Viewing video affects preferences for treatment of low back pain

Viewing an evidence-based video provides support to patients with low back pain in making decisions about whether to undergo surgical versus non surgical treatment, reports a study in a recent issue of Spine. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

"The video helped those patients who were uncertain at baseline to form a preference, and helped those patients who started with an initial preference to strengthen their preference," according to the study by Dr. Jon D. Lurie and colleagues of Dartmouth Medical School, Hanover, N.H.

Dr. Lurie and colleagues analyzed data on patients enrolled in a large clinical trial of surgical versus nonsurgical treatment for low back pain. All patients had one of three specific causes of back pain: herniated disc, spinal stenosis, or degenerative spinal disease.

As part of the trial, the patients were offered the opportunity to view a video decision aid on the choice between surgical and nonsurgical treatment. The videos provided information on the research-based evidence for surgical versus nonsurgical treatment for the patient's specific cause of back pain.

Eighty-six percent of the patients watched the videos. The researchers looked at whether and how watching the videos affected patients' preferences for treatment.

The results suggested that patients who watched the video were more likely to shift their preferences. About 38 percent of patients who viewed the video changed their treatment preferences, compared to 21 percent of those who did not watch the video.

For patients whose preference shifted after watching the video, 55 percent shifted toward surgery. Watching the video was also more likely to strengthen the patients' preferences, whether they initially preferred surgical or nonsurgical treatment.

Of patients who started with no preference, 27 percent preferred nonsurgical treatment and 22 percent preferred surgery after watching the video; the remaining 51 percent remained uncertain. The researchers point out, "There was no consistent trend in preference shifts either toward or away from surgery, suggesting that the decision aid had a balanced effect on treatment preferences…it did not appear to be biased either for or against one treatment approach."

There's a growing emphasis on shared decision-making between patients and their doctors. Shared decision-making is especially appropriate for conditions like surgery for low-back pain, in which it's reasonable to opt for surgical or nonsurgical treatment. For example, patients must decide for themselves whether the possibility of faster improvement with surgery is a good tradeoff for the associated risks.

Videos are one type of decision aid being investigated to help patients make shared treatment decisions. Studies suggest that decision aids can improve knowledge, create more realistic expectations, reduce conflict, and help patients be more actively involved in decision-making.

Viewing an evidence-based decision-aid video help patients form or strengthen their preference for surgical versus nonsurgical treatment for low back pain, the new results suggest. Dr. Lurie and colleagues conclude, "Unbiased, evidence-based decision aids such as these can be useful tools to help patients with lumbar spine disorders participate with their physicians in making an informed choice regarding whether or not to have spine surgery."