Journal of Rehabilitation Medicine 51-9 | Page 74

J Rehabil Med 2019; 51: 698–704 ORIGINAL REPORT EFFECT OF ADDING LAY-TUTORS TO A BACK SCHOOL PROGRAMME FOR PATIENTS WITH SUBACUTE, NON-SPECIFIC LOW BACK PAIN: A RANDOMIZED CONTROLLED CLINICAL TRIAL WITH A TWO-YEAR FOLLOW-UP Inge GRUNDT LARSEN, MPH 1 , Lisa GREGERSEN OESTERGAARD, PhD 1,2 , Lene M. THOMSEN, MR 3 , Claus VINTHER NIELSEN, PhD 4 and Berit SCHIØTTZ-CHRISTENSEN, PhD 5 From the 1 Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus C, 2 The Research Initiative of Activity Studies and Occupational Therapy, Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, 3 Danish Rheumatism Association, Gentofte, 4 Section of Social Medicine and Rehabilitation, Department of Public Health, Aarhus University, Aarhus C and 5 Research Department, Spine Centre of Southern Denmark, Lillebaelt Hospital, Institute of Regional Health Services Research, University of Southern Denmark, Middelfart, Denmark Objective: To evaluate the effect of adding a lay-tu- tor to the educational sessions of a back school pro- gramme for patients with subacute low back pain. Methods: Patients with subacute low back pain were randomized to a 10-week programme comprising 10 h education and 20 h physical exercise led by a for- mer patient as lay-tutor, or a programme led by a physiotherapist. In the intervention group, former patients served as lay-tutors in the educational ses- sions, teaching in conjunction with physiotherapists. In the control group, 2 physiotherapists led the en- tire educational programme. Disability, back pain, leg pain and health status were evaluated blindly at 3 and 24 months. Results: Eighty-seven patients with subacute low back pain referred for treatment at 6 selected phy- siotherapy clinics were allocated to either an inter- vention group (n  = 42) or a control group (n  = 45). No statistically significant difference was found bet- ween the 2 groups. Both groups of patients showed a statistically significant improvement in health and pain measurements from the start of the study to the 3- and 24-month follow-up. Conclusion: No short- or long-term effect was found of adding a lay-tutor to the educational sessions of a back school programme for patients with subacu- te low back pain with regards to functional activity, back pain, leg pain or general health. The main limi- tations are that the potential effect of including lay- tutors in the educational part of a back school pro- gramme as an intervention in itself has to be tested, and the programme has to be tested as a complete protocol. Also, no specific testing has been perfor- med to confirm the ideal number of sessions in the programme. Key words: subacute low back pain; lay-tutor; patient educa- tion; self-care; self-management. Accepted Jul 5, 2019; Epub ahead of print Aug 14, 2019 J Rehabil Med 2019; 51: 698–704 Correspondence address: Berit Schiøttz-Christensen, Research De- partment, Spine Centre of Southern Denmark, Lillebaelt Hospital, In- stitute of Regional Health Services Research, University of Southern Denmark, DK-5500 Middelfart, Denmark. E-mail: Berit.Schiottz-Chris- [email protected] LAY ABSTRACT National and international guidelines recommend group exercise programmes for patients with specific or non- specific low back pain. This includes advice and informa- tion tailored to the patients’ needs and capabilities in order to help them self-manage their back pain. Eighty- seven patients with subacute low back pain were al- located to a 10-week programme comprising 10 h of education and 20 h of physical exercise. In the interven- tion group (42 patients), the educational part was led by a lay-tutor. In the control group (45 patients), the educational part was led by physiotherapists. Compared with patients in the educational sessions led by phy- siotherapists, patients in those led by lay-tutors did not show more improved health and pain measurements at 3 and 24 months follow-up after the start of the study. In conclusion, adding a lay-tutor to the educational ses- sions of a back school programme for subacute low back pain patients did not change the outcome at short- and long-term follow-up. N ational and international guidelines recommend group exercise programmes for patients with spe- cific or non-specific low back pain (1, 2). This includes the provision of advice and information tailored to the patients’ needs and capabilities in order to help them self-manage their back pain (3). In Denmark, back school programmes (BSP) are typically offered within the primary healthcare sector. The programmes include a combination of physical ex- ercises and education and are usually led by healthcare professionals. Education, aiming to equip the patients with adequate knowledge and skills to better manage their health-related problems, is included in the most recent programmes (4). By increasing the patients’ knowledge and skills, the educational part of the back school aims to support a patient’s motivation to change their health-related behaviour and to strengthen their ability to self-manage their back pain (5). It has been proposed that the inclusion of a lay-person as a facili- tator might increase short- and long-term self-efficacy and self-management among patients with chronic conditions (5). This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm doi: 10.2340/16501977-2584 Journal Compilation © 2019 Foundation of Rehabilitation Information. ISSN 1650-1977