Walking and education intervention significantly reduces recurrence of low back pain

In a recently published study, LancetThe researchers conducted a randomized controlled trial (RCT) to determine the clinical impact. efficacy The effectiveness and cost-effectiveness of the WalkBack personalized walking education intervention program in preventing recurrent low back pain in Australians.

background

Low back pain is a frequent and malignant condition that causes disability and increases healthcare costs. Recurrences result in significant disability and economic burden for individuals and society, leading to prolonged absenteeism and increased healthcare costs. Exercise may prevent recurrence, but the efficacy and cost-effectiveness of low-cost treatments such as walking are unknown.

Studies have shown that combining physical activity with education can reduce relapse, but group-based programs may limit access. Walking improves cardiovascular health and reduces the risk of non-communicable diseases.

About the Research

In this two-arm RCT, researchers investigated whether walking combined with educational awareness could prevent recurrence of low back pain in an efficient and cost-effective manner.

The researchers recruited individuals through community advertising and physician referrals in Australia who reported recently recovering from a nonspecific low back pain episode lasting more than 24 hours. They randomly assigned individuals in a 1:1 ratio to receive either a customized walking and education intervention delivered by a physiotherapist over six months, or a control group that received no treatment.

The researchers followed participants for one to three years, depending on the date of enrollment. The primary outcome was the number of days until the first recurrence of an activity-limiting back pain episode, as reported monthly by study subjects. The researchers assessed cost-effectiveness from a societal perspective, expressed as additional costs per quality-adjusted life year (QALY) gained.

The researchers defined nonspecific low back pain as pain between the 12th rib and the buttock crease that lasted for more than 24 hours, pain that the clinician could not link to a specific diagnosis, pain intensity greater than 2.0 on a numeric rating scale of 0 to 10, and pain that interfered with daily activities in any way on the modified PROMIS PI9 item. The researchers defined recovery as pain lasting for more than 1 week with a pain rating of 1.0 or less.

The researchers excluded people with comorbidities that would prevent them from participating in a walking program, walking for physical activity more than three times a week (more than 30 minutes a day), regular participation in an exercise program (such as Pilates) to prevent the recurrence of back pain, more than 150 minutes per week of moderate-to-vigorous physical activity (more than three days a week), spinal surgery within the past six months, and pregnancy.

Secondary outcomes assessed every 3 months included disability. [Roland Morris Disability Questionnaire (RMDQ)]health-related quality of life (EuroQoL EQ-5D-5L), physical activity and sedentary behaviour (Active Australia Survey, an adaptation of the International Physical Activity Questionnaire (IPAQ)), co-interventions, and adverse events adjudicated using International Classification of Diseases, 11th Revision (ICD-11) codes. The researchers used Cox proportional hazards regression analyses to obtain hazard ratios (HRs) for the analyses. They performed a sensitivity analysis from the healthcare perspective and completed case data only.

result

Between September 23, 2019 and June 10, 2022, the researchers screened 3,206 participants for eligibility, excluded 2,505 (78%), and randomly assigned 701 to the study group. Most participants (81%) were women, and the mean age was 54 years. The intervention reduced activity-limiting back pain episodes (HR, 0.7). The median time to pain recurrence was 208 days and 112.0 days in the intervention and control groups, respectively.

The incremental cost per QALY gained was estimated at AUD 7802, indicating a 94% chance of the program being economical at a willingness-to-pay cutoff of $28 000.The number of people experiencing one or more adverse events per year was similar in the intervention (183 of 351, 52%) and control groups (190 of 350, 54%), but there were more adverse events related to the lower limbs in the intervention versus control groups (100 vs 54).

Patients who received the intervention had significantly improved disability and health-related quality of life and increased total and brisk daily steps at 3 months compared with the control group, although differences in steps were not sustained at 12 months. Intervention adherence scores on the Brief Adherence Rating Scale (BARS) were 7.3, 6.6, 6.0, and 5.7 at 3, 6, 9 months, and 1 year, respectively.

Conclusion

This study showed that a personalized walking and educational intervention program significantly reduced the recurrence of low back pain in people who had not previously engaged in regular exercise. The program is cost-effective, safe, scalable, and easily accessible, making it a potential treatment for low back pain. It also reduced low back pain-related disability for up to 12 months.

Findings suggest that this intervention, if widely implemented, has the potential to significantly reduce the personal and societal costs associated with low back pain. Future studies should evaluate the application and effectiveness of this intervention, particularly as part of discharge planning after acute low back pain episodes, when delivered in fewer sessions, and by other providers.