Walking Coaching Intervention Effective and Cost-Effective At Reducing Back Pain (June 2024)

Take Home

Promote Walking: Encourage patients recovering from low back pain to engage in a progressive walking program, ideally tailored to individual needs.

Education Integration: Combine walking programs with educational sessions to help patients understand pain management and reduce fear.

Health Coaching Approach: Utilize health coaching techniques, including goal setting and motivational interviewing, to enhance adherence to the walking program.

Monitor Adverse Events: Be aware of potential lower extremity injuries and adjust the program as needed to prevent them.

A copy of the education and program design is included on the publisher’s article page for free download. This can be used as a great tool for developing and deploying walking programs in your clinical practice.

Background

Low back pain recurrence is a significant health and economic issue. Exercise is recommended for prevention, but the effectiveness of a simple, accessible intervention like walking has not been established.

Trial Design

this was a two-armed, randomised controlled trial named WalkBack was conducted to assess the effectiveness and cost-effectiveness of an intervention for preventing low back pain recurrence. The study included adults in Australia who had recently recovered from non-specific low back pain. Participants received an individualised , progressive walking and education program facilitated by six physiotherapist sessions over six months. Participants in the control group did not receive any treatment. Participants were followed up monthly for a period ranging from 12to 36 months. The primary outcome was the number of days to the first recurrence of activity-limiting low back pain, self-reported by participants each month. Cost-effectiveness was evaluated by calculating the incremental cost per quality-adjusted life-year (QALY) gained.

Results

A total of 701 participants were randomly assigned to the intervention group (351participants) and the control group (350 participants).  The mean age of participants was 54 years, with 81% being female.  The intervention group experienced a significant reduction in the recurrence of low back pain, with a hazard ratio of 0.72 (p=0.0002). The median number of days to recurrence was 208 days for the intervention group compared to 112 days for the control group. The incremental cost per QALY gained was AU$7802, with a 94% probability of cost-effectiveness at a threshold of AU$28,000.  The occurrence of adverse events was similar between the groups; however, the intervention group had a higher incidence of lower extremity injuries.

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