Physios urge clinicians and researchers to work with patients to reduce flare ups of low back pain

Dr Ferreira and Professor Hancock argue that re-occurrences of LBP have been understudied and should be a priority for prevention research in the future.

There is a need to investigate interventions that reduce the frequency and severity of recurrences or flare-ups and give individuals the skills to self-manage most LBP without seeking care or taking time off work [Giovanni Ferreira and Mark Hancock]

While prevention is supposed to be a ‘fundamental tenet’ of medicine, clinicians and researchers have focused their attention on developing treatment options for those currently experiencing a LBP, they suggest.

‘For example, while a recent review of LBP prevention included 40 trials, there are several thousand trials evaluating treatments for LBP. Clinical practice guidelines are largely silent on the issue of prevention of LBP, providing little guidance to clinicians.’

Recurrences rates of LBP are high

Seven people in 10 (70 per cent) have at least one recurrence within 12 months

Four in 10 (40 per cent) report activity limitation or seek care as a consequence of the flare-up

Prioritise prevention

The impact of developing even ‘moderately effective’ secondary prevention interventions could reap dividends, Dr Ferreira and Professor Hancock note.

‘Prevention of flare-ups is understudied and should be a priority for future LBP prevention research. There is a need to investigate interventions that reduce the frequency and severity of recurrences or flare-ups and give individuals the skills to self-manage most LBP without seeking care or taking time off work.’

'Scalable and acceptable' should be the watchwords

The authors argue that prevention strategies must be ‘scalable and acceptable’ – and that this need has largely been ignored by those conducting research on LBP prevention.

‘For example, although exercise combined or not with education is the only known effective intervention for preventing LBP, trials where exercise programmes were shown to be effective typically involved many supervised exercise sessions, were resource intensive, not widely accessible, and lacked flexibility – characteristics that reduce the likelihood of people engaging with such programmes in real life.

'This means that the capacity to scale-up exercise interventions to prevent LBP recurrence is currently limited. To optimise the likelihood of wide-scale implementation, prevention interventions should be codesigned with patients and clinicians and trials should include nested evaluations of acceptability and barriers to implementation.'

Conclusion: need to 'limit research waste'

The authors conclude: 'Effective LBP prevention is critical in reducing the burden due to LBP. The recommendations in this article aim to shape future LBP prevention research, so it has the greatest value and limits research waste.'

To see the full version of 'Recommendations for shaping the future of low back pain prevention research', visit: http://dx.doi.org/10.1136/bjsports-2020-103744