A progressive walking and education program, consisting of six physiotherapist-facilitated sessions over 6 months, can delay the recurrence of low back pain by nearly 100 days compared to no treatment, with the intervention group experiencing a median time to recurrence of 208 days versus 112 days for the control group (hazard ratio, 0.72; 95% confidence interval, 0.60–0.85; P = .0002), according to a recent randomized controlled trial.
Published in The Lancet, investigators examined the impact of a tailored walking and education program on reducing low back pain recurrence. Participants used a pedometer and walking diary, and received education on basic pain science and strategies to reduce recurrence risk. The trial evaluated both clinical and economic outcomes.
The WalkBack trial included 701 adults across Australia who had recently recovered from non-specific low back pain. Individuals were randomized into an intervention group, receiving the walking and education program, and a control group with no treatment. The primary outcome measured was the number of days until the first recurrence of activity-limiting low back pain, monitored over 12 to 36 months.
Secondary outcomes favored the intervention group, including reduced back pain-related disability over 12 months and increased daily steps and minutes of physical activity at 3 months compared to the control group.
Strengths of the study included the randomized controlled design, prespecified protocol and analysis plan, and high retention and adherence rates. Limitations were that most participants were female, physically active adults were excluded, and the lack of blinding may have introduced some bias in self-reported outcomes.
The intervention was cost-effective, with an incremental cost per quality-adjusted life-year (QALY) gained of AU$7,802 (approximately US$5,227) and a 94% probability of being cost-effective at a willingness-to-pay threshold of AU$28,000 (approximately US$18,760).
The authors suggest this accessible, low-cost intervention has the potential to substantially reduce the personal and societal burden of recurrent low back pain if widely implemented. Future research should assess implementation in clinical practice, test effectiveness with other clinician types or fewer sessions, and explore prevention effects of other forms of exercise.
The authors reported no conflict of interest.