QUESTIONS: What is the effect of advice/education compared with placebo or no advice/education on pain and disability in people with non-specific spinal pain? To what extent do characteristics of the patients, trial or intervention modify the estimate of the treatment effects?
DESIGN: A systematic review with meta-analyses of randomised controlled trials.
PARTICIPANTS: Adults with non-specific back and/or neck pain with or without radiating leg/arm pain of any duration were included. Trials recruiting pregnant women or surgical patients in the immediate postoperative phase were ineligible.
INTERVENTION: Advice or education.
OUTCOME MEASURES: The primary outcomes were self-reported pain and disability, and the secondary outcome was adverse events. The following potential effect modifiers were examined: risk of bias, duration of pain, location of pain, intensity of intervention and mode of intervention.
RESULTS: Twenty-seven trials involving 7,006 participants were included. Eighteen of the included trials were assessed as being at low risk of bias (= 6 on the PEDro scale). There was low-quality evidence that advice had a small effect on pain (MD -8.2, 95% CI -12.5 to -3.9, n = 2,241) and moderate-quality evidence that advice had a small effect on disability (MD -4.5, 95% CI -7.9 to -1.0, n = 2,579) compared with no advice or placebo advice in the short-term. None of the items that were assessed modified the treatment effects.
CONCLUSION: Advice provides short-term improvements in pain and disability in non-specific spinal pain, but the effects are small and may be insufficient as the sole treatment for patients with spinal pain.
REGISTRATION: PROSPERO CRD42020162008.
|Rehab Clinician (OT/PT)|
The study showed a small, short-term benefit of advice for patients with nonspecific back pain. It is a difficult, wooly topic as advice was not well specified and there was no exploration as to the knowledge of the "no advice group" (even casual advice or self-help from the internet could not be excluded). At best, advice seems to offer some short term benefit, but may not be enough to obviate other treatment measures, e.g., drugs or physiotherapy.
As an inpatient physical therapist, I find that many times advice is a majority of the treatment session because the symptoms are in the acute phase. As some surgeons have begun to take cash only, the inclusion of PT in the acute phase has been questioned. In regards to unspecified back pain, this article has very interesting information that should prompt PT's to re-evaluate how they treat in the acute phases of low back pain.
Thi sis a well researched article and current topic of interest.