Research Summary

One-Page Information Fact Sheets Improve Shared Decision-Making Preparedness in Low Back Pain Care

Edited by:
Kate Young

Key Highlights:

  • In a randomized clinical trial of 1080 adults with uncomplicated low back pain, information-style fact sheets improved preparedness for shared decision-making compared with advice-based sheets.
  • The mean Preparation for Decision Making score was 57.6 with the information sheet versus 52.9 with the advice sheet.
  • The difference was more pronounced among patients with chronic low back pain.
  • Neither fact sheet changed patients’ intentions to pursue recommended or nonrecommended treatments.

Take Your Understanding of Low Back Pain to the Next Level at the Practical Updates in Primary Care Virtual Meeting

Practical Updates in Primary Care provides expert-led education on atopic dermatitis and related clinical challenges. Join clinicians nationwide for practical insights, emerging research, and evidence-based strategies.

Register for Practical Updates in Primary Care today to deepen your clinical expertise and improve patient management.

A randomized clinical trial published in JAMA Network Open examined whether different educational fact sheet formats could better prepare patients to engage in shared decision-making about treatment options. Researchers found that a 1-page information sheet listing guideline-recommended management options modestly improved patient-reported preparedness for decision-making compared with a directive advice sheet focused on self-management strategies.

The investigators designed the study to compare 2 commonly used approaches to patient education in primary care. While both aim to support evidence-based care, one approach provides nondirective information about available treatment options, whereas the other offers direct guidance on how to manage low back pain. The trial evaluated which strategy better prepares patients to participate in discussions with clinicians and make informed decisions about care.

The study was a two-arm, parallel randomized clinical trial conducted between April 1, 2023, and April 30, 2024. Adults aged 18 years or older who had consulted a physician for uncomplicated low back pain within the previous 4 weeks were eligible. Participants were recruited either through physician clinics using automated SMS invitations or via online advertisements on social media platforms.

A total of 1080 participants were randomized to receive one of two one-page fact sheets: an information sheet adapted from a JAMA Patient Page describing guideline-endorsed treatment options, or an advice sheet derived from an Australian clinical care standard emphasizing self-management strategies. Outcomes were collected immediately after participants read the fact sheet. The primary outcome was preparedness for shared decision-making, measured using the 10-item Preparation for Decision Making scale, which ranges from 0 to 100. Secondary outcomes included intentions to use recommended interventions such as staying active, physical therapy, or heat application, as well as nonrecommended interventions including imaging and opioid medications.

Study Findings

The trial population included 1080 adults with a mean age of 51.9 years; 70.7% were women. Of the participants randomized, 803 provided complete data for the primary outcome analysis. Mean preparation scores were higher in the information sheet group than in the advice sheet group, with scores of 57.6 and 52.9 respectively. The adjusted mean difference was 4.7 points (95% CI, 1.0–8.5; P = .01) on the 100-point scale.

Subgroup analyses indicated a stronger effect among participants with chronic low back pain. In this subgroup, preparation scores averaged 58.3 with the information sheet compared with 51.9 with the advice sheet, yielding an adjusted mean difference of 6.4 points (95% CI, 1.7–11.0; P = .007). Among patients with acute low back pain, the difference between groups was not statistically significant.

The researchers observed no significant differences between groups in intentions to pursue guideline-recommended treatments such as staying active, physical therapy, or heat therapy. Similarly, intentions to seek imaging or opioid medications did not differ between the two groups. Participants rated the advice sheet as more comprehensible, whereas the information sheet was considered more informative and balanced.

Clinical Implications

According to the study authors, providing patients with a brief fact sheet listing evidence-based treatment options may better support preparation for shared decision-making than a directive advice-based resource. The findings suggest that nondirective educational materials may help patients engage more effectively in conversations with clinicians about management options for low back pain.

The authors noted several limitations. Some participants may not have fully read the fact sheet, although sensitivity analyses accounted for those who spent very little time reviewing the material. Additionally, preparedness for decision-making was measured only immediately after reading the resource, and the clinical meaningfulness of the small observed effect remains uncertain.

Expert Commentary

“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,” the researchers concluded.

Reference
Longtin C, Chang JR, Hersch J, et al. One-page patient fact sheets for low back pain in primary care: a randomized clinical trial. JAMA Netw Open. 2025;8(7):e2523352. doi:10.1001/jamanetworkopen.2025.23352.