Acute low back pain (ALBP) is very prevalent in the United States, accounting for substantial morbidity, functional limitations, pain, and health care costs. Despite its prevalence and impact, there are relative few well-designed data-based studies upon which to base treatment strategies that prevent recurrences and reduce limitations from ALBP. Psychosocial interventions that target improved symptom control and patient functioning have the potential to improve the outcomes of patients with ALBP. We propose to develop and evaluate a psychosocial intervention designed to enhance self-efficacy and social support for patients with ALBP. Following a six-month developmental phase during which all materials will be developed and pilot tested, this project proposes to conduct a randomized, controlled trial in which eligible patients with ALBP are randomized to receive the intervention or usual care (160 patients per group). The intervention program will consist of: (1) patient education regarding ALBP, (2) explanations and rationales, in layman's terms, of diagnostic and treatment options for ALBP; (3) discussions regarding the management of negative affect (i.e., depression, anger, fear, hostility, anxiety); (4) methods to involve social support systems; and (5) strategies to involve the primary care physician to reinforce patients' behaviors and progress. Patients will be followed for 12 months, with outcomes being assessed at 3 and 12 months. Primary outcomes are health-related quality of life (i.e., functional status, role function, back pain symptoms) and patient satisfaction with care. Secondary outcomes include health care utilization, direct health care costs, self-efficacy, and social support. The cost- effectiveness of the intervention will also be estimated. Notably, this investigation will be conducted among socioeconomically vulnerable patients with ALBP, a group that shoulders a disproportionate burden of disability and morbidity from musculoskeletal conditions and comorbid medical conditions.
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