“By encouraging active self-management using health coaching principles, the WalkBack intervention might be able to reduce the prevalence of recurrent low back pain and associated burden on health care systems,” wrote investigators.
An individualized, progressive walking and education intervention may reduce low back pain recurrence in adults who are not previously engaged in regular physical activity, according to study results published in The Lancet.1 Study authors noted that walking represents an accessible, scalable, and safe approach to managing the condition.
Person walking on trail / lzf - stock.adobe.com
Low back pain is the leading cause of years lived with disability. In 2020, it was estimated to affect 619 million people globally, a number expected to increase to 843 million by 2050.2 Recurrences are common and can significantly impact both individual quality of life and societal costs. Despite this, there is a lack of guidance on prevention and management of recurrent low back pain.
Incorporate these strategies into your pharmacy practice to improve patient outcomes.
Although exercise has been shown to alleviate low back pain, previous studies on exercise-based interventions for the condition have often relied on group programs that require clinician supervision and specialized equipment and can be costly.3 These factors can limit access for many patients.
Walking is a low-cost, convenient exercise that is adaptable to busy lifestyles. To explore its potential for preventing recurrent low back pain, researchers compared this intervention to a control group and evaluated its effectiveness and cost-effectiveness.
WalkBack was a two-armed, randomized, controlled trial involving adults aged 18 and older from Australia. Participants were selected if they recently recovered from an episode of non-specific low back pain that was not attributed to a specific diagnosis and which lasted for at least 24 hours.
Between September 23, 2019, and June 10, 2022, 701 participants were randomly assigned to either an individualized, progressive walking and education intervention facilitated by 6 sessions with a physiotherapist across 6 months or to a control group. Participants were monitored for at least 12 months, but no longer than 36 months, depending on the date of enrollment.
The primary outcome was days to the first recurrence of an activity-limiting episode of low back pain, as assessed through monthly self-reports. Cost-effectiveness was evaluated from the societal perspective and expressed as an incremental cost per quality-adjusted life-year (QALY) gained.
Steps were measured by hip-worn triaxial accelerometers. Initially, the study planned for health care professionals to collect a timed 10-meter walking test for the intervention group at baseline and 3 months. However, due to the COVID-19 pandemic and restrictions on in-person care, this measurement was discontinued.
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Investigators found that the median days to any low back pain recurrence was 208 days (95% CI: 149 to 295) in the intervention group and 112 days (95% CI: 89 to 140) in the control group. What’s more, the intervention group showed lower levels of disability compared to the control group at all timepoints. These results indicated that the walking-education intervention was able to extend the duration between low back pain recurrences and lessen their frequency.
For QALYs, the incremental cost-effectiveness ratio was AU $7802 (USD $5311) per QALY gained compared to no treatment. For recurrence, the incremental cost-effectiveness ratio was AU $1120 (USD $762) per participant prevented from having a recurrence leading to activity limitation compared to no treatment.
The intervention group gained a mean difference of 0.023 QALYs compared to the control group (95% CI: 0.011 to 0.034). Additionally, the intervention group had a lower rate of recurrences leading to activity limitation in the first 12 months (95% CI: -0.22 to -0.09).
Also notably, a significantly higher percentage of participants in the control group sought a co-intervention than did participants in the intervention group (P = .0005; 174 of 350 and 128 of 351, respectively). These most frequently included treatments provided by massage therapists, physiotherapists, and chiropractors.
Similar numbers of patients in the 2 groups had at least 1 adverse event over 12 months, but there were more adverse events related to the lower extremities in the intervention group than in the control group.
Ultimately, investigators concluded that “by encouraging active self-management using health coaching principles, the WalkBack intervention might be able to reduce the prevalence of recurrent low back pain and associated burden on health care systems.” This suggests that pharmacist-patient counseling can effectively incorporate walking as a simple, affordable, and potentially impactful strategy for managing this common condition.
READ MORE: Pain Management Resource Center
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