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Pamphlets Won't Help Patients Get Back to Work More Quickly After Back Injury

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WebMD Health News

June 23, 2000 -- If you've ever had a work injury that resulted in low back pain, you probably knew you weren't going to die, even though you felt like it. If you got a pamphlet in the mail reassuring you that you would recover, and giving you some healthy back tips, would this pamphlet help you get back to work sooner?

If you answered "no," you would be in the majority. According to an article published in a recent issue of the journal Spine, educational pamphlets were found to be ineffective in reducing back-related disability following a work-related low back injury. These findings are particularly disappointing given that patient education has been a popular strategy recently in the medical community's efforts to reduce back-related disability.

However, the investigators are hopeful that the problem with pamphlets will be solved by fine-tuning the message and the medium. "Even the best educational method will not reduce disability without effective content," the authors write. For example, a better place and way to educate people with work-related back injuries may help them recover faster. In this study, the only education was a pamphlet sent in the mail. Patients who are back to work may also benefit from seminars at the workplace. However, the authors acknowledge that employees usually see sessions involving mandatory participation as a big yawn.

It's important to know that these findings only pertained to patients whose injuries were sustained at work, lead author Rowland G. Hazard, MD, tells WebMD. "In this population of patients with back pain reporting work-related injury, just giving them a pamphlet is not enough to change their disability outcomes," he says. The study didn't measure the effectiveness of such a pamphlet for patients with injuries due to other causes. Hazard is a professor of orthopaedics and rehabilitation at the University of Vermont in Burlington, and the director of intensive rehabilitation at the Spine Institute of Vermont in Williston.

He and his colleagues identified 726 workers who had reported back pain within 11 days of an injury on the job. Of the 488 who consented to participate, 229 of them were sent an educational pamphlet in the mail. In follow-up telephone interviews, 87% of those who were sent a pamphlet recalled getting it, and more than half thought that it had been helpful. Unfortunately, only 25 (11%) thought the pamphlet had aided their return to work.

More than 90% of the overall group were back to work three months after their injury. At this time, according to the authors, there were no significant differences between the groups who received the pamphlets and those who didn't in regard to pain severity, improvement of pain since its worst, or the number of health care visits. Even the 25 patients who thought the pamphlet helped speed their return to work did not actually return to work more quickly than those who found it ineffective, write the authors.

An effective pamphlet needs to be part of an overall treatment approach, Marco Campello, PT, tells WebMD in an interview seeking an objective assessment of the study. "[O]ther studies have proven before that a pamphlet alone, without any guidance, doesn't work," says Campello, the associate clinical director of the Occupational and Industrial Orthopaedic Center at the Hospital for Joint Diseases in New York City. A team of physicians, nurses, and physical therapists should be telling the patient that people tend to recover well after a low back injury, he says. If that information is reinforced by the pamphlet's content, then the pamphlet is an effective tool.

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