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Back DisorderNCT04600843

Effects of Patient Education Manual in Patient With Chronic Low Back Pain

A study testing Physical therapy with Patient education and Physical Therapy without patient Education in people with Back Disorder, run by Riphah International University at 1 site in Pakistan.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

It was a randomized clinical trial conducted to determine the effects of patient education manual on pain, range of motion and function in patient with chronic low back pain at Salamat hospital Satellite Town Gujranwala in patients with 6-month chronic low back pain who were willing to follow patient education manual. Read more about this study

Who is it for?
Ages 20 to 50 years
Conditions the study is for
Back Disorder
What is being tested?
Physical therapy with Patient education and Physical Therapy without patient Education
Could I receive a placebo?
No, everyone receives an active treatment
How many people
24 participants
Where
1 sitePakistan
Study dates
30 Dec 2019to 30 Sep 2020
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 20 to 50 years
  • All sexes
  • No healthy volunteers
  • Adult

Who may be able to join

  • 6 months chronic,
  • localized low back pain

Who cannot join

  • Patients with radicular low back pain
  • Ankylosing spondylitis
  • spinal stenosis
  • Fibromyalgia
  • 0steoprosis
  • Cognitive impairment
  • Traumatic injury

Trial locations and contacts

1 site in 1 country.

Pakistan1 site
  • Salamat Hospital,Satellite Town

    Chak One Hundred Seventy-five Nine Left, Punjab Province

Other trials in Pakistan

About this study

Official title: Effects of Patient Education Manual on Pain, Range of Motion and Function in Patient With Chronic Low Back Pain Neck Pain

It was a randomized clinical trial conducted to determine the effects of patient education manual on pain, range of motion and function in patient with chronic low back pain at Salamat hospital Satellite Town Gujranwala in patients with 6-month chronic low back pain who were willing to follow patient education manual. Patients were assessed for pain, disability due to backpain and lumbar ranges, at baseline, 2nd, 4th and 6th week of intervention. The SPSS 20.0 version was used to analyse data. Tests of normality were executed that whether data was normative or non-parametric, based on which outcomes were compared either using independent samples t test or Mann-Whitney test.

Read the detailed description

The goal of current study was to figure out how patient education manual can impact the outcomes, such as decreasing pain and disability and increasing range of lumbar spine, in patients having low back pain. The patient education manual model has been under research in recent time all over the world. There have been mixed results. Mostly there is moderate to high quality evidence in support of patient education that it can help improving the efficacy of physical therapy treatment. However, the previous literature lacks in uniformity of outcome measures used in the studies and spinal ranges have not been studied in majority studies.

This study was conducted by developing a patient education manual given to patients along with routine physical therapy. The study findings showed that the patients with combination of patient education manual and routine physical therapy improved their disability level significantly more than the patients in control group receiving routine physical therapy alone. However, there was no significant difference in improvement of pain itself and spinal ranges of lumbar region except lumbar flexion which was improved significantly among patient education manual group. When the analysis was performed for within group pre and post interventional difference in both groups separately, it was seen that patient improved in both groups significantly at all stages of measurements such as 2nd, 3rd and 6th week, p value less than 0.05.

Looking closer, it was seen that pain was improving similarly in both groups, p value more than 0.05. However, it was slightly better in Group A, having combination of patient education manual and routine physical therapy, with a slight mean difference i.e. -.33333 at 2nd and 4th week and -.41667 at 6th week post intervention. In past studies pain has been reported to be significantly better with patient education groups.

The disability was measured by Oswestry Disability Index for back pain. It was seen that patients having patient education manual significantly improved at all assessment stages i.e. at 2nd, 4th and 6th week, p value less than 0.05. This was the only outcome in this study showing a significantly better effect of patient education manual with straight and clear findings. The mean difference was of 4.25000 at 2nd week, while peak mean difference of 8.83333 points was seen at 4th week which declined to 4.83333 at 6th week but it was still significantly better as compared to routine physical therapy group. It also indicated the gradually fading off difference in long term assessment. In previous studies functional has always been found to improve with patient education. This might due to nature of this outcome which is based on patients' experience and perception, which means due to patient education or information material, it is possible that it has uplifted moral of patients and ultimately, they feel better in all aspects of function. Whatsoever the reason, disability can be greatly improved by use of patient education method in patient with low back pain.

The spinal ranges was the special outcome measure in current study that has been addressed the least in previous literature. It was seen that except lumbar flexion, all ranges were improving without any significant difference, even the improvement in lumbar flexion became same at 6th week assessment. Moreover, there was no consistency in mean difference of ranges, some ranges improved slightly better at one stage of assessment while the same ranges were slightly less improved at other stage, but overall there was no significant difference.

A study had discussed effect of patient education on ranges in terms of its long-term impact and recurrence of hypomobility in spinal region. The study has multiple outcome measures such as pain, disability, ranges and quality of life. The study suggested that all in short term patient education played a significantly better role in improving pain, function and life quality but ranges were no different. Furthermore, all ranges were not measured due to their consistently being similar.

It can be said that all outcomes in which were clinician-based has no difference of improvement in patient education manual group or that of control group while the outcome which were based on patient's perception were improved more among patient education manual group. This pattern can be seen in satisfaction with manual therapy. Although, satisfaction was not associated with treatment group as shown by non-significant p value of chi square more than 0.05, but it can be seen that patients with patient education manual reported themselves to be 'very satisfied' category while in control group the majority patients reported themselves in 'satisfied' category. This showed that all patients were satisfied with care provided for treatment of backpain but providing a patient education manual can further boost their satisfaction which is then reflected in their function.

In short, the outcomes such as function were improved with combination of patient education manual and routine physical therapy while the pain and ranges were no different with or without patient education manual. There needs further studies with more sample size and long term assessment in order see long term impact of patient education manual.

Conditions
Back Disorder
Being tested
Physical therapy with Patient education, Physical Therapy without patient Education
Keywords
Back Pain Exercise Therapy, Patient Education Manual

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Physical therapy with Patient educationOther

    Also called patient education manual

    patient manual was translated and validated in Urdu which was provided to patients so that they can follow it at home

  • Physical Therapy without patient EducationOther

    Group B was only treated with proper physical therapy treatment protocol according to patient presenting condition

Study groups in NCT04600843
Study groupRoleWhat they receive
Physical therapy with Patient educationExperimentalTreated with proper physical therapy treatment protocol according to patient presenting condition and patient education manual
Receives: Other: Physical therapy with Patient education
Physical Therapy without patient EducationExperimentalTreated with proper physical therapy treatment protocol according to patient presenting condition
Receives: Other: Physical Therapy without patient Education

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Oswestry Disability Index

    The Oswestry Disability Index (ODI) (also known as the Oswestry Low Back Pain Disability Questionnaire) is an extremely important tool that researchers and disability evaluators use to measure a patient's permanent functional disability. The test is considered the 'gold standard' of low back functional outcome tool. The scores for all questions answered are summed, then multiplied by two to obtain the index (range 0 to 100). Zero is equated with no disability and 100 is the maximum disability possible

    Measured: 6th Week

Secondary outcomes (1)
  1. Numeric Pain Rating Scale (NPRS)

    NPRS is anchored by terms describing pain severity extremes. The 11-point numeric scale ranges from '0' representing one pain extreme (e.g. "no pain") to '10' representing the other pain extreme (e.g. "pain as bad as you can imagine" or "worst pain imaginable").

    Measured: 6th Week

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted23 Oct 2020
  2. Study start30 Dec 2019
  3. Primary completion30 Aug 2020
  4. Study completion30 Sep 2020

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
24 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04600843
Sponsor's protocol ID
REC/RCRS/20/1003 Mubashra
Status last verified
Oct 2020
First submitted
19 Oct 2020
Last updated
28 Oct 2020
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Sahin N, Karahan AY, Albayrak I. Effectiveness of physical therapy and exercise on pain and functional status in patients with chronic low back pain: a randomized-controlled trial. Turk J Phys Med Rehabil. 2017 Aug 9;64(1):52-58. doi: 10.5606/tftrd.2018.1238. eCollection 2018 Mar.

    PubMed 31453489
  • Saper RB, Lemaster C, Delitto A, Sherman KJ, Herman PM, Sadikova E, Stevans J, Keosaian JE, Cerrada CJ, Femia AL, Roseen EJ, Gardiner P, Gergen Barnett K, Faulkner C, Weinberg J. Yoga, Physical Therapy, or Education for Chronic Low Back Pain: A Randomized Noninferiority Trial. Ann Intern Med. 2017 Jul 18;167(2):85-94. doi: 10.7326/M16-2579. Epub 2017 Jun 20.

    PubMed 28631003
  • Traeger AC, Lee H, Hubscher M, Skinner IW, Moseley GL, Nicholas MK, Henschke N, Refshauge KM, Blyth FM, Main CJ, Hush JM, Lo S, McAuley JH. Effect of Intensive Patient Education vs Placebo Patient Education on Outcomes in Patients With Acute Low Back Pain: A Randomized Clinical Trial. JAMA Neurol. 2019 Feb 1;76(2):161-169. doi: 10.1001/jamaneurol.2018.3376.

    PubMed 30398542
  • Pieber K, Herceg M, Quittan M, Csapo R, Muller R, Wiesinger GF. Long-term effects of an outpatient rehabilitation program in patients with chronic recurrent low back pain. Eur Spine J. 2014 Apr;23(4):779-85. doi: 10.1007/s00586-013-3156-z. Epub 2014 Jan 11.

    PubMed 24413743
  • Hanney WJ, Masaracchio M, Liu X, Kolber MJ. The Influence of Physical Therapy Guideline Adherence on Healthcare Utilization and Costs among Patients with Low Back Pain: A Systematic Review of the Literature. PLoS One. 2016 Jun 10;11(6):e0156799. doi: 10.1371/journal.pone.0156799. eCollection 2016.

    PubMed 27285608
  • Medeiros FC, Costa LOP, Added MAN, Salomao EC, Costa LDCM. Longitudinal Monitoring of Patients With Chronic Low Back Pain During Physical Therapy Treatment Using the STarT Back Screening Tool. J Orthop Sports Phys Ther. 2017 May;47(5):314-323. doi: 10.2519/jospt.2017.7199. Epub 2017 Mar 29.

    PubMed 28355979
  • Barbari V, Storari L, Ciuro A, Testa M. Effectiveness of communicative and educative strategies in chronic low back pain patients: A systematic review. Patient Educ Couns. 2020 May;103(5):908-929. doi: 10.1016/j.pec.2019.11.031. Epub 2019 Dec 4.

    PubMed 31839351
  • Beattie PF, Silfies SP, Jordon M. The evolving role of physical therapists in the long-term management of chronic low back pain: longitudinal care using assisted self-management strategies. Braz J Phys Ther. 2016 Nov-Dec;20(6):580-591. doi: 10.1590/bjpt-rbf.2014.0180. Epub 2016 Jun 30.

    PubMed 28001268
  • Burns SA, Cleland JA, Rivett DA, Snodgrass SJ. Effectiveness of physical therapy interventions for low back pain targeting the low back only or low back plus hips: a randomized controlled trial protocol. Braz J Phys Ther. 2018 Sep-Oct;22(5):424-430. doi: 10.1016/j.bjpt.2018.08.014. Epub 2018 Sep 7.

    PubMed 30217693
  • Cherkin DC, Deyo RA, Street JH, Hunt M, Barlow W. Pitfalls of patient education. Limited success of a program for back pain in primary care. Spine (Phila Pa 1976). 1996 Feb 1;21(3):345-55. doi: 10.1097/00007632-199602010-00019.

    PubMed 8742212
  • Davin S, Lapin B, Mijatovic D, Fox R, Benzel E, Stilphen M, Machado A, Katzan IL. Comparative Effectiveness of an Interdisciplinary Pain Program for Chronic Low Back Pain, Compared to Physical Therapy Alone. Spine (Phila Pa 1976). 2019 Dec 15;44(24):1715-1722. doi: 10.1097/BRS.0000000000003161.

    PubMed 31794508
  • de Souza FS, Ladeira CE, Costa LOP. Adherence to Back Pain Clinical Practice Guidelines by Brazilian Physical Therapists: A Cross-sectional Study. Spine (Phila Pa 1976). 2017 Nov 1;42(21):E1251-E1258. doi: 10.1097/BRS.0000000000002190.

    PubMed 28399548
  • Deutscher D, Werneke MW, Hayes D, Mioduski JE, Cook KF, Fritz JM, Woodhouse LJ, Stratford PW. Impact of Risk Adjustment on Provider Ranking for Patients With Low Back Pain Receiving Physical Therapy. J Orthop Sports Phys Ther. 2018 Aug;48(8):637-648. doi: 10.2519/jospt.2018.7981. Epub 2018 May 22.

    PubMed 29787696
  • Du S, Hu L, Dong J, Xu G, Chen X, Jin S, Zhang H, Yin H. Self-management program for chronic low back pain: A systematic review and meta-analysis. Patient Educ Couns. 2017 Jan;100(1):37-49. doi: 10.1016/j.pec.2016.07.029. Epub 2016 Jul 25.

    PubMed 27554077
  • Fritz JM, Kim M, Magel JS, Asche CV. Cost-Effectiveness of Primary Care Management With or Without Early Physical Therapy for Acute Low Back Pain: Economic Evaluation of a Randomized Clinical Trial. Spine (Phila Pa 1976). 2017 Mar;42(5):285-290. doi: 10.1097/BRS.0000000000001729.

    PubMed 27270641

Questions about this trial

What is this clinical trial studying?

A study testing Physical therapy with Patient education and Physical Therapy without patient Education in people with Back Disorder, run by Riphah International University at 1 site in Pakistan.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 2 inclusion and 7 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 28 Oct 2020. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Pakistan. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Oswestry Disability Index (time frame: 6th Week). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04600843, which also lists 15 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 28 Oct 2020.

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