Low-back disorders are common and involve complex interactions
among physiologic, psychosocial, and environmental factors. Patients
with lumbar spine problems are often confused by the ill-defined
nature of their condition and the apparent ambiguity in the decision-making
process for both diagnosis and treatment. When referral is made for
consideration of surgical intervention, the ability of a patient
to participate effectively in his or her care is tested. Efforts
to educate patients about their conditions and to permit them to participate
in a shared decision-making process by providing them with valid scientific
information are laudable and would seem likely to influence patient satisfaction
and compliance. In fact, this well-designed and well-executed study
by Deyo and colleagues shows that the majority of patients in both
the video group and the booklet group were satisfied with their
care but that no difference existed between the groups. Symptomatic
and functional improvement was seen in all patient subgroups (herniated
disc, spinal stenosis, and other diagnoses) regardless of the educational
subset. This is expected because the natural history of low-back disorders
is one of improvement despite the method of treatment.
The most relevant finding of the study is the influence that
the video had on the decision-making process among patients with
herniated discs. Fewer patients in the video group than in the booklet
group opted for surgery, likely because of a better understanding
of the condition, its fairly benign natural history, and the relative
benefits and risks of surgery. If disease-specific, interactive
educational materials that are easy to use and understand are helpful
in reducing the rate of surgery without negatively affecting outcomes,
then such efforts to educate patients are worthwhile.