
Protocol article protocol 05/01/2010 Yes No