The WalkBack Trial: Effectiveness and cost-effectiveness of an individualised, progressive, walking and education program for preventing low back pain recurrence

Natasha Pocovi, Christine Lin, Simon French, Petra Graham, Johanna van Dongen, Jane Latimer, Dafna Merom, Anne Tiedemann, Chris Maher, Kate Tong, Ornella Clavisi, Mark Hancock
Purpose:

The primary purpose of this randomised controlled trial was to establish the effectiveness and cost-effectiveness of an individualised, progressive walking and education intervention to prevent recurrences of low back pain.

Methods:

The WalkBack trial was a two-armed randomised controlled trial, recruiting adults (aged ≥18 years) across Australia who had recently recovered from an episode of non-specific low back pain. Participants were randomly assigned to an individualised, progressive walking and education intervention or a no-treatment control group. Those allocated to the intervention group received 6 sessions with a physiotherapist upskilled in health coaching to facilitate a progressive walking program and education over 6 months. Participants were followed monthly for a minimum of 12 and a maximum of 36 months, depending on the date of enrolment. The primary outcome was days to the first recurrence of an activity-limiting episode of low back pain, collected monthly via participant self-report. Secondary outcomes included days to the first recurrence of any recurrence of low back pain and days to the first recurrence of low back pain leading to care seeking. Cost-effectiveness was evaluated from the societal perspective. 

Results:

Seven hundred and one participants (n=351 intervention, n=350 control) were randomised between September 23, 2019, and June 10, 2022. The intervention effectively prevented an episode of activity-limiting low back pain (hazard ratio (HR) 0.72, 95% CI 0.60-0.85, p=0.0002). The intervention also reduced the risk of any recurrences of low back pain and care-seeking recurrences of low back pain compared to the control group (HR 0.80, 95% CI 0.68 to 0.94, p=0.0066 and HR 0.57, 95% CI 0.44 to 0.74, p0.0001, respectively). The intervention also had a high probability of being cost-effective (94% at a willingness-to-pay of AU$28,000/QALY).

Conclusion(s):

An individualised, progressive walking and education intervention significantly reduced low back pain recurrence and was highly likely to be cost-effective. The efforts of future work will focus on scaling up and implementing this intervention into routine clinical practice.

Implications:

This accessible, scalable, and safe intervention could profoundly impact how low back pain is managed, emphasising the importance and value of preventive care.

Funding acknowledgements:
The WalkBack trial was supported by National Health and Medical Research Council, Australia (APP1161889).
Keywords:
Prevention
Pain
Exercise
Primary topic:
Musculoskeletal: spine
Did this work require ethics approval?:
Yes
Name the institution and ethics committee that approved your work:
Macquarie University Human Research Ethics Committee
Provide the ethics approval number:
HREC:5201949218164
Has any of this material been/due to be published or presented at another national or international conference prior to the World Physiotherapy Congress 2025?:
Yes

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