If you haven’t had time to listen to Dr Mary Wyatt’s recorded webinar Speak to recover — the art of messaging in injury care, don’t worry. We’ve summarised Dr Wyatt’s presentation into a 3-Part article so you can read it instead. You can read Part 1 here.

In an earlier life, Dr Wyatt was part of an international community of researchers researching primary care management of back pain. Fast forward 20 years and Dr Wyatt says we’re still trying to progress the effective messages from that research. 

Dr Wyatt highlights a few studies that show how important recovery-oriented messaging is for back problems.

Study 1 — Good prognosis for low back pain when left untampered

A Norwegian rehab physician, Dr Indahl, did a study that showed that people in Noway's social insurance scheme who were allocated to an intervention group that received messaging had a 50% reduction in their disability compared to those who received usual care.

Dr Wyatt was curious to know why this was so effective. She had the opportunity to meet with Dr Indahl, attend his clinic and learn more. Dr Wyatt says she learned that 'he's a magic storyteller...He had a way with words in how he conveyed this basic message to patients — don't worry too much about your back problem'. 

He would say it in many different ways. He had lines like: ‘I'm not suggesting you jump off a 6-story building, but you shouldn't be worried about what you're doing with your back’. Or, ‘It's good to keep moving. It's good to do normal things’. 

What Dr Indahl was saying was that not everyone can do normal things. But if you tell people to do normal things, they're much more likely to do them. 

Dr Indahl also said: ‘When your back gets sore it’s a sign there’s not enough circulation of the blood and so you need to move to get the circulation going’. Even though that's not a research-based explanation, it got them moving. 

Dr Wyatt says: 'He taught them stretches for their back. And he taught them that their mood, or when they’re tense, while not the cause of their back pain, might make it worse. He got the result he did in the study by giving them lots of rich explanations that allowed them to understand how to manage their back problem'.

That 3 to 4-hour advice and explanation was a pretty simple intervention. And Dr Wyatt suggests that we can get those results too if we get our messaging right. 

What was the key to his messaging?

Dr Indahl’s messaging:

• empowered workers
• gave them an understanding of their problem and how to deal with it
• reduced their fear of pain, which is a huge issue in our world
• normalised the situation rather than medicalised it
• challenged misconceptions and tackled them head-on
• promoted active recovery, and
• fostered self-efficacy.

This study was repeated. It had 15% less impact, which Dr Wyatt attributes to Dr Indahl's skills as a storyteller. But she says when she’s used this approach with people ‘you can just see their shoulders relax and it takes a bit of the worry away’.

Study 2 — the ‘Back pain: Don't take it lying down’ campaign

This was a high-spend, high-saturation messaging campaign by WorkSafe Victoria in 1997. It included about 20 different messages in videos from medical experts, international sports people and actors that were sent to doctors. Those doctors still talk about how much easier the campaign made it for them to talk to people about being active and looking after their backs and not going down a negative path. 

Follow-up studies showed that:

• the benefits lasted for about 4 or 5 years
• there was a reduction in back pain claims and days lost from work after the campaign but no reduction in other claims
• there was an improvement in beliefs about back pain.

For example, 90's cricketing icon, Merve Hughes, had this message:

Here’s another example of the messaging, this time from a doctor:

What’s happening in practice?

Dr Wyatt says that we’re still struggling to get these good messages from 20 years ago out. Rather, the messages that patients mostly get are:

• they need to have a scan or some type of investigation 
• they need to go for some treatment, and 
• if they're not improving they need to see a specialist. 

And when the scan shows disc degeneration, the messaging they get encourages them down the medicalisation path: ‘You need treatment to improve and we need to do something to fix you’.  

An example

Joe is a firefighter. His (edited) story is an example of the impact that the bad messages people get when they read their scan reports have on their lives:

Dr Wyatt says the problem is that our current messaging sends people in this direction. And that’s why, if we want to have a positive impact on people’s motivation and support behaviours that will help them recover well, we need to hone the art of messaging. Not just in the area of healthcare, but in case management, rehab and other areas too.

In Part 3, Dr Wyatt talks more about messaging in the area of supervisor involvement in RTW.