Back Pain: Advice and Education Provide Small Short-Term Improvements in Pain and Disability Interview with:
Caitlin Jones PhD Candidate
The University of Sydney
Faculty of Medicine and Health, Sydney School of Public Health
Institute for Musculoskeletal Health
Royal Prince Alfred Hospita
Australia  What is the background for this study? What are the main findings?

Response: Despite advice being recommended internationally as a treatment for spinal pain, the evidence behind that was uncertain and out of date. We didn’t think that the strong and widespread recommendation to provide advice was reflective of the available evidence. There have been multiple, more recent, trials of advice and education with varying results, so it was a good time to collate and summarise these with a systematic review.

Our main findings were that advice and education had a small effect on pain and disability compared to no advice and education, or placebo in the short term. The effects were around 10 points of improvement for pain and 5 points for disability on a 0 to 100-point scale. There was evidence of no effect at all other time points (immediate, intermediate and long term). The specific content of the advice didn’t seem to make much difference.

We compared simple contemporary advice (such as advice to keep active and to avoid bed rest and reassurance about the positive prognosis) to more comprehensive advice, such as ergonomic advice (specific postural and biomechanical information) or pain neuroscience education, and found them all to be about equally effective. Whether the participants’ symptoms were acute or chronic, the intensity of the intervention in terms of time spent with a therapist, how the intervention was delivered and the depth and type of the content didn’t impact outcomes. What should readers take away from your report?

Response: While the findings for advice and education in the short term is positive, the effect size is considered small. We suggest that advice should not be used as a sole first-line treatment. Other interventions are likely to be needed to effectively manage people’s symptoms. It is important to point out that therapists should not forgo advice and education, despite the small effects on pain and disability, due to other benefits such as feeling reassured and because our patients have a right to be informed about their conditions. What recommendations do you have for future research as a result of this work?

Response: It would be interesting to know what proportion of participants were able to heed the advice (eg, kept active and avoided bed rest) and whether that was associated with a larger effect. This review couldn’t measure how well people were adhering to the advice they were given. We also wonder whether advice and education might have larger effects in populations that have a lower level of health literacy and unhelpful beliefs about back pain. It is reasonable to imagine that those are the people who stand to gain the most benefit from receiving advice, compared to those who already have a decent understanding and appropriate beliefs.

Future research could focus more on how much the participant learnt and how that affected their health behaviours, not only on what advice and education were provided. They are not necessarily the same thing.

No disclosures


Caitlin MP Jones, Christina Abdel Shaheed, Giovanni E Ferreira, Priti Kharel, Chung-Wei Christine Lin, Chris G Maher,
Advice and education provide small short-term improvements in pain and disability in people with non-specific spinal pain: a systematic review,
Journal of Physiotherapy, Volume 67, Issue 4, 2021,

Pages 263-270, ISSN 1836-9553,

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