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BACKGROUND: Reassurance is recommended in the management of chronic low back pain (CLBP). Reassuring messages include that serious pathology has been excluded and movement is safe. The impact of patient awareness of reassuring messages on patient outcomes has not been investigated. We aimed to describe the characteristics of people reporting awareness of reassuring messages after a 3 month education and exercise program for CLBP and to determine if awareness of reassuring messages at 3 months influences patient outcomes at 6 months. METHODS: We performed a secondary analysis of 3850 adults who received a structured group-based education and exercise program for CLBP. Expert knowledge was used to construct directed acyclic graphs to identify relevant confounders. We used linear mixed models, adjusted for the identified confounders, to determine associations between self-reported awareness of reassuring messages at 3 months and patient outcomes at 6 months (pain, disability, fear-avoidance and self-efficacy), and to determine associations between baseline patient characteristics and awareness of reassuring messages at 3 months. RESULTS: More awareness of reassuring messages at 3 months positively influenced pain intensity (regression coefficients; 95% confidence interval: -0.27; -0.39, -0.14), disability (-1.01; -1.58, -0.44), and fear-avoidance (-0.85; -1.13, -0.57) at 6 months. Less threatening illness perceptions and higher levels of self-efficacy at baseline were associated with more awareness of reassuring messages at 3 months; whereas being older, male, having more leg pain, and higher fear-avoidance were associated with less awareness of reassuring messages at 3 months. CONCLUSIONS: While effects were small, awareness of reassuring messages positively influenced patient outcomes at 6 months. SIGNIFICANCE STATEMENT: Our study is the first to examine whether patient awareness of reassuring messages influences patient outcomes in chronic low back pain. We found that more awareness of reassuring messages after a group education and exercise intervention reduced pain intensity, disability and fear-avoidance. While effects were small, awareness of reassuring messages positively influenced patient outcomes. Clinicians should consider the benefits of delivering key reassuring messages as part of multi-modal low back pain management.
Young et al. (Thu,) studied this question.