Individualized walking and education program reduces the recurrence of low back pain

1. Walking significantly reduced low-back pain recurrence compared to the control group.

2. Patients in the walking group saved approximately AU $7802 per quality-adjusted life-years gained.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Low back pain recurrence is common, contributing significantly to both the disease burden and economic costs associated with this condition. While exercise is recommended to prevent recurrence, the effectiveness and cost-efficiency of simple, low-cost interventions such as walking remain unclear. This randomized controlled trial evaluated the clinical effectiveness and cost-effectiveness of an individualized, progressive walking and education program to prevent low back pain recurrence. The primary outcome of this study was time to first recurrence of activity-limiting low back pain, while the key secondary outcome was the cost-effectiveness expressed as incremental cost per quality-adjusted life-year (QALY) gained. According to study results, walking significantly reduced the recurrence of low back pain and was found to be highly cost-effective. Although this study was well done, it was limited by a higher number of lower extremity adverse events in the intervention group compared to the control group.

Click to read the study in The Lancet

Relevant Reading: The Treatment of Acute Low Back Pain — Bed Rest, Exercises, or Ordinary Activity?

In-depth [randomized controlled trial]: Between Sept 23, 2019, and Jun 10, 2022, 3206 patients were screened for eligibility across 25 physiotherapy clinics in Australia. Included were patients ≥18 years old with a history of low back pain lasting at least 24 hours. Altogether, 701 patients (351 in the walking group and 350 in the control group) were included in the final analysis. The primary outcome of days to first recurrence showed that walking significantly reduced recurrence of low-back pain compared to control (median 208 days vs. 112 days, hazard ratio [HR] 0.72, 95% confidence interval [CI] 0.60-0.85, p=0.0002). Similarly, the secondary outcome of cost-effectiveness demonstrated that the intervention was cost-effective, with an incremental cost per quality-adjusted life-year (QALY) gained of AU $7802, and a 94% probability of being cost-effective at a $28,000 willingness-to-pay threshold. Overall, findings from this study suggest that progressive walking and education can effectively and cost-efficiently reduce the recurrence of low back pain.

Image: PD

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