People who regularly have lower back pain go longer without the discomfort if they incorporate walks into their weekly routines, researchers suggested after the first controlled trial of its kind.
More than 600m people worldwide experience pain in this part of the back, which often recurs after initially resolving, but despite this high prevalence, there is very little research into its prevention, said Tash Pocovi at Macquarie University in Sydney, Australia.
Wanting to find an affordable and relatively accessible way for people to avoid the pain returning, Pocovi and her colleagues designed the “WalkBack” trial.
They selected 701 Australians, aged between 20 and 82, who had experienced an episode of lower back pain without a specific diagnosis, such as a fracture or infection, within the previous six months.
On average, they had each had 33 episodes of lower back pain, which interfered with their daily activities and lasted at least 24 hours. None regularly chose to go for recreational walks or engaged in any kind of exercise programme for pain management.
New Scientist reports that the study team asked 351 of them to develop an individualised walking programme with the help of a private physical therapist, aiming for a gradual build-up to 30 minutes of walking, five days a week, within six months.
The programme varied according to each individual to help them stick to it, said Pocovi. By 12 weeks, the participants were walking an average of 130 minutes per week.
They were also told about the latest scientific knowledge regarding lower back pain, which was meant to reassure them that it was safe to move under the supervision of their physical therapist, Pocovi said. “A lot of people become avoidant and fearful of movement when they have a history of back pain,” she added.
The remaining 350 volunteers received no such education or walking programme recommendation.
Pocovi and her team followed all of the participants for up to three years. Regardless of which group they were in, they were free to seek any additional treatment for their pain.
On average, those in the treatment group had their first recurrence of activity-limiting lower back pain 208 days after the study began, compared with 112 days in the control group.
Furthermore, wrote the team in The Lancet, half the people in the control group sought other interventions, such as massages and chiropractic treatment, compared with only 36% of those following the walking and education programme. However, the latter group was more likely to experience mild complications of exercise, such as sprains.
Study details
Effectiveness and cost-effectiveness of an individualised, progressive walking and education intervention for the prevention of low back pain recurrence in Australia (WalkBack): a randomised controlled trial
Natasha Pocovi, Chung-Wei Christine Lin, Jane Latimer et al.
Published in The Lancet on 19 June 2024
Summary
Background
Recurrence of low back pain is common and a substantial contributor to the disease and economic burden of low back pain. Exercise is recommended to prevent recurrence, but the effectiveness and cost-effectiveness of an accessible and low-cost intervention, such as walking, is yet to be established. We aimed to investigate the clinical effectiveness and cost-effectiveness of an individualised, progressive walking and education intervention to prevent the recurrence of low back pain.
Methods
WalkBack was a two-armed, randomised controlled trial, which recruited adults (aged 18 or older) from across Australia who had 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. Participants were randomly assigned to an individualised, progressive walking and education intervention facilitated by six sessions with a physiotherapist across six months or to a no treatment control group (1:1). The randomisation schedule comprised randomly permuted blocks of 4, 6, and 8 and was stratified by history of more than two previous episodes of low back pain and referral method. Physiotherapists and participants were not masked to allocation. Participants were followed for a minimum of 12 months and a maximum of 36 months, depending on the date of enrolment. The primary outcome was days to the first recurrence of an activity-limiting episode of low back pain, collected in the intention-to-treat population via monthly self-report. Cost-effectiveness was evaluated from the societal perspective and expressed as incremental cost per quality-adjusted life-year (QALY) gained.
Findings
Between 23 September 2019, and 10 June 2022, 3 206 potential participants were screened for eligibility, 2 505 (78%) were excluded, and 701 were randomly assigned (351 to the intervention group and 350 to the no treatment control group). Most participants were female (565 [81%] of 701) and the mean age of participants was 54 years (SD 12). The intervention was effective in preventing an episode of activity-limiting low back pain (hazard ratio 0·72 [95% CI 0·60–0·85], p=0·0002). The median days to a recurrence was 208 days (95% CI 149–295) in the intervention group and 112 days (89–140) in the control group. The incremental cost per QALY gained was AU$7 802, giving a 94% probability that the intervention was cost-effective at a willingness-to-pay threshold of $28 000. Although the total number of participants experiencing at least one adverse event over 12 months was similar between the intervention and control groups (183 [52%] of 351 and 190 [54%] of 350, respectively, p=0·60), there was a greater number of adverse events related to the lower extremities in the intervention group than in the control group (100 in the intervention group and 54 in the control group).
Interpretation
An individualised, progressive walking and education intervention significantly reduced low back pain recurrence. This accessible, scalable, and safe intervention could affect how low back pain is managed.
New Scientist article – Walking helps keep people free of lower back pain for longer (Open access)
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