Describing the nonsurgical, nonpharmacological interventions offered to adolescents with persistent back pain in randomized trials: A scoping review.

BACKGROUND AND OBJECTIVES: Persistent nonspecific back pain is now established as a biopsychosocial phenomenon that can be meaningfully affected by individuals' cognitions, emotions, lifestyle factors and family and social relationships. Recent guidelines for the treatment of adolescents with persistent nonspecific back pain, as well as those for youth with mixed chronic pain, strongly recommend interdisciplinary care in which adolescents receive treatment for both mind and body. The objective of this scoping review was to examine the interventions evaluated in randomized trials for adolescents with persistent back pain to determine whether they correspond to these guidelines and to reveal future research priorities. DATABASES AND DATA TREATMENT: The review protocol was registered in March 2022. We followed the PRISMA guidelines for scoping reviews. Twelve electronic databases were searched for relevant study reports. Data were charted on study characteristics, participant characteristics and intervention details using the Template for Intervention Description and Replication (TIDieR) checklist. RESULTS: The search yielded 1952 records, of which eight reports representing seven randomized trials were eligible. The most common interventions were exercise therapy (n = 6) and back education (n = 4). Five studies employed multiple intervention components, but none was multidisciplinary. Studies primarily targeted posture or biomechanical factors. One study included an intervention addressing participants' fears and beliefs about pain. CONCLUSIONS: Randomized trials for adolescents with persistent back pain have primarily relied upon an outdated, biomechanical explanation of persisting pain. Future randomized trials should align with current treatment recommendations and measure outcomes across multiple biopsychosocial domains. SIGNIFICANCE: This scoping review describes in detail the interventions included in randomized trials for adolescents with persistent, nonspecific back pain. The review is important because it reveals discrepancies between those interventions and the interventions recommended for this population.

Patient knowledge and recall of health information following exposure to "facts and myths" message format variations.

OBJECTIVE: To assess if exposure to varying "facts and myths" message formats affected participant knowledge and recall accuracy of information related to influenza vaccination. METHODS: Consenting patients (N=125) were randomized to receive one of four influenza related messages (Facts Only; Facts and Myths; Facts, Myths, and Refutations; or CDC Control), mailed one week prior to a scheduled physician visit. Knowledge was measured using 15 true/false items at pretest and posttest; recall accuracy was assessed using eight items at posttest. RESULTS: All participants' knowledge scores increased significantly (p<0.05); those exposed to the CDC Control message had a higher posttest knowledge score (adjusted mean=11.18) than those in the Facts Only condition (adjusted mean 9.61, p=<0.02). Participants accurately recalled a mean of 4.49 statements (SD=1.98). ANOVA demonstrated significant differences in recall accuracy by condition [F(3, 83)=7.74, p<.001, η(2)=0.22]. CONCLUSION: Messages that include facts, myths, and evidence to counteract myths appear to be effective in increasing participants' knowledge. We found no evidence that presenting both facts and myths is counterproductive to recall accuracy. PRACTICE IMPLICATIONS: Use of messages containing facts and myths may engage the reader and lead to knowledge gain. Recall accuracy is not assured by merely presenting factual information.