AN INTERACTIVE, TAILORED, MULTIMEDIA INSTRUCTIONAL MODULE FOR PATIENTS WITH LOW BACK PAIN. Stephen L. Goffar* U.S. Army, Honolulu, HI PURPOSE: To reduce disability from low back pain by promoting early return to activity through high quality, motivating instruction that is tailored to be highly relevant to the patient. TARGET AUDIENCE: This multimedia instructional module was designed to be most appropriate to the active duty military population, however, the base content is appropriate for the working age, English speaking population. PROGRAM DESIGN: This program was designed to integrate the best practices in the fields of Physical Therapy, Educational Psychology, Educational Technology, Communication, and Computer Science. Specifically, the researcher made efforts to capitalize on the successes demonstrated in the tailoring of text-based patient education materials by applying the same methods to a multimedia environment. Tailored, text-based materials have been shown to be retained for future reference, their content remembered and discussed with others, and they have been shown to result in levels of health behavior change unmatched by standardized materials. Multimedia instructional materials overcome the limitations of text-based materials imposed by literacy by presenting messages in multiple learning modalities and promote attention/motivation through the presentation of moving images and sound. Tailored Multimedia content provides motivational information that is highly relevant to the patient and, according to the Elaboration Likelihood Model, has the greatest chance of being processed in a manner that produces positive change. This instructional module is delivered on CDROM and collects patient specific information by way of an integrated survey tool and, based on this information, modifies the video, animation, text, and narration of the instructional module to be reflective of the patient's situation. Following presentation of the content, the program prints a personalized, two page, tailored, summary of its recommendations. The module's content is currently tailored in response to 10 different criteria: 1) patient reported experience with LBP (Acute or Chronic) to include time since last episode, 2) current pain level (VAS), 3) the patients own terms used to describe their pain (sharp, dull, tight, ache) 4)gender, 5) perceived causes of LBP, 6) work site, 7) preferred sporting activities and 8) changes in levels of participation, 9) fear of physical activity, and 10) patient reported expectations for return to work. These criteria are used to establish a series of logic rules that determine what content, imagery, and sound is presented to the patient. DEVELOPMENT PROCESS: Following a review of the literature pertaining to the efficacy of back schools for reducing disability from low back pain the author began a two year exploration of adult learning theory and behavior change literature in an effort to find measures that might enhance patient outcomes. During this exploration a number of themes emerged. First, adult learners in any setting must feel the information they are given is relevant and immediately applicable in their lives. Second, the perceptions they bring to the learning situation must be valued and built upon rather than simply discredited. Third, the methods of delivering information must be convenient and entertaining. This lead to the theory that a tailored, multimedia instructional program based on the proven psychosocial approach would have the greatest effect in reducing fear-avoidance beliefs, promote early mobility, and result in less disability from LBP. Previously, such tailoring required a dedicated computer programmer and a great deal of money, but Trivantis' Lectora Publisher software allowed the author to independently design and develop this instructional module with the use of consumer quality digital camera, a digital video recorder, and a personal computer. The criteria upon which to tailor content was decided upon and written into the base content that mirrored the text based materials that accompany the DoD/VA Clinical Practice Guideline for Low Back Pain and the United Kingdom's Low Back Pain CPG. Military specific imagery was acquired from the U.S. Army Center for Health Promotion and Preventive Medicine, and photographed by the author and associates. Animations that supplement text and narrations within the module were developed by the author using Macromedia's FLASH software. Lectora Publisher integrates all content and imagery and publishes the instructional module to CDROM that is able to run in any Windows environment. The current version is written to be interactive in order to allow the learner to skip chapters and move through the content in a non-linear fashion. This allows the learner to view the entire 33 minutes of content or only certain sections they find interesting for a shorter session. Regardless of duration, the patient is always able to print the summary pages. BENEFITS: This program was designed for use in primary care on the day a patient reported with the complaint of low back pain which provides the benefit of early, appropriate, and relevant instruction. When made available in the healthcare facility this ensures the patient is exposed to the information rather than failing to read and understand text-based materials or failing to attend a less convenient back school. Comments from patients that participated in the formative evaluation of the product lauded the imagery, the specificity of the content, its convenience, and in one case remarked how much more was learned than during the 1+ hour back school she recently attended. The long term impact of this multimedia instructional program will be reported in the summer of 2005 after the completion of a randomized clinical trial compares its effectiveness (reducing FABQ scores and RDQ scores) to a professionally prepared pamphlet and a back class taught in Physical Therapy. EQUIPMENT: None FUNDING SOURCE: None KEYWORDS: Back Pain, Patient Education, Tailoring, Multimedia, Computer Based Learning Copyright 2009 by the American Physical Therapy Association. 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