{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T15:25:23Z","timestamp":1788449123460,"version":"build-2803163510"},"reference-count":48,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T00:00:00Z","timestamp":1780531200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T00:00:00Z","timestamp":1780531200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["European Journal of Pain"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Reassurance is recommended in the management of chronic low back pain (CLBP). Reassuring messages include that serious pathology has been excluded and movement is safe. The impact of patient awareness of reassuring messages on patient outcomes has not been investigated. We aimed to describe the characteristics of people reporting awareness of reassuring messages after a 3 month education and exercise program for CLBP and to determine if awareness of reassuring messages at 3 months influences patient outcomes at 6 months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a secondary analysis of 3850 adults who received a structured group\u2010based education and exercise program for CLBP. Expert knowledge was used to construct directed acyclic graphs to identify relevant confounders. We used linear mixed models, adjusted for the identified confounders, to determine associations between self\u2010reported awareness of reassuring messages at 3 months and patient outcomes at 6 months (pain, disability, fear\u2010avoidance and self\u2010efficacy), and to determine associations between baseline patient characteristics and awareness of reassuring messages at 3 months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>More awareness of reassuring messages at 3 months positively influenced pain intensity (regression coefficients; 95% confidence interval: \u22120.27; \u22120.39, \u22120.14), disability (\u22121.01; \u22121.58, \u22120.44), and fear\u2010avoidance (\u22120.85; \u22121.13, \u22120.57) at 6 months. Less threatening illness perceptions and higher levels of self\u2010efficacy at baseline were associated with more awareness of reassuring messages at 3\u2009months; whereas being older, male, having more leg pain, and higher fear\u2010avoidance were associated with less awareness of reassuring messages at 3\u2009months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>While effects were small, awareness of reassuring messages positively influenced patient outcomes at 6 months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Significance Statement<\/jats:title>\n                    <jats:p>Our study is the first to examine whether patient awareness of reassuring messages influences patient outcomes in chronic low back pain. We found that more awareness of reassuring messages after a group education and exercise intervention reduced pain intensity, disability and fear\u2010avoidance. While effects were small, awareness of reassuring messages positively influenced patient outcomes. Clinicians should consider the benefits of delivering key reassuring messages as part of multi\u2010modal low back pain management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ejp.70306","type":"journal-article","created":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T11:41:47Z","timestamp":1780573307000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Does Awareness of Key Reassuring Messages Influence Patient Outcomes in Participants With Chronic Low Back Pain? Secondary Analysis of an Observational Study in Primary Care"],"prefix":"10.1002","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5730-0184","authenticated-orcid":false,"given":"Anika","family":"Young","sequence":"first","affiliation":[{"name":"Department of Chiropractic Macquarie University  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian","family":"Traeger","sequence":"additional","affiliation":[{"name":"Institute for Musculoskeletal Health University of Sydney  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"French","sequence":"additional","affiliation":[{"name":"Department of Chiropractic Macquarie University  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"Kongsted","sequence":"additional","affiliation":[{"name":"Department of Sports Science and Clinical Biomechanics University of Southern Denmark  Odense M Denmark"},{"name":"Chiropractic Knowledge Hub  Odense M Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Hancock","sequence":"additional","affiliation":[{"name":"School of Health Sciences and Nursing Macquarie University  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inge","family":"Ris","sequence":"additional","affiliation":[{"name":"Department of Sports Science and Clinical Biomechanics University of Southern Denmark  Odense M Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Kirkegaard","sequence":"additional","affiliation":[{"name":"Clinician Researcher Smertevidenskab  Aarup Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hazel","family":"Jenkins","sequence":"additional","affiliation":[{"name":"Department of Chiropractic Macquarie University  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,4]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-155-2-201107190-00005"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.322.7301.1516"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/j.pain.0000000000002978"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjpt.2022.100413"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/ejp.2083"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.5271\/sjweh.1360"},{"key":"e_1_2_11_8_1","article-title":"Individual Patient Education for Low Back Pain","volume":"2008","author":"Engers A.","year":"2008","journal-title":"Cochrane Database of Systematic Reviews"},{"issue":"8","key":"e_1_2_11_9_1","first-page":"271","article-title":"The Oswestry Low Back Pain Disability Questionnaire","volume":"66","author":"Fairbank J.","year":"1980","journal-title":"Physiotherapy"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2665-9913(23)00098-X"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000002066"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1080\/10810730.2016.1201175"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0274527"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-009-1016-7"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-019-2925-1"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjhp.12668"},{"key":"e_1_2_11_17_1","first-page":"632","article-title":"A Primary Care Back Pain Screening Tool: Identifying Patient Subgroups for Initial Treatment","volume":"59","author":"Hill J. 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