European Spine Journal

, Volume 18, Issue 7, pp 1050–1058 | Cite as

Psychosocial education improves low back pain beliefs: results from a cluster randomized clinical trial (NCT00373009) in a primary prevention setting

  • Steven Z. George
  • Deydre S. Teyhen
  • Samuel S. Wu
  • Alison C. Wright
  • Jessica L. Dugan
  • Guijun Yang
  • Michael E. Robinson
  • John D. Childs
Original Article


The general population has a pessimistic view of low back pain (LBP), and evidence-based information has been used to positively influence LBP beliefs in previously reported mass media studies. However, there is a lack of randomized trials investigating whether LBP beliefs can be modified in primary prevention settings. This cluster randomized clinical trial investigated the effect of an evidence-based psychosocial educational program (PSEP) on LBP beliefs for soldiers completing military training. A military setting was selected for this clinical trial, because LBP is a common cause of soldier disability. Companies of soldiers (n = 3,792) were recruited, and cluster randomized to receive a PSEP or no education (control group, CG). The PSEP consisted of an interactive seminar, and soldiers were issued the Back Book for reference material. The primary outcome measure was the back beliefs questionnaire (BBQ), which assesses inevitable consequences of and ability to cope with LBP. The BBQ was administered before randomization and 12 weeks later. A linear mixed model was fitted for the BBQ at the 12-week follow-up, and a generalized linear mixed model was fitted for the dichotomous outcomes on BBQ change of greater than two points. Sensitivity analyses were performed to account for drop out. BBQ scores (potential range: 9–45) improved significantly from baseline of 25.6 ± 5.7 (mean ± SD) to 26.9 ± 6.2 for those receiving the PSEP, while there was a significant decline from 26.1 ± 5.7 to 25.6 ± 6.0 for those in the CG. The adjusted mean BBQ score at follow-up for those receiving the PSEP was 1.49 points higher than those in the CG (P < 0.0001). The adjusted odds ratio of BBQ improvement of greater than two points for those receiving the PSEP was 1.51 (95% CI = 1.22–1.86) times that of those in the CG. BBQ improvement was also mildly associated with race and college education. Sensitivity analyses suggested minimal influence of drop out. In conclusion, soldiers that received the PSEP had an improvement in their beliefs related to the inevitable consequences of and ability to cope with LBP. This is the first randomized trial to show positive influence on LBP beliefs in a primary prevention setting, and these findings have potentially important public health implications for prevention of LBP.


Primary prevention Patient education Biopsychosocial Public health 


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Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Steven Z. George
    • 1
  • Deydre S. Teyhen
    • 2
  • Samuel S. Wu
    • 3
  • Alison C. Wright
    • 2
  • Jessica L. Dugan
    • 2
  • Guijun Yang
    • 3
    • 4
  • Michael E. Robinson
    • 5
  • John D. Childs
    • 2
  1. 1.Department of Physical Therapy, Brooks Center for Rehabilitation StudiesCenter for Pain Research and Behavioral Health, University of FloridaGainesvilleUSA
  2. 2.US Army-Baylor University Doctoral Program in Physical Therapy (MCCS-HGE-PT)Army Medical Department Center and SchoolFort Sam HoustonUSA
  3. 3.Department of Epidemiology and Health Policy ResearchUniversity of FloridaGainesvilleUSA
  4. 4.Department of StatisticsTianjin University of Finance and EconomicsTianjinPeople’s Republic of China
  5. 5.Department of Clinical and Health Psychology, Center for Pain Research and Behavioral HealthUniversity of FloridaGainesvilleUSA

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