One-Page Patient Fact Sheets for Low Back Pain in Primary Care
Bibliographic record
Abstract
Importance: Supporting informed decision-making is a fundamental aspect of primary care for low back pain. Two alternative approaches are providing fact sheets that list information about managing back pain or fact sheets that give advice on how to self-manage back pain, the comparative effects of which are unknown. Objective: To determine the effects of 1-page fact sheets on patient-reported preparedness for shared decision-making among people with low back pain. Design, Setting, and Participants: This 2-group parallel randomized clinical trial recruited 1080 adults from April 1, 2023, to April 30, 2024, who had recently seen their physician for uncomplicated low back pain. Participants were randomized to receive 1 of 2 one-page fact sheets. Outcomes were collected immediately after reading the fact sheet. Interventions: The information sheet was a 1-page fact sheet from a reputable medical journal and listed guideline-recommended management options. The advice sheet was a 1-page fact sheet from a recent clinical care standard and provided advice on how to self-manage low back pain. Main Outcomes and Measures: The primary outcome was patient-reported preparedness for decision-making, measured by the 100-point Preparation for Decision Making scale (where higher scores indicated higher preparedness for decision-making). Secondary outcomes included intentions for guideline-recommended interventions (staying active, physical therapies, and heat application) and nonrecommended interventions (imaging and opioid medicines). Analysis was performed on an intent-to-treat basis. Results: The total study sample included 1080 patients (mean [SD] age, 51.9 [14.7] years; 764 women [70.7%]). After reading the fact sheet, mean (SD) scores for preparation for decision-making were 57.6 (26.5) in the information sheet group and 52.9 (26.2) in the advice sheet group (adjusted mean difference, 4.7 points; 95% CI, 1.0-8.5 points; P = .01). A larger effect was observed among participants with chronic low back pain (mean [SD], 58.3 [28.9] points with information sheet vs 51.9 [28.4] points with advice sheet; adjusted mean difference, 6.4 points; 95% CI, 1.7-11.0 points; P = .007) compared with those with acute low back pain (mean [SD], 57.8 [26.0] points with information sheet vs 56.6 [29.2] points with advice sheet; adjusted mean difference, 1.2 points; 95% CI, -4.9 to 7.4 points; P = .70). There were no significant between-group differences in intentions to use guideline-recommended or nonrecommended interventions. Conclusion and Relevance: In this randomized clinical trial among people who had recently seen their physician for uncomplicated low back pain, an information sheet listing management options was more effective than an advice sheet at preparing patients for shared decision-making. It is uncertain whether this effect is meaningful. Trial Registration: http://anzctr.org.au Identifier: ACTRN12623000603617.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".