Physician-authored summaries and commentary on the most important medical research, provided by the NEJM Group, a division of the Massachusetts Medical Society.
© Massachusetts Medical SocietySeptember 2024
Six sessions of guidance by a physical therapist nearly doubled time to back pain recurrence.
Exercise and education can prevent some recurrences of low back pain, but most studied interventions have involved group sessions, direct clinician supervision and equipment, all of which increase costs. Walking improves a variety of health outcomes inexpensively, but whether it helps prevent recurrence of low back pain is unknown.
Australian investigators randomised 700 adults (80% women; mean age, 54 years) who had recovered from an episode of nonspecific low back pain (pain duration, 24 hours or longer; median lifetime episodes, 33) during the past six months to an individualised, progressive walking and education program or to no treatment. The intervention was structured to optimise longterm adherence and involved six in-person or remote sessions with a physical therapist who encouraged walking for at least 30 minutes five times weekly by the end of the six-month program.
Median time to recurrence of low back pain was significantly longer in the intervention group than in the control group (208 vs 112 days), and the intervention group was significantly less likely to report or seek care for recurrent low back pain during the first year of follow up.
Comment: This inexpensive and effective program for preventing some recurrences of low back pain should be attractive to health systems and insurers. Primary care clinicians should encourage patients with nonspecific back pain to walk regularly, but individualised guidance and follow up from trained physical therapists probably is what made this intervention effective.
Bruce Soloway, MD, Associate Professor Emeritus of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York, USA.
Pocovi NC, et al. Effectiveness and cost-effectiveness of an individualised, progressive walking and education intervention for the prevention of low back pain recurrence in Australia (WalkBack): a randomised controlled trial. Lancet 2024; 404: 134-144.
This summary is taken from the following Journal Watch titles: General Medicine, Ambulatory Medicine.