Question: In patients with low-back disorders, does
the use of an interactive video program in addition to written materials affect
symptomatic and functional improvement, patient satisfaction, and choice
of treatment compared with the use of written materials alone?
Design: Randomized (allocation concealed), unblinded,
controlled trial with 1-year follow-up.
Setting: Neurosurgical practice of a health maintenance
organization in Seattle, Washington, and an orthopaedic surgery
practice of a university center in Iowa City, Iowa, USA.
Patients: 393 patients who were 18 years of age
(mean age, 53 years; 52% men) and were referred for consideration
of lumbar spine surgery for herniated discs, spinal stenosis, or
other spinal problems. Exclusion criteria included cauda equina
syndrome, progressive neurologic deficit, hearing or visual impairment,
severe comorbidities, possible pregnancy, malignancy, infection,
and previous back surgery. 344 patients (88%) completed
follow-up.
Intervention: Patients were allocated to an interactive
video program plus an educational booklet (n = 190)
or to the booklet alone (n = 203). The
video program involved use of a videodisk player, computer, touch-screen
monitor, and printer. Patients entered their age and diagnoses and
viewed information pertinent to their circumstances, including anatomy, causes
of back pain, outcome probabilities from treatment, and interviews
with other patients. The outcome probabilities were based on data
from randomized trials. The educational booklet contained anatomical
drawings, discussions of surgical and nonsurgical treatments, and
general descriptions of expected outcomes.
Main outcome measures: Functional status (assessed
with use of the Roland Disability Questionnaire and the SF-12),
improvement of symptoms, choice of treatment, and patient satisfaction
with overall care and with the decision-making process.
Main results: 97% of patients in the video
group reported viewing the program and 84% reported reading
at least half of the booklet; 97% of patients in the booklet group
reported reading at least half of the booklet. Patients in both
groups had improvement in terms of symptoms and function. At 1 year,
the groups did not differ for mean improvement in the Roland score,
back or leg pain severity, or satisfaction with current symptoms
(table). The
results did not appreciably change when patients were analyzed according
to diagnosis. Fewer video-group patients chose surgery than booklet-group
patients did, but the difference was not statistically significant (26% vs.
33%; P = 0.08), except for the
subgroup of patients with herniated discs (31% vs. 47%; P = 0.05).
The groups did not differ for satisfaction with care or with the
decision-making process.
Conclusions: In patients with low-back pain, an interactive
video program plus printed materials did not improve symptomatic or
functional outcomes or affect patient satisfaction more than printed
materials alone did. Patients with herniated discs who viewed the
videodisks were less likely to choose surgery.