Low back pain (LBP) affects approximately one in six Australians at any one time and four in five people will be affected by it sometime in their lives. LBP also accounts for approximately $9 billion in direct and indirect healthcare costs in Australia  every year and is the leading cause of disability worldwide.

Scientific evidence shows that treatments often offered to people with LBP are not evidence-based, and are potentially harmful. Previous research also highlights the importance of providing education and self-management strategies. These strategies, however, can be difficult to implement in clinical practice.

Patient adherence to healthcare recommendations is challenging and a substantial barrier to implementing selfmanagement approaches for LBP. A delivery method for lifestyle-based and behavioural change interventions that has received increasing interest is mobile text messaging.

The positive aspects of text message-based interventions relate to its vast availability and little to no technological expertise nor internet connection requirement. Research has shown that text message interventions effectively promote self-management for different health conditions, such as HIV, diabetes, and cardiovascular diseases.

They also support behaviour change and help people to increase physical activity participation, quit smoking and lose weight. However, it is still unknown if text messages can support people with LBP to selfmanage their condition.

Our research team led by Professor Manuela Ferreira has developed TEXT4myBACK, a lifestyle-based self-management text message intervention. TEXT4myBACK was developed through an iterative process involving clinicians, researchers, consumers and consumer advocates and based on evidence.

We now want to investigate the effectiveness of this text message intervention.

Aims

Our aim is to assess the effectiveness of a lifestyle-based self-management text message intervention compared to minimal intervention (ie, general LBP and healthy diet information package) for adults with non-specific, non-persistent LBP. A randomised controlled trial will be conducted to evaluate its effectiveness in terms of function, pain and quality of life.

Our hypothesis is that the TEXT4myBACK text message intervention will result in significant improvements in function, compared to control (minimal educational package). 

Study design Adults with non-specific, non-persistent (12 weeks duration) LBP who have a mobile phone that can receive text messages will be invited to participate. Three hundred and four people will be recruited and randomised to the TEXT4myBACK intervention group or minimal educational package group. A health counsellor will be monitoring the replies to the text messages to ensure participant safety.

The TEXT4myBACK intervention group will receive semi-personalised text messages providing advice, motivation and information to improve LBP education, physical activity, sleep, mood, use of care and medication. Some messages will be targeted according to participants’ characteristics (ie, presence of sleep issues, physical activity level, LBP duration, job characteristics, taking medication at baseline) or will include their preferred contact name. This group will receive four text messages per week for 12 weeks. Messages will be sent on randomly selected days, at randomly selected times.

The control group will receive a single text message containing a link to access a LBP and healthy diet information package.

The primary outcome will be function. Pain, physical activity levels, sedentary behaviour, global impression of change, eHealth literacy, quality of life, and healthcare utilisation will be assessed as secondary outcomes. All outcomes will be assessed via online survey at baseline, three, six and 12 months. A parallel cost-effectiveness analysis will also be performed.

Significance

We will investigate if a lifestyle-based  self-management intervention can  improve function and other health-related outcomes in people with non-specific, non-persistent LBP compared to a minimal educational package.

LBP currently impacts different aspects of life of millions of Australians, including work, family and social activities, causing enormous societal and economic burden. If proven effective, this innovative lifestylebased self-management intervention will represent an easy, accessible and affordable intervention to support recovery from LBP.

Opportunity to be involved If you would like to support this project and help to identify potential participants, get in contact with  the TEXT4myBACK Study Team  by emailing text4myback.study@ sydney.edu.au or calling  (02) 9926 4809. You can also forward potential participants  to the online pre-screening at  http://bit.ly/text4myback.