Materiais educativos contendo informações derivadas de diretrizes de prática clínica são eficazes para mudar as crenças dos pacientes com dor lombar não específica? Um estudo clínico aleatorizado

Abstract

Low back pain is an extremely prevalent and disabling condition worldwide. One strategy to treat low back pain patients is to implement evidence-based interventions. Clinical practice guidelines are considered a reliable source of information, however, clinicians find it difficult to implement them in clinical practice. Considering the two recent theoretical frameworks in the health field, evidence-based practice and shared decision-making, it is recommended that health decision-making integrate scientific evidence and patient preferences. However, for patients to be able to participate effectively in this process, they need to be well informed about their condition. In this context, educational materials, such as animated videos and infographics, can help to educate and inform patients. This research aims to investigate the effectiveness of 3 educational materials, animated video, infographic and written summary, in changing the beliefs of patients with low back pain regarding their condition and the usefulness of imaging tests. The present study is a randomized clinical trial. Low back pain patients who sought care at physiotherapy services were recruited for the study. At the initial assessment, clinical data and information on primary and secondary outcomes were collected. The primary outcome of the study was measured using the Back Belief Questionnaire and the secondary outcome was assessed using 2 specific questions (Q1 and Q2) about beliefs related to the need for imaging tests. After the initial evaluation, patients with low back pain were randomized to read / watch one of the following educational materials: animated video, infographic and written summary. The outcomes were re-evaluated immediately after the intervention. For the analysis of the primary outcome, ANOVA 3 x 2 repeated measures were used to analyze the difference between the means. For the secondary outcome, the odds ratio (OR) and the 95% confidence interval (95% CI) were calculated to compare which educational material is capable of identifying participants most likely to report correct beliefs about prescribing images. A total of 159 patients (53 patients per group) were recruited for the study. All three groups improved their scores on the Back Belief Questionnaire, with an average score increase of 6.9 points (95% CI: 6.1 to 7.6) between the initial assessment and after the intervention. However, there were no differences between groups. For the secondary outcome, correct beliefs were reported more with the infographic than with the animated video (Q1 - OR = 3.9; 95% CI: 1.7 to 8.7 / Q2 - OR = 6.8; 95% CI: 2.7 to 17.2) and were reported more with written material than with animated video (Q1 - OR = 3.3; 95% CI: 1.5 to 7.4 / Q2 - OR = 3, 7; 95% CI: 1.6 to 8.5). Therefore, our findings suggest that the three materials were equally effective in improving patients' beliefs related to the Low Back Pain Belief Questionnaire, but the infographic and written summary were superior to than the video animation in promoting correct beliefs about imaging prescription.