Walking regimen may reduce low back pain recurrence

An individualized, progressive walking and education intervention for patients with low back pain significantly reduced pain recurrence, an Australian study found.

WalkBack, a two-armed, randomized controlled trial, recruited adults from across Australia who had recently recovered from an episode of nonspecific low back pain that was not attributed to a specific diagnosis and which lasted for at least 24 hours. Participants were randomly assigned 1:1 to the walking program supplemented by six sessions with a physiotherapist for six months or to a no-treatment control group and were followed for 12 to 36 months. The primary outcome was days to the first recurrence of an activity-limiting episode of low back pain, collected by monthly self-report. The study was published June 19 by The Lancet.

There were 351 patients in the intervention group and 350 in the control group. The intervention was effective in preventing an episode of activity-limiting low back pain (hazard ratio [HR], 0.72 [95% CI, 0.60 to 0.85]; P=0.0002). The median days to a recurrence was 208 days (95% CI, 149 to 295 days) in the intervention group versus 112 days (95% CI, 89 to 140 days) in the control group.

The incremental cost per quality-adjusted life-year gained was $7,802 in Australian dollars, giving a 94% probability that the intervention was cost-effective at a willingness-to-pay threshold of $28,000 Australian. The total number of participants who had 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; 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).

Walking is a scalable and safe intervention, the authors noted. "Being accessible and low cost, this intervention has a better potential of being successfully implemented at scale than previously investigated forms of exercise. These results indicate the importance of preventive management and could affect how low back pain is managed," they wrote.

An editorial stated that given the relatively complex nature of the intervention, with components including physiotherapist appointments, education, health coaching, and a walking program, it is unclear that the walking was the effective component. Preventive interventions for back pain are important, neglected, and unlikely to be taken up by payers in increasingly resource-constrained settings, the editorial said.

"By design, preventive interventions need to ensure population coverage to be effective," the editorial stated. "It is unlikely that the existing health-care workforce (physiotherapists) have this capacity and therefore alternative providers (eg, social prescribers, exercise professionals, and digital offers) should be explored. Further research that explores delivery of this intervention using such providers might also shed light on the effect of the physiotherapist component of intervention delivery."