Low back pain (LBP) is one of the most common causes of disability and is associated with a number of comorbid conditions such as excess weight, physical inactivity, poor diet and smoking. 

Recent years have seen an increase in the amount of research investigating how to prevent and treat LBP, particularly through combating comorbid conditions.

Researchers in New South Wales completed a study exploring a Healthy Lifestyle Program for LBP (HeLP) intervention encompassing guidelinebased care, LBP-specific healthy lifestyle education and resources, and support through clinical and telehealth consultations with a physiotherapist and dietitian. 

‘There’s a presumed link between lifestyle risks and chronic LBP, which comes from measuring people over time and historically looking back on their lifestyle change and the development and persistence of low back pain,’ says Dr Christopher Williams from the University Centre for Rural Health, the University of Sydney. 

‘But until our program it’s been unknown whether targeting those specific lifestyle risks then helps people reduce their LBP.’ 

The trial was conducted between September 2017 and December 2020 and involved 346 participants (mean age 50.2 years) who had activity-limiting chronic LBP and at least one lifestyle risk (overweight, poor diet, physical inactivity and/or smoking). 

The primary outcome was LBP disability, measured using the Roland- Morris Disability Questionnaire at 26 weeks. 

The secondary outcomes were weight, pain intensity, quality of life and smoking. 

‘We asked consumers about their preferences of care and identified that many people don’t receive care addressing both their lifestyle risks and LBP, certainly not in the same appointment or in the same context of care. 

'We then asked them what a model of care might look like and how they would like to receive it. 

'This led to the development of HeLP, which involved four consultations with a physiotherapist, one consultation with a dietitian and referral to telephone-based coaching. 

'We compared that to what we might call best-practice physiotherapy, offering good advice, education and some appropriate exercises.’ 

Over 26 weeks, there was a −1.3-point difference (p = 0.03) in disability favouring the HeLP intervention. 

There was no evidence of a difference in effect for disability between participants with a healthy BMI and those with a high BMI. 

There was a difference in weight assessment (p = 0.049) and physical functioning quality of life score (p = 0.04) favouring the HeLP intervention; however, no significant effect was seen for pain intensity score, smoking status or mental functioning quality of life at 26 weeks. 

The research also compared data between compliers in the intervention group and ‘would-be’ compliers in the control group— those with similar characteristics—finding a large meaningful difference in disability of −5.4 points (p = 0.01). 

‘The main takeaway from the study would be that integrating lifestyle conversations and support for people with chronic LBP who also have or present with lifestyle risks improves outcomes beyond current recommended physiotherapy. 

'If we can engage those patients in this process a bit more, we might expect a large and meaningful improvement in disability that corresponds with improvements in quality of life and improved lifestyle risk, particularly regarding BMI.’ 

The next phase of the research, currently underway, involves randomised controlled trials comparing an adapted digital-care model to the in-person model as well as trials on the best ways of providing training and capacity building for clinicians to integrate support for lifestyle risks into LBP care.