RCT Results: Can Low Back Pain Recurrence Be Prevented by Walking?
BACKGROUND AND PURPOSE:
- Pocovi et al. (The Lancet, 2024) investigated the clinical effectiveness and cost-effectiveness of a simple individualized walking program to prevent the recurrence of low back pain
METHODS:
- Randomized controlled trial
- WalkBack trial
- intervention delivered by 25 private Australian physiotherapy clinics
- Participants
- ≥18 years
- Recently recovered from an episode of non-specific low back pain
- No specific diagnosis
- Lasted for at ≥24 hours
- Interventions
- Individualized, progressive walking and education intervention | 6 sessions with a physiotherapist across 6 months
- No treatment control
- Study design
- Goal: Walk 5 times per week for ≥30 min daily by 6 months
- Individualization as appropriate
- Participants were followed for ≥12 months for a maximum of 36 months
- Cost-effectiveness was evaluated from the societal perspective and expressed as incremental cost per quality-adjusted life-year (QALY) gained
- Goal: Walk 5 times per week for ≥30 min daily by 6 months
- Primary outcome
- Days to the first recurrence of an activity-limiting episode of low back pain
RESULTS:
- Intervention: 351 individuals | No treatment control: 350 individuals
- Mean age: 54 (SD, 12) | Female: 81%
- The intervention was effective at preventing an episode of activity-limiting low back pain
- Hazard ratio (HR) 0.72 (95% CI, 0.60 to 0.85) | P=0.0002
- Median days to a recurrence
- Intervention: 208 (95% CI, 149 to 295) days
- Control: 112 (95% CI, 89 to 140) days
- The incremental cost per QALY gained was AU$7802
- There was a 94% probability that the intervention was cost-effective at a willingness-to-pay threshold of $28,000
- The total number of participants experiencing at least one adverse event over 12 months was similar between the intervention and control groups
- Intervention: 52% | Control: 54% | P=0.60
- Adverse events
- Overall adverse events were similar between groups, including serious adverse events
- There was a greater number of adverse events related to the lower extremities in the intervention group than in the control group
CONCLUSION:
- Low back pain recurrence was prevented with an individualized, progressive walking and education intervention program
- The program was also considered cost effective
- The authors state
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
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