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Can a Back Pain E-mail Discussion Group Improve Health Status and Lower Health Care Costs?
A Randomized Study
Kate R. Lorig, DrPH;
Diana D. Laurent, MPH;
Richard A. Deyo, MD;
Margaret E. Marnell, PhD;
Marian A. Minor, PhD;
Philip L. Ritter, PhD
Arch Intern Med. 2002;162:792-796.
Background Given the high health care utilization, limited evidence for the effectiveness
of back pain interventions, and the proliferation of e-mail health discussion
groups, this study seeks to determine if the Internet can be used to improve
health status and health care utilization for people with chronic back pain.
Methods Randomized controlled trial. Participants included 580 people from 49
states with chronic back pain having at least 1 outpatient visit in the past
year, no "red-flag" symptoms, and access to e-mail. Major exclusion criteria
included continuous back pain for more than 90 days causing major activity
intolerance and/or receiving disability payments.
Intervention Closed, moderated, e-mail discussion group. Participants also received
a book and videotape about back pain. Controls received a subscription to
a non–health-related magazine of their choice.
Main Outcome Measures Pain, disability, role function, health distress, and health care utilization.
Results At 1-year treatment, subjects compared with controls demonstrated improvements
in pain (P = .045), disability (P = .02), role function (P = .007), and health
distress (P = .001). Physician visits for the past
6 months declined by 1.5 visits for the treatment group and by 0.65 visits
for the control group (P = .07). Mean hospital days
declined nearly 0.20 days for the treated group vs and increased 0.04 days
for the control group (P = .24).
Conclusions An e-mail discussion group can positively affect health status and possibly
health care utilization. It may have a place in the treatment of chronic recurrent
back pain.
From Stanford University School of Medicine (Drs Lorig and Ritter and
Ms Laurent) and Department of Psychiatry, Stanford University Medical Center
(Dr Marnell), Stanford, Calif; University of Washington, School of Medicine,
Seattle (Dr Deyo); and Department of Physical Therapy, University of Missouri,
Columbia (Dr Minor).
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