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Effects of minimal intervention for patient education on psychosocial outcomes for patients with low back pain: a systematic review
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Introdução: A lombalgia é uma das principais causas de carga global no mundo. A implementação de uma intervenção mínima de educação ao utente (IMEU) tem sido descrita como tendo o potencial para aumentar a eficiência dos cuidados de saúde sem comprometer os resultados clínicos. Embora o seu impacto na dor e incapacidade tenha já sido estudado, os efeitos em medidas de resultado psicossociais não são claros. Objetivos: Determinar os efeitos da IMEU comparada com a ausência ou outras intervenções em medidas de resultado psicossociais em indivíduos com lombalgia. Metodologia: Realizou-se uma revisão sistemática de ensaios clínicos aleatorizados que comparou a IMEU com a ausência ou outras intervenções. A pesquisa foi efetuada na MEDLINE, Embase, CENTRAL, CINAhL e PsycINFO até novembro/2024. O risco de viés foi avaliado através da Cochrane risk-of-bias tool e a certeza da evidência através da GRADE. Efetuou-se uma síntese narrativa dos resultados recorrendo ao método de contagem dos votos. Resultados: Quando comparada com ausência de intervenção (2 estudos), a IMEU parece não demonstrar diferenças a curto-prazo nos níveis de incómodo, catastrofização e autoeficácia. Quando comparada com outras intervenções passivas (3 estudos), também não parecem existir diferenças na ansiedade, depressão, medo de movimento, catastrofização e autoeficácia a curto-, médio- e longo-prazo. Os resultados foram inconclusivos para a comparação entre a IMEU e outras intervenções ativas (5 estudos) relativamente ao incómodo a curto- e médio-prazo. Nesta comparação, não foram encontradas diferenças nas crenças relacionadas com a lombalgia. A certeza da evidência foi maioritariamente muito baixa. Discussão: Os efeitos da IMEU em medidas de resultado psicossociais são incertos, pelo que a sua utilização isolada tem um valor clínico questionável. Investigação futura deverá focar-se na realização de ensaios clínicos de melhor qualidade e na análise de resultados como o retorno ao trabalho e o consumo de recursos de saúde.
Background: Low back pain (LBP) is a leading and growing cause of burden worldwide. The early provision of minimal intervention of patient education (MIPE) has been suggested as an efficient, low-cost intervention that can be implemented at scale without compromising patient outcomes. While MIPE has been studied for its effects on pain and disability, the influence on psychosocial outcomes remains unclear. Objectives: To determine the effects of MIPE compared to no or other interventions on psychosocial outcomes in individuals with LBP. Methods: A systematic review of randomised controlled trials comparing MIPE to no, or other interventions in patients with LBP was conducted. Studies were searched in MEDLINE, Embase, CENTRAL, CINAhL and PsycINFO from inception to November 2024. Risk of bias was assessed using the revised Cochrane risk-of-bias tool and certainty of evidence using the GRADE framework. A narrative synthesis using vote-counting was performed. Results: When compared to no intervention (2 studies), MIPE may have no differences in short-term bothersomeness, pain catastrophizing and pain self-efficacy. When compared to other passive interventions (3 studies), no differences also seem to exist for short-, medium-, and long-term anxiety, depression, fear-avoidance, pain catastrophizing, and pain self-efficacy. Results were inconclusive for the comparison of MIPE with other active interventions (5 studies) for short- and medium-term bothersomeness. For this comparison, no differences were found on back-related beliefs at any timepoint. Certainty of evidence was mostly very low. Conclusion: Current evidence on the effects of MIPE on psychosocial outcomes is very uncertain. The delivery of MIPE as a one-fits-all, stand-alone intervention has questionable clinical value. Future research should focus on the design of adequately powered trials using validated outcome measures and on the analysis of the effects of MIPE on other outcomes such as return to work and healthcare consumption.
Background: Low back pain (LBP) is a leading and growing cause of burden worldwide. The early provision of minimal intervention of patient education (MIPE) has been suggested as an efficient, low-cost intervention that can be implemented at scale without compromising patient outcomes. While MIPE has been studied for its effects on pain and disability, the influence on psychosocial outcomes remains unclear. Objectives: To determine the effects of MIPE compared to no or other interventions on psychosocial outcomes in individuals with LBP. Methods: A systematic review of randomised controlled trials comparing MIPE to no, or other interventions in patients with LBP was conducted. Studies were searched in MEDLINE, Embase, CENTRAL, CINAhL and PsycINFO from inception to November 2024. Risk of bias was assessed using the revised Cochrane risk-of-bias tool and certainty of evidence using the GRADE framework. A narrative synthesis using vote-counting was performed. Results: When compared to no intervention (2 studies), MIPE may have no differences in short-term bothersomeness, pain catastrophizing and pain self-efficacy. When compared to other passive interventions (3 studies), no differences also seem to exist for short-, medium-, and long-term anxiety, depression, fear-avoidance, pain catastrophizing, and pain self-efficacy. Results were inconclusive for the comparison of MIPE with other active interventions (5 studies) for short- and medium-term bothersomeness. For this comparison, no differences were found on back-related beliefs at any timepoint. Certainty of evidence was mostly very low. Conclusion: Current evidence on the effects of MIPE on psychosocial outcomes is very uncertain. The delivery of MIPE as a one-fits-all, stand-alone intervention has questionable clinical value. Future research should focus on the design of adequately powered trials using validated outcome measures and on the analysis of the effects of MIPE on other outcomes such as return to work and healthcare consumption.
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Educação ao utente Intervenção mínima Lombalgia Resultados psicossociais Revisão sistemática Low back pain Minimal intervention Patient education Psychosocial outcomes Systematic review