Zorzi E1, Vanti C2, Pillastrini P1
1University of Bologna, DIBINEM, Bologna, Italy, 2University of Bologna, Bologna, Italy
Background: Despite educational booklets are recommended by Clinical Guidelines within the conservative therapy for non-specific spinal pain, no comprehensive systematic review has been conducted to date on their effectiveness when used as sole treatment.
Purpose: To determine if educational booklets are effective in non-specific spinal pain with respect to pain, function/disability, and quality of life, by comparison to non-treatment/placebo, to any other treatment or used in combination with any other treatment, compared to other treatment alone.
Methods: A systematic review of Randomized Controlled Trials (RCTs) published until August 2017 and investigating the effectiveness of the booklets in adult/elderly population with non-specific spinal pain was conducted. Eligible studies have been identified by searching in PubMed-MEDLINE, CINAHL, PsycINFO, Cochrane Library, Scopus, and PEDro databases. The methodological quality of the included studies was measured with the PEDro score; the relevant data were synthesized in tables and a systematic summary of the results was made.
Results: From the initials 1364 RCTs, 12 articles have been included; eight of them were quoted with high methodological quality. There is limited evidence from only one study that educational booklets are less effective than massage in chronic non-specific Neck Pain for pain (during the treatment period), and function/disability (at 4-weeks follow-up). There is no evidence on the effectiveness of the booklets in the treatment of musculoskeletal thoracic pain.
Concerning acute/subacute non-specific low back pain (LBP), there is strong evidence of no difference between booklets and usual care for function/disability, both at short and long term, and for pain at 3-weeks follow-up. Moreover, there is a conflicting evidence of less efficacy of the booklets in comparison to other interventions (e.g. McKenzie, manipulations, heat wrap therapy, and exercises) for pain and function. Concerning chronic LBP, there is strong evidence of lower effectiveness of the booklets compared to yoga and limited evidence of lower effectiveness than stretching for pain and function, both at short- and long-term follow-up. There is conflicting evidence of effectiveness similar to non-treatment for pain and function/disability, at short term follow-up.
In spinal pain, there is conflicting evidence that the booklets do not bring any additional benefits compared to non-treatment for pain at short-term, and compared to an information package or to Cognitive-Behavioral Therapy, for pain and function, at long-term follow-up. Same results emerged by comparing booklets and different treatments (e.g. McKenzie or Solution-Find Approach) in terms of function/disability and quality of life, at both short- and long-term follow-up.
Conclusion(s): Educational booklets do not seem very effective tools for non-specific spinal pain, concerning pain, function/disability, and quality of life. However, since they are simple to deliver, inexpensive and not-harmful tools, high quality research is suggested in this field, focusing on different outcome measures, as cost-efficacy, number of recurrences, cognitive-behavioural components, etc.
Implications: Educational booklets are not suggested as sole treatment in neck and low back pain to improve pain, function/disability, and quality of life. No suggestion can be expressed concerning the effectiveness of educational booklets in thoracic musculoskeletal pain.
Keywords: booklet, spine, pain
Funding acknowledgements: We declare that this study was unfunded.
Purpose: To determine if educational booklets are effective in non-specific spinal pain with respect to pain, function/disability, and quality of life, by comparison to non-treatment/placebo, to any other treatment or used in combination with any other treatment, compared to other treatment alone.
Methods: A systematic review of Randomized Controlled Trials (RCTs) published until August 2017 and investigating the effectiveness of the booklets in adult/elderly population with non-specific spinal pain was conducted. Eligible studies have been identified by searching in PubMed-MEDLINE, CINAHL, PsycINFO, Cochrane Library, Scopus, and PEDro databases. The methodological quality of the included studies was measured with the PEDro score; the relevant data were synthesized in tables and a systematic summary of the results was made.
Results: From the initials 1364 RCTs, 12 articles have been included; eight of them were quoted with high methodological quality. There is limited evidence from only one study that educational booklets are less effective than massage in chronic non-specific Neck Pain for pain (during the treatment period), and function/disability (at 4-weeks follow-up). There is no evidence on the effectiveness of the booklets in the treatment of musculoskeletal thoracic pain.
Concerning acute/subacute non-specific low back pain (LBP), there is strong evidence of no difference between booklets and usual care for function/disability, both at short and long term, and for pain at 3-weeks follow-up. Moreover, there is a conflicting evidence of less efficacy of the booklets in comparison to other interventions (e.g. McKenzie, manipulations, heat wrap therapy, and exercises) for pain and function. Concerning chronic LBP, there is strong evidence of lower effectiveness of the booklets compared to yoga and limited evidence of lower effectiveness than stretching for pain and function, both at short- and long-term follow-up. There is conflicting evidence of effectiveness similar to non-treatment for pain and function/disability, at short term follow-up.
In spinal pain, there is conflicting evidence that the booklets do not bring any additional benefits compared to non-treatment for pain at short-term, and compared to an information package or to Cognitive-Behavioral Therapy, for pain and function, at long-term follow-up. Same results emerged by comparing booklets and different treatments (e.g. McKenzie or Solution-Find Approach) in terms of function/disability and quality of life, at both short- and long-term follow-up.
Conclusion(s): Educational booklets do not seem very effective tools for non-specific spinal pain, concerning pain, function/disability, and quality of life. However, since they are simple to deliver, inexpensive and not-harmful tools, high quality research is suggested in this field, focusing on different outcome measures, as cost-efficacy, number of recurrences, cognitive-behavioural components, etc.
Implications: Educational booklets are not suggested as sole treatment in neck and low back pain to improve pain, function/disability, and quality of life. No suggestion can be expressed concerning the effectiveness of educational booklets in thoracic musculoskeletal pain.
Keywords: booklet, spine, pain
Funding acknowledgements: We declare that this study was unfunded.
Topic: Musculoskeletal: spine
Ethics approval required: No
Institution: University of Bologna
Ethics committee: Comitato Etico Indipendente di Area Vasta Emilia Centro
Reason not required: This type of study (systematic reviews) does not require ethical approval
All authors, affiliations and abstracts have been published as submitted.
