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The Long-term Effects of a Self-management Program for Inner-city Primary Care Patients With Acute Low Back Pain
Teresa M. Damush, PhD;
Morris Weinberger, PhD;
Susan M. Perkins, PhD;
Jaya K. Rao, MD;
William M. Tierney, MD;
Rong Qi, MS;
Daniel O. Clark, PhD
Arch Intern Med. 2003;163:2632-2638.
Background We evaluated the effect of a self-management program for low-income primary care patients with acute low back pain (ALBP) from inner-city neighborhood health centers.
Methods We conducted a randomized controlled trial of a self-management program compared with usual care at university-affiliated neighborhood health centers and an emergency department of an inner-city public teaching hospital. We enrolled 211 patients who visited a physician for ALBP (<90 days' duration). The self-management program consisted of 3 group sessions and telephone follow-up that focused on understanding back pain, increasing physical activity, and dealing with fears and frustrations.
Results At baseline, 4 months, and 12 months, blinded interviewers assessed back pain physical function (Roland Disability Questionnaire), health status (Arthritis Impact Measurement Scales), self-efficacy, and time spent in physical activity. Compared with patients receiving usual care, intervention patients reported significantly better scores on the Roland Disability Questionnaire (P = .009), mental functioning (P = .009), self-efficacy to manage ALBP (P = .03), time spent in physical activity (P = .047), and reduced fears of movement/reinjury (P = .005) after 12 months.
Conclusion A self-management program can improve and maintain functional status, mental functioning, and self-efficacy to manage future symptoms for 1 year among primary care patients with ALBP living in the urban, inner city.
From the Indiana University Center for Aging Research (Drs Damush, Weinberger, Tierney, and Clark), Regenstrief Institute Inc (Drs Damush, Weinberger, Tierney, and Clark), Indiana University School of Medicine (Drs Damush, Weinberger, Perkins, Rao, Tierney, and Clark and Ms Qi), Roudebush VAMC (Drs Weinberger, Rao, and Tierney), and Department of Biostatistics, Indiana University (Dr Perkins and Ms Qi), Indianapolis, Ind. Dr Weinberger is now with the Department of Health Policy and Administration, University of North Carolina, Chapel Hill, and Dr Rao is now with the Centers for Disease Control and Prevention, Atlanta, Ga. The authors have no relevant financial interest in this article.
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