895 - The Effect of Shared Decision Making on Patient Outcome in Low Back Pain Care: Systematic Review

Objectives:
To conduct a systematic review to understand how shared decision making (SDM) in low back pain (LBP) care impacts patient outcomes.

Design:
We designed a systemic review of peer-reviewed, randomized control studies between 2012 to 2022. Two independent reviewers followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and searched for publications within MEDLINE, Embase, and Web of Science before June 30, 2022. Eligible studies encompassed LBP patients aged ≥18 years in any outpatient setting (primary care, orthopedics, PM&R, physical therapy) and incorporated shared decision making. Excluded were conference abstracts, opinion pieces, and non-English articles. Discrepancies were resolved by a third reviewer. Selected studies needed to report data on at least one of three patient outcome domains relevant to SDM: affective-cognitive, behavioral, or health.

Results:
Of the 290 publications reviewed, six articles met our criteria, involving 1476 LBP patients (636 males and 840 females). Two studies found that decision coaching and decision aids (DA) significantly increased patient self-efficacy and reduced unnecessary imaging at 3- and 12-months post-intervention. A third study utilizing a tailored web-based DA significantly decreased patients’ decisional conflict. Furthermore, a fourth study showed that patients using the selfBACK DA app, which provided weekly exercise recommendations, experienced reduced pain three months post-intervention. However, a fifth study reported no pain disability improvement six months post-intervention after patients received positive reinforcement from SDM-trained practitioners. Finally, the sixth RCT demonstrated that telephone counseling and patient involvement in creating opioid tapering plans significantly decreased opioid use after spinal surgery.

Conclusions:


A heterogeneous array of SDM studies have demonstrated that SDM can improve patient self-efficacy, reduce decisional conflict, decrease opioid use post-spinal surgery, and limit inappropriate imaging. However, variations in interventions and outcomes preclude broad generalization. Consequently, ample opportunities remain to better assess if and how much SDM can effectively improve LBP patient outcomes.