Lower back pain: a change of mindset may be better than physio

A trial of 1,624 people with chronic lower back pain found that an enhanced transtheoretical model intervention (ETMI) — a self‑management approach that addresses beliefs and encourages leisure physical activity — improved function and reduced the number of treatment sessions compared with usual care, while pain scores did not differ significantly. The study was published in JAMA Network Open.

Researchers report that focusing on patients' beliefs and their preferred leisure activity can improve function for people with chronic lower back pain. The finding comes from a trial involving 1,624 patients who received either usual care or an enhanced transtheoretical model intervention (ETMI). ETMI is a self‑management approach that prioritises addressing unhelpful beliefs about prognosis and encouraging physical activity chosen by the patient. Clinical guidelines recommend reassurance and support for self‑management as first‑line care, but that is often overlooked in practice. Key findings: - Of the 1,624 patients, 83% were reported as receiving "usual care" while 259 patients received ETMI. - Patients who received ETMI needed fewer treatment sessions and showed greater improvements in overall function and in fear‑avoidance beliefs than those given usual care. - There were no significant differences between groups in reported pain intensity over the past 24 hours. - Improvements in activity limitation associated with ETMI were also reported among patients who had diagnoses of depression or anxiety. Summary: The trial indicates that a self‑management approach that targets beliefs and encourages leisure‑time physical activity can improve function and reduce service use for some people with chronic lower back pain. Undetermined at this time.