An individualised self-management exercise and education program did not prevent recurrence of low back pain but may reduce care seeking: a randomised trial

Tarcisio F de Campos; Natasha C Pocovi; Chris G Maher; Helen A Clare; Tatiane M da Silva; Mark J Hancock

doi:10.1016/j.jphys.2020.06.006

An individualised self-management exercise and education program did not prevent recurrence of low back pain but may reduce care seeking: a randomised trial

J Physiother. 2020 Jul;66(3):166-173. doi: 10.1016/j.jphys.2020.06.006. Epub 2020 Jul 21.

Authors

Tarcisio F de Campos¹, Natasha C Pocovi², Chris G Maher³, Helen A Clare⁴, Tatiane M da Silva⁵, Mark J Hancock²

Affiliations

¹ Department of Health Professions, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia. Electronic address: tarcisio.de-campos@hdr.mq.edu.au.
² Department of Health Professions, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.
³ Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
⁴ Helen Clare Physiotherapy, Sydney, Australia.
⁵ Master and Doctoral Programs in Physical Therapy, Universidade Cidade de Sao Paulo, Sao Paulo, Brazil.

PMID: 32709590
DOI: 10.1016/j.jphys.2020.06.006

Abstract

Question: What is the effect of a McKenzie-based self-management exercise and education program on the risk of recurrence of low back pain (LBP) and on the impact of LBP?

Design: Randomised controlled trial with concealed allocation, blinded assessors and intention-to-treat analysis.

Participants: 262 adults recently recovered from an episode of LBP.

Intervention: The experimental group received a McKenzie-based self-management exercise and education program delivered over two individual sessions of 30 to 45 minutes with a physiotherapist, approximately 2 weeks apart. The control group received a single advice session over the phone.

Outcome measures: The primary outcome was time to first recurrence of an episode of activity-limiting LBP. Secondary outcomes included time to recurrence of any LBP, time to a recurrence causing care seeking and a composite measure of pain and function ('impact of LBP'). Participants were followed-up monthly for ≥ 12 months.

Results: The estimated effect of the experimental intervention on the risk of recurrence of an episode of: activity-limiting LBP was HR 1.11 (95% CI 0.80 to 1.54), any LBP was HR 0.95 (95% CI 0.72 to 1.26), and LBP for which care was sought was HR 0.69 (95% CI 0.46 to 1.04). The quarterly estimates of the experimental intervention's effect on impact of LBP and their 95% CIs were all within 4 points above or below 0 (no effect) on this scale from 8 to 50.

Conclusion: This study's best estimate is that a McKenzie-based self-management exercise and education program does not produce a worthwhile reduction in the risk of an activity-limiting episode of LBP; however, modestly reduced or moderately increased risk cannot be ruled out. It may markedly reduce the risk of an episode of LBP resulting in care seeking, but does not have any worthwhile effect on the impact of LBP over 12 months.

Trial registration: ACTRN12616000926437.

Keywords: Low back pain; Physical therapy; Prevention; Randomised controlled trial; Recurrence.

Publication types

Randomized Controlled Trial

MeSH terms

Adult
Exercise Therapy / methods*
Female
Humans
Low Back Pain / therapy*
Male
Middle Aged
Patient Acceptance of Health Care*
Recurrence
Self-Management / methods*
Single-Blind Method
Surveys and Questionnaires