Outcomes in Participants With Chronic Low Back Pain? Secondary Analysis of an Observational Study in Primary Care

Background: Reassurance is recommended in the management of chronic low back pain (CLBP). Reassuring messages includethat serious pathology has been excluded and movement is safe. The impact of patient awareness of reassuring messages on pa-tient outcomes has not been investigated. We aimed to describe the characteristics of people reporting awareness of reassuringmessages after a 3 month education and exercise program for CLBP and to determine if awareness of reassuring messages at 3months influences patient outcomes at 6 months.Methods: We performed a secondary analysis of 3850 adults who received a structured group-based education and exercise pro-gram for CLBP. Expert knowledge was used to construct directed acyclic graphs to identify relevant confounders. We used linearmixed models, adjusted for the identified confounders, to determine associations between self-reported awareness of reassuringmessages at 3 months and patient outcomes at 6 months (pain, disability, fear-avoidance and self-efficacy), and to determineassociations 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 reas-suring messages at 3 months; whereas being older, male, having more leg pain, and higher fear-avoidance were associated withless 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 patientoutcomes in chronic low back pain. We found that more awareness of reassuring messages after a group education and exerciseintervention reduced pain intensity, disability and fear-avoidance. While effects were small, awareness of reassuring messagespositively influenced patient outcomes. Clinicians should consider the benefits of delivering key reassuring messages as part ofmulti-modal low back pain management.