A recent systematic journal has shown that WHO recommendations concerning chronic low back pain (1) do not include weight loss, due to data from a level of confidence deemed very low and studies presenting a risk of high bias. In addition, no recommendation on smoking cessation is mentioned. If exercise is considered a fundamental treatment for low back pain, the literature approaching the sedentary lifestyle is lacking. Faced with these gaps, a summer test to examine the effect of the integration of care -lifelong healthcare care in chronic low back pain, compared only to the care recommended by the guidelines.
A randomized trial with 346 low backgrounds
This controlled trial was conducted in Australia between 2017 and 2020 with 346 participants with chronic low back pain with at least one risk of lifestyle such as overweight, unbalanced diet, physical inactivity and/or smoking (2). The participants were distributed randomly to benefit from the HELP intervention (n = 174) or rehabilitation care based on the recommendations only (n = 172), with stratification according to the body mass index (BMI).
The intervention targeting a healthier lifestyle was based on physiotherapy and dietetics consultations, educational resources, and a coaching health by phone over 6 months. The criterion of main judgment was the incapacity linked to low back pain at 26 weeks measured by the score of the Roland Morris Disability Questionnaire (RMDQ, from 0 to 24, the highest scores indicate greater disability). Were also analyzed the weight, the intensity of the pain, the quality of life and smoking.
-Participants (average age 50.2 years, women 55 %) had an initial median RMDQ score around 14 (14.7 in the intervention group, 14.0 in the control group). At 26 weeks, the difference between groups was -1.3 points in favor of the intervention (95 % CI -2.5 to -0.2; p = 0.03). The analysis has also shown a significant clinical improvement in secondary criteria, in favor of the HELP group in terms of weight loss (−1.6 kg; 95 % CI; 3.2 to −0.0 kg; p = 0.049) and a greater improvement in quality of life (physical operating score 1.8; 95 % CI, 0.1 to 3.4; p = 0.04).
Integrate the lifestyle into the management
This randomized clinical trial suggests that the integration of risk management linked to lifestyle in the management of low back pains could provide an improvement in functional incapacity compared to care -based on guidelines, with a significant benefit for those that have complied with at least half of the treatment. These care models that include support to approach behavior are promising to improve disability, weight and quality of life. It could be interesting to study the longer term effects in terms of functional evolution of low back pain but also with regard to the possible decrease in the incidence of chronic diseases. The current offer of digital technologies makes it possible to design a wide range of lifestyle interventions, adapted to the needs of patients, making it possible to improve both accessibility and acceptability.
