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Original Investigation
April 8, 2002

Can a Back Pain E-mail Discussion Group Improve Health Status and Lower Health Care Costs?A Randomized Study

Author Affiliations

From Stanford University School of Medicine (Drs Lorig and Ritter and Ms Laurent) and Department of Psychiatry, Stanford University Medical Center (Dr Marnell), Stanford, Calif; University of Washington, School of Medicine, Seattle (Dr Deyo); and Department of Physical Therapy, University of Missouri, Columbia (Dr Minor).

Arch Intern Med. 2002;162(7):792-796. doi:10.1001/archinte.162.7.792

Background  Given the high health care utilization, limited evidence for the effectiveness of back pain interventions, and the proliferation of e-mail health discussion groups, this study seeks to determine if the Internet can be used to improve health status and health care utilization for people with chronic back pain.

Methods  Randomized controlled trial. Participants included 580 people from 49 states with chronic back pain having at least 1 outpatient visit in the past year, no "red-flag" symptoms, and access to e-mail. Major exclusion criteria included continuous back pain for more than 90 days causing major activity intolerance and/or receiving disability payments.

Intervention  Closed, moderated, e-mail discussion group. Participants also received a book and videotape about back pain. Controls received a subscription to a non–health-related magazine of their choice.

Main Outcome Measures  Pain, disability, role function, health distress, and health care utilization.

Results  At 1-year treatment, subjects compared with controls demonstrated improvements in pain (P = .045), disability (P = .02), role function (P = .007), and health distress (P = .001). Physician visits for the past 6 months declined by 1.5 visits for the treatment group and by 0.65 visits for the control group (P = .07). Mean hospital days declined nearly 0.20 days for the treated group vs and increased 0.04 days for the control group (P = .24).

Conclusions  An e-mail discussion group can positively affect health status and possibly health care utilization. It may have a place in the treatment of chronic recurrent back pain.