GLITtER (Green Light Imaging Interpretation to Enhance Recovery): a psychoeducational intervention for adults with low back pain attending secondary care.

The intervention group will receive ‘GLITtER’, integrated into the routine Spinal Assessment Clinic (SAC) consultation at the Royal Adelaide Hospital. What is GLITtER (Green Light Imaging Interpretation to Enhance Recovery)? * GLITtER is a brief intervention that will be integrated into current practice in the SAC. It will be conducted face-to-face by clinicians with more than 5 years of experience working in this setting. * It will extend the clinic consultation time by a maximum of 10 minutes * GLITtER offers the treating clinicians a framework for interpreting imaging findings. Key components (to be verbally delivered while reviewing the patient's own imaging results) are: 1. Reframing of ‘normal’ imaging findings. E.g. “We now understand that many scan findings like degeneration and disc bulges are actually completely normal – you can think of them a bit like wrinkly skin or grey hair: as physical changes that ‘just happen’ over time”. 2. Most/many of the findings on your scan are also found on scans of people who have never had back pain. They would have been present well BEFORE your back pain started and they will still be there once your back pain has settled. 3. There is often very little link between scan findings and a person’s activity levels. 4. Summary: Scans (on their own) actually don’t explain much about a. Your current pain – especially why you have good days and bad b. The activity you are capable of c. Or how likely you are to recover: because the changes on your scans will still be there when your pain goes away. * On the basis of the above information patients will be ‘given’ (verbally) a metaphorical ‘green light’. The clinician will explain to the patient that after reviewing their imaging and assessing them in the clinic they consider that movement and activity is safe: the patient is given the green light to increase their activity level (and it is important for their recovery). This green light message is re-iterated on the first page of the take-home information. * GLITtER offers a simple strategy for promotion of activity. Patients will be introduced to the activity “TICK” list – an acronym for: make a Time, it’s Important, be Consistent, Know your back is up to it. This TICK list is included on each page of the 4-week take-home information. * GLITtER offers take home information: designed as a 4-week series of key messages displayed in poster style. Participants will be instructed to display Week 1 when they arrive home, and change the poster weekly. The main themes of this information are as follows: 1. Scan findings should not cause worry; it is safe to be active. Many ‘abnormal’ findings on scans are actually completely normal (“like wrinkles on the inside”) and are not associated with pain or likely recovery. The spine is a strong and stable structure and needs to move. 2. Pain is complex and lots of things contribute to the experience of pain. Chronic pain often has little to do with damage – it is produced by a nervous system that is ‘over-protective’. 3. Activity and exercise are important for recovery and have many benefits. These include benefits to physical health and well-being, psychological benefits and restoration of the ‘over-protective’ system. * Involves SMS follow ups (X4) with links to online education resources. Brief SMS messages will be sent on Mondays for the subsequent 4 weeks (following the consultation). The SMS message will prompt the participant to display/turn over/read the information sheet they were provided at their consultation, and to plan some activity/exercise for the week ahead. * Includes brief written communication with the patient’s General Practitioner. This information will inform the GP that their patient was part of a pilot study assessing an educational intervention designed to reassure patients and promote activity. It will outline the main messages provided to the patient: 1. Surgical intervention is not indicated and further scans are not required 2. Scan findings should not cause worry; it is safe to be active 3. Pain is complex (chronic pain often has little to do with damage) 4. Activity and exercise are important for recovery and have many benefits Contact details for the principal researcher will also be provided. Adherence to reading of the poster information will be assessed at one-month follow-up.