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Abstract
Low back pain is a common ailment in the general population and in the military, resulting in a lost work time and even disability in both groups. Educational interventions based on a fear-avoidance beliefs model are the present standard of care, but lack consistently demonstrated improvement outcomes in fear-avoidance beliefs, disability, and pain.
Drawing from research in education psychology, education technology, and behavior change, this study lays a theoretical foundation for design and delivery of a dynamic, interactive multimedia educational intervention consisting of tailored behavior change messages aimed at educating back pain patients and eliciting positive health behavior changes. The effectiveness of this innovation is compared to two traditional educational interventions in a randomized clinical trial.
One hundred and fifty military patients with back pain were randomly assigned to one of three instructional interventions: pamphlet (IP), group health education class (GHE), or the computer-based, tailored, multimedia instructional module (TMI). Fear-avoidance beliefs, disability, and pain outcomes were measured before the intervention and at 2, 4, 6, 12, and 26 weeks post intervention. Fifty-one subjects consistently provided follow-up data (IP, N = 14; GHE, N = 11; TMI, N = 26).
A repeated measures ANOVA yielded no significant between-groups differences in disability, or pain levels. Controlling for severity of initial levels of fear-avoidance beliefs (FABQphys) revealed significant between-group differences, F(2, 45) = 3.22, p = 0.0493.
Only the TMI group demonstrated statistically significant within-group improvements in disability (RDQ) [t(25) = 3.27, p = 0.0032] and pain levels [t(25) = 2.95, p = .0004]. The TMI group also consistently reported clinically significant improvements in pain and disability eight weeks earlier than the traditional IP or GHE groups.
Secondary data suggest that the TMI module had a greater motivational effect on subjects than either traditional education intervention. A significantly greater number of patients from the TMI group remained engaged in this research effort [χ2(2) = 11.23, p = <0.01].
Results demonstrate that a dynamic, tailored, multimedia instructional module is a viable alternative to the traditional pamphlet and group educational interventions used in the military primary care setting for patients with low back pain. Further research is suggested to determine whether making the tailored multimedia module available on demand might further improve outcomes.
