Elsevier

Joint Bone Spine

Volume 69, Issue 6, December 2002, Pages 597-603
Joint Bone Spine

ORIGINAL ARTICLE
Beneficial effects of information leaflets before spinal steroid injection

https://doi.org/10.1016/S1297-319X(02)00457-8Get rights and content

Abstract

How beneficial is the provision of information leaflets to low back pain patients before steroid injection under fluoroscopy? Objectives. To compare the value of information leaflets with verbal information on steroid injection under fluoroscopy. Methods. Alternate month design. One hundred and twenty-three low back pain patients hospitalized for steroid injection under fluoroscopy were enrolled in the trial. Fifty-two patients received both written standardized information and non-standardized verbal information (intervention group), seventy one patients received only non-standardized verbal information (control group). Anxiety assessed at baseline evaluation and just before the injection; satisfaction related to the information received assessed on discharge day; knowledge about steroid injection assessed 4 hours and 1 month after the injection. Results. Patients had a high anxiety level at baseline evaluation. Written standardized information did not decrease significantly anxiety (P = 0.068) before the injection, had no effect on pain during the injection, but increased patients' knowledge about the adverse effects on the day of injection and 1 month later (P = 0.040 and P = 0.084 respectively), and improve satisfaction with information received about potential complications of the steroid injections (P = 0.018). Conclusions. Providing an information leaflet to low back pain patients undergoing steroid injection under fluoroscopy tends to reduce state anxiety, and increases patients' knowledge and satisfaction with information about the risks of the injection.

Introduction

French legislation concerning information about risks and complications in medical procedures has recently changed 〚1〛. Doctors are now compelled to notify patients of exceptional risks and complications of treatments and other medical procedures and to ensure understanding of this information before performing these procedures. In response to this change, efforts are being made by the French accreditation agency (ANAES) to promote the use and evaluation of leaflets to convey information 〚2〛. Providing information to the patient has two goals. The first is to increase satisfaction, knowledge and understanding. Being informed is a dimension of patient satisfaction 〚3〛. Dissatisfied patients have been shown to initiate complaints about physicians 〚4〛 and the defense societies warn that most complaints are provoked by doctors failing to communicate adequately 〚5〛. The second goal is to reduce anxiety and pain to avoid adverse consequences like massive stress response 〚6〛. Many physicians assumed that providing information about risks and complications of medical procedures would generate an unnecessary and harmful degree of anxiety, decrease retention of information and alter the doctor-patient relationship 〚7〛.

Several studies have investigated the use of leaflets to improve and standardize the information received by patients. These studies have shown mixed results depending on the type of procedure applied and the pathology involved. After delivery of information on medical procedures, anxiety remains stable before colposcopy or inguinal hernia repair under general anesthesia 8, 9 and decreases before tooth extraction 〚10〛. Satisfaction can be affected 〚11〛 or not by delivery of information 〚12〛. The effects on knowledge are variable; both temporary improvement 〚13〛 and no change 11, 14 have been described. None of these studies has been conducted among low back pain patients. Steroid injection under fluoroscopy is a widely used treatment for low back pain treatment. Periganglionic 〚15〛, intradural 〚16〛, intradiscus 17, 18, and facet joint steroid injection 〚19〛 are among the most common procedures. The aim of this trial was to investigate the impact of written standardized information (leaflets), provided in addition to verbal information on anxiety, pain, knowledge and satisfaction in low back pain patients hospitalized for steroid injection under fluoroscopy.

Section snippets

Institutional board approval and patient consent

As low back pain is an accepted clinical indication for steroid injections under fluoroscopy performed during this study, French bioethic legislation did not require consent from the Hospital Ethics Committee. Patients gave their oral consent to participate.

Study population and setting

Patients suffering from low back pain and hospitalized for steroid injection during an 8-month period (March to October 2000) were recruited from two departments of a tertiary care teaching hospital. These departments of physical and

Results

Between March and October 2000, 172 patients were eligible for the study. Ten patients were excluded: three had mental impairment and seven spoke insufficient French to understand the questionnaires. Forty-six were not included because the 2 hours between information provision and injection could not be respected. The remaining 123 patients were enrolled, 52 during the intervention period and 71 during the control period. There were no differences in baseline characteristics between the groups

Discussion

This study shows that written standardized information (leaflets) about steroid injection under fluoroscopy can increase the satisfaction of low back pain patients and their knowledge related to adverse effects. This written standardized information also tends to reduce patients' state anxiety. Most complaints lodged against doctors in France for the last decade involved lack of information about risks related to medical procedures 〚21〛. As information appears to be a major dimension of patient

Acknowledgements

The authors wish to thank all the medical doctors and nurses of both departments for their help during the trial.

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