Written by Mary Marschner
Spoon Feed
For adults with limited baseline walking or exercise who present with an episode of low back pain, introducing a walking program with education about back pain increases the time between back pain episodes and decreases how often they present to a healthcare provider.
Synopsis
The WalkBack randomized controlled trial assessed the effectiveness of an individualized walking and education program in preventing recurrence of low back pain. Results showed a significant reduction in the risk of recurrence for the intervention group (hazard ratio 0.72, p=0.0002), with a median recurrence time of 208 days versus 112 days in the control. The intervention also demonstrated cost-effectiveness with an incremental cost per quality-adjusted life-year (QALY) gained of AU$7802, offering a 94% probability of cost-effectiveness at the AU$28,000 threshold. These findings support this low-cost, scalable intervention as a preventive strategy for recurrent low back pain. [AI generated]
Walk it off
Acute episodes of lower back pain are common, and our medical recommendations are somewhat limited: Rest a little, go to physical therapy, and keep yourself active. Unfortunately, PT is expensive, requires scheduling, and is often not practical for a busy adult. This study explores a flexible intervention to prevent the next recurrence and the next office visit: consistent walking and back pain education with a trained physiotherapist. Overall, this is a great study looking at an accessible, flexible, cost-effective intervention for low back pain and needs to be expanded. However, the study is limited by exclusion criteria, and it is difficult to broadly apply this to community patients, given limited access to physiotherapists who can build a walking program, educate patients, and check in with them. The study excluded 78% of people who presented with acute lower back pain, and most of the excluded patients were people with chronic back pain and people who already exercise or walk.
How will this change my practice?
This won’t change my clinical practice yet. But for patients with limited time and funds to see PT, low baseline walking, and acute low back pain, this is an easy recommendation: Add 30 mins of walking.
Source
Effectiveness and cost-effectiveness of an individualized, progressive walking and education intervention for the prevention of low back pain recurrence in Australia (WalkBack): a randomized controlled trial. Lancet. 2024 Jul 13;404(10448):134-144. doi: 10.1016/S0140-6736(24)00755-4. Epub 2024 Jun 19. PMID: 38908392
