The research team has prepared an educational program using interactive media (both computer and videodisc) to help patients with low back disorders make more informed decisions about undergoing back surgery. Back pain is an ideal problem for this type of educational intervention, because it is extremely common, health care costs are high (over $24 billion a year), and back surgery is almost always an elective procedure whose major benefit is accelerated symptom relief. The videodisc program provides an individualized presentation, depending on the patient's age and diagnosis, and provides the best available information regarding expected treatment outcomes of surgical and nonsurgical care. It includes commentary from actual patients who have experienced good and bad outcomes from their treatment choices. The investigators now propose a randomized trial to evaluate the impact of this program on patient functional status; satisfaction with medical care; knowledge of low back problems relevant to making informed choices; likelihood of selecting surgical therapy; and health care utilization. This trial will compare the low back pain videodisc program to written educational materials as adjuncts to usual care for low back pain. Patients randomly allocated to the control group will receive a specially designed brochure on patient treatment choices for low back problems. Subjects in the videodisc intervention group view the video program and receive a printed table of the data they have seen. The study will be conducted in two sites: a closed-panel HMO (where subjects will be identified by surgical referrals from primary care practice); and a fee- for-service academic surgical practice. Following the educational intervention, patient knowledge and attitudes will be assessed, and treatment choices recorded. Patients will then receive follow-up at three and twelve months to determine their health status, function, satisfaction, and health care utilization. We anticipate that a total of 600 subjects will be enrolled and randomly allocated. Because of the different practice sites, the results should be widely generalizable, and there will be some opportunity to assess whether the impact of the videodisc varies in different types of practices. If the new videodisc educational technology proves effective, it will serve to enhance patient autonomy and empower patients in their health care decision-making. It may also modify surgical rates, since patients have proven in other settings to be more risk averse than surgeons, and sometimes make different treatment choices.
