Lifestyle care improves low back pain, results ‘speak for themselves’

Key takeaways:

• Differences in low back disability at 26 weeks favored the integrated lifestyle care intervention.
• This treatment approach could also be beneficial for several other chronic diseases.

Integrating lifestyle care into low back pain management resulted in greater improvements in disability, weight loss and physical quality of life vs. just guideline-recommended care, a randomized study showed.

The findings, published in JAMA Network Open, “could influence future updates to back pain guidelines,” Emma Mudd, PhD, senior research officer at the University of Sydney in Australia and the analysis’ lead author, said in a press release. “Patients valued the holistic support, and the outcomes speak for themselves.”

Current clinical guidelines for low back pain from organizations like WHO “do not recommend lifestyle-focused treatment approaches due to very-low-certainty evidence of benefit,” according to Mudd and colleagues.

However, they added that integrated care is endorsed by health policy and governments for people with several health challenges, “acknowledging the associations between chronic diseases and their determinants.”

To provide greater evidence on the effects of lifestyle medicine for low back pain researchers randomly assigned 346 Australian participants with such pain and at least one lifestyle risk — like overweight, smoking, poor diet or physical inactivity — to either:

• the Healthy Lifestyle Program, or HeLP, intervention; or
• guideline-based physiotherapy care.

The HeLP intervention included guideline-based care while also integrating pain-specific healthy lifestyle education and support through educational resources, clinician consultations and telephone-based health coaching.

Those assigned to the other study group received guideline care only, which included back pain education, advice and exercise.

The difference in low back disability, assessed with the Roland Morris Disability Questionnaire (RMDQ), between the groups at 26 weeks served as the study’s primary outcome. The questionnaire graded disability on a scale of 0 to 24, with higher scores indicating greater disability.

The researchers also examined several secondary outcomes, like changes in weight, smoking, pain intensity and physical and mental quality of life.

The mean RMDQ scores at baseline were 14.7 in the HeLP group and 14 in the guideline-care-only group.

The researchers reported a 1.3-point mean difference (95% CI, 2.5 to 0.2) in disability favoring HeLP at 26 weeks.

The sensitivity analysis of the primary outcome revealed a significantly larger difference in disability favoring HeLP compliers vs. compliers of guideline care only (mean difference = 5.4 points; 95% CI, 9.7 to 1.2).

HeLP participants also lost more weight (1.6 kg; 95% CI, 3.2 to 0) and had greater improvement in physical quality of life (physical functioning score = 1.8; 95% CI, 0.1-3.4) vs. participants given only guideline care.

There was no significant difference between the treatment group in the remaining secondary outcomes or for serious adverse events.

Mudd and colleagues noted that more research is needed to clarify some remaining questions about integrated lifestyle care — such as what resources are needed to implement this care into routine practice — while engaging patients in this treatment “remains a challenge that may undermine extensive implementation.”

They also wrote that the data show how integrating lifestyle care into back pain management may have broader health implications, with the treatment not only addressing the pain but also “[providing] an opportunity for preventive care of other burdensome chronic diseases in an at-risk population group.”

“Clinicians treating back pain should consider how they integrate lifestyle support into their day-to-day care,” Christopher M. Williams, PhD, an associate professor at the University of Sydney and a study co-author, said in the release. “There doesn’t appear to be a right or a wrong way to do this, as long as the patient feels they are being heard, and they are part of the decision-making.”

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