Regular walking may help prevent recurring episodes of lower back pain, a new study suggests.
Among adults who recently recovered from an episode of low back pain, those who participated in an individualized walking program had fewer repeated episodes of low back pain and took longer before a recurrence than their peers in a group witness, the authors discovered.
The Australian WalkBack program was also “cost-effective, as most of the savings came from reduced hours off work and we also saw a significant reduction in lower back pain that required care-seeking,” the author said. principal Natasha Pocovi, PhD, Ministry of Health. Sciences Macquarie University, Sydney, said Medscape Medical News.
The study was published online June 19 in The Lancet.
Common and disabling
Low back pain is common and often disabling. About 7 in 10 people who recover from an episode of low back pain will experience a recurrence within the following year.
Exercise is recommended to prevent recurrent attacks, but the effectiveness and cost-effectiveness of an accessible, inexpensive intervention such as walking remains to be established.
The WalkBack trial recruited 701 adults (mean age 54 years; 81% women) who had recently recovered from an episode of low back pain. They had had an average of 33 previous episodes of low back pain and were considered to be at high risk of recurrence in the next 12 months.
Half were randomly assigned to an individualized, progressive walking program comprising six physiotherapist-guided training sessions over 6 months and the other half to a no-treatment control group.
The trial was conducted in 25 private physiotherapy clinics across Australia. Participating physiotherapists completed 3 hours of online health coaching training.
A guiding goal for the intervention group was to walk 5 times per week for at least 30 minutes per day for 6 months, although the program was individualized as needed. Participant diaries showed that the median walking times per week by the intervention group were three times in week 1 and four times in week 12.
Walking + Education = Profit
The walking intervention was effective in preventing an activity-limiting episode of low back pain (risk ratio: 0.72; P. = .0002). The median time to recurrence was longer in intervention participants than in control participants (208 days versus 112 days).
The additional cost per quality-adjusted life year gained was AUD$7,802 (approximately US$5,201), “giving a 94% probability that the intervention would be cost-effective compared to no-treatment control.” at a willingness-to-pay threshold of $28,000.” “, report the authors.
The total number of adverse events was similar in all groups. However, the intervention group reported approximately twice as many lower extremity injuries as those seen in the control group (100 versus 54).
Pocovi said Medscape Medical News that it is difficult to determine which elements of the WalkBack intervention contributed most to preventing low back pain, given the multifaceted nature of the program.
“Our study looked at a combination of walking and education delivered by a physiotherapist qualified in health coaching,” Pocovi explained.
“The benefits of walking could have come from the gentle movements, loading and strengthening of spinal structures and muscles, the relaxation and stress relief it provides, and the release of feel-good endorphins. be,” Pocovi said.
Training provided by the physiotherapist aimed at giving people a better understanding of pain, reducing fear associated with exercise and movement and giving people the confidence to manage their pain could also be considered.
“It’s probably a combination of those things,” Pocovi said.
An “interesting question” is whether patients would get the same benefits if they adopted a walking program themselves, Pocovi said.
“It is possible that some patients are able to develop their own program and motivate themselves; however, many people in our trial reported needing (and appreciating) support from a clinician to develop and progress their program and helping them stay on track and accountable Additionally, the education provided can be very important for some patients and will be best delivered by a healthcare clinician,” Pocovi said..
Valuable contribution, with caveats
The WalkBack trial represents a “valuable contribution to a neglected area of back pain treatment and prevention of recurrence,” wrote two UK-based physiotherapists who wrote an accompanying editorial.
“However, health service payers or commissioners are unlikely to agree to offer six physiotherapy appointments to asymptomatic people in increasingly resource-constrained settings,” Diarmuid Denneny of Brunel University of London, Uxbridge, England, and Jackie Walumbe, of the University of Oxford. , England, wrote.
“By design, preventive interventions must ensure population coverage to be effective. Existing healthcare staff (physiotherapists) are unlikely to have this capacity and therefore alternative providers (e.g. social prescribers, health care professionals) exercise and digital offerings) should be explored,” they noted.
Denneny and Walumbe also pointed out that most study participants were well educated and at least in good general health and that no data on ethnicity was provided.
“Additional work evaluating this intervention in larger, more diverse populations, including people with comorbidities and those experiencing socioeconomic deprivation, is needed to assess real-world application and outcomes,” they said. they write.
Funding for the trial was provided by the National Health and Medical Research Council. The authors have no relevant conflicts of interest. Denneny reports consultation fees from the Live Well with Pain and Leva clinic; a grant from the Chartered Society of Physiotherapy; and served as a committee member representing physical therapy on the National Institute for Health and Care Excellence NG193 Steering Committee. Walumbe reports travel support from the Chartered Society of Physiotherapy Charitable Trust and is a former co-chair of the Physiotherapy Pain Association.