Self-Management Strategies for Lower Back Pain

Overseen By Boyi Hu, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Florida

Disqualifiers: Major trauma, Surgery, Pregnancy, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 3

Duration: 10 weeks

164 Participants Needed

Trial Summary

What is the purpose of this trial?

The primary purpose of this hybrid Type II comparative effectiveness and implementation study is to compare two self-management strategies in nursery and landscape workers. This randomized pragmatic study will compare interventions with different degrees of support to determine if self-management videos plus multimodal personalized support is more effective than self-management videos alone for improving LBP among horticulture workers. Both groups will review short self-management video modules to introduce general pain concepts and the importance of managing pain without medication, risks of opioid use, self-management of pain, and simple ergonomic strategies for both groups. Both groups will choose 1 self-management strategy to manage pain at home and 1 ergonomic workplace strategy to limit pain. The video+support group will receive 1) check-list guidance, 2) review videos of their work tasks, and 3) receive text reminders to support implementation. Surveys will include instruments reflecting low back pain disability, pain, work ability, and affective or cognitive characteristics (self-efficacy, pain anxiety, depression, coping), collected at baseline, pre- and post-intervention, with follow-ups at 3- and 6-months. Workers will be videoed pre- and post-intervention for calculation of work risk and to compare any changes after the intervention. Specific aim 2 will identify contextual factors impacting engagement, adoption, effectiveness, and implementation. Interviews, focus groups, and field notes will be used to explain results and establish patterns to inform future translation.

Will I have to stop taking my current medications?

The trial focuses on managing pain without medication, but it doesn't specify if you need to stop your current medications. It's best to discuss this with the trial coordinators or your doctor.

What data supports the effectiveness of the treatment Ergonomics, Workplace Ergonomics, Ergonomic Interventions, Self-management Strategies, Self-management, Calm Place, Guided Relaxation Program for lower back pain?

Research shows that ergonomic training and self-management strategies can improve work performance and reduce the risk of low back pain. Studies involving body mechanics instruction and participatory ergonomics have demonstrated better manual handling and reduced pain in workers, suggesting these approaches can be effective in managing lower back pain. ^{1 2 3 4 5}

Is it safe to use self-management strategies and ergonomic interventions for lower back pain?

The studies reviewed do not report any specific safety concerns related to self-management strategies or ergonomic interventions for lower back pain. However, one study noted that self-administered programs might lead to increased awareness of symptoms, which could be perceived negatively if not managed properly. ^{4 6 7 8 9}

How is the treatment 'Self-Management Strategies for Lower Back Pain' different from other treatments for this condition?

This treatment is unique because it focuses on self-management strategies, including workplace ergonomics and guided relaxation, empowering patients to actively manage their own lower back pain through behavior changes and lifestyle adjustments, rather than relying solely on medication or passive treatments. ^{10 11 12 13 14}

Research Team

Kim Dunleavy, PT, PhD

Principal Investigator

University of Florida

Eligibility Criteria

This trial is for full-time horticulture workers experiencing low back pain, who are over 18 and speak English or Spanish. It's aimed at those in small to medium-sized businesses willing to be videotaped at work. It excludes those with recent major back trauma, surgery, seeking disability compensation, or pregnant.

Inclusion Criteria

Workers willing to be videotaped during work activities for movement analysis

I have had lower back pain for the last 3 months.

I am an owner, manager, or supervisor willing to participate.

Exclusion Criteria

Workers who have self-disclosed pregnancy

Workers seeking disability or workman's compensation

I have had major surgery, trauma, or spinal nerve blocks in the last year.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants review self-management video modules and select strategies for 10 weeks

10 weeks

Regular video reviews and text reminders

Follow-up

Participants are monitored for safety and effectiveness after treatment

6 months

Follow-up surveys at 3 and 6 months

Treatment Details

Interventions

• Ergonomics
• Self-management

Trial Overview The study compares two methods: self-management (SM) alone versus SM with personalized ergonomic choices (SM+PE). Both groups learn about managing pain without medication and choose a home pain management strategy and a workplace ergonomic strategy.

Participant Groups

Group I: Self-management videos + Multimodal personalized support Experimental Treatment 4 Interventions

Participants will review short video modules on pain self-management without medication and ergonomic work adjustment and select 1 self-management option and 1 ergonomic option to use for 10 weeks. Participants will use 1) checklists to guided choices for strategies based on their self-identified most difficult work activities due to pain and options that they are not using regularly, 2) review video recordings of their own work movements to assist with ergonomic problem-solving and 3) receive text message reminders

Group II: Self-management videos Active Control 1 Intervention

Participants will review short video modules on pain self-management without medication and ergonomic work adjustment and select 1 self-management option and 1 ergonomic option to use for 10 weeks

Who Is Running the Clinical Trial?

University of Florida

Lead Sponsor

Trials

1,428

Recruited

987,000+

Findings from Research

In a study involving 30 young workers aged 14 to 19, those who received body mechanics instruction showed significantly better performance in maintaining proper spinal alignment during work compared to those who did not receive instruction.

The findings suggest that job-specific body mechanics training, provided by occupational therapists, is an effective method for preventing low back pain in young workers.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effect of body mechanics instruction on work performance among young workers. McCauley, M.[2019]

A workplace intervention for nursing personnel that included ergonomic training and an exercise program based on the Feldenkrais Method led to an increased rate of correct manual handling activities.

This suggests that such interventions can effectively reduce the risk of low back pain among nurses by improving their handling techniques.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[A workplace intervention aimed at increasing awareness in nursing personnel performing manual handling activities]. Scorpiniti, A., Lorusso, A., L'Abbate, N.[2017]

The participatory ergonomics (PE) program for workers with low back pain (LBP) showed high satisfaction rates, with a median score of 7.8 out of 10, and 66.7% of participants felt it positively influenced their return-to-work process.

Out of 270 ergonomic solutions proposed, nearly 49% were fully or partially implemented within three months, indicating that while there were challenges, such as technical difficulties and physical limitations, the program was effective in promoting workplace adjustments.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Participatory ergonomics as a return-to-work intervention: a future challenge? Anema, JR., Steenstra, IA., Urlings, IJ., et al.[2017]

A comprehensive return-to-work (RTW) program for occupational low back pain (LBP) was developed using intervention mapping, which combines best evidence and stakeholder input to address unique workplace challenges.

Key features of the program include trained personnel to coordinate the RTW process, identifying barriers to RTW, and empowering injured workers in decision-making, aiming to improve recovery and reduce disability.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Designing a workplace return-to-work program for occupational low back pain: an intervention mapping approach. Ammendolia, C., Cassidy, D., Steensta, I., et al.[2021]

A feasibility study involving clam farmers showed that participatory ergonomics, where workers selected their own strategies for managing low back pain, led to significant improvements in pain-related disability and anxiety after 8 weeks.

74% of participants reported pain improvements that exceeded the minimal detectable change, indicating that the self-management strategies were effective in reducing pain during work tasks.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Outcomes of Participatory Ergonomics and Self-management in Commercial Clam Farmers with Chronic Low Back Pain: A Feasibility Study. Dunleavy, K., Kane, A., Coffman, A., et al.[2022]

The Stay@Work participatory ergonomics program effectively engaged workers in identifying and prioritizing ergonomic measures to prevent low back pain (LBP) and neck pain (NP), with a high participation rate of 87% among working group members across 19 departments.

Despite positive feedback on the program and training, only 34% of prioritized ergonomic measures were perceived as implemented, indicating a gap between planning and actual implementation in the workplace.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Process evaluation of a participatory ergonomics programme to prevent low back pain and neck pain among workers. Driessen, MT., Proper, KI., Anema, JR., et al.[2021]

The auto-instructional preventive program aimed at improving musculoskeletal comfort among 36 secretaries and bank clerks led to an increase in the number and severity of reported symptoms after its implementation.

While the program raised awareness of ergonomic issues related to their work, it highlighted that self-administered interventions alone may not be effective in controlling musculoskeletal symptoms and could potentially worsen them.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Self-administered preventive programme for sedentary workers: reducing musculoskeletal symptoms or increasing awareness? Coury, HJ.[2019]

In a study involving 2,297 participants with acute low back pain, adding brief pain science or ergonomics messages to standard guideline advice did not improve feelings of reassurance regarding the safety of daily activities or the absence of serious conditions causing pain.

Surprisingly, the inclusion of ergonomics advice actually decreased reassurance about continuing daily activities, suggesting that not all supplementary information is beneficial for patients with acute low back pain.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adding Brief Pain Science or Ergonomics Messages to Guideline Advice Did Not Increase Feelings of Reassurance in People With Acute Low Back Pain: A Randomized Experiment. Ferreira, GE., Zadro, JR., Traeger, AC., et al.[2023]

A 10-year follow-up study at the Tokyo Metropolitan Bureau of Waste Management showed that a participatory occupational safety and health program significantly reduced compensated low back pain cases from 318 to 87 and claimed low back pain from 343 to 92.

The program involved employee-employer collaboration and included training, safety procedure revisions, and improvements in working conditions, demonstrating its effectiveness in preventing low back pain in the workplace.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A follow-up study of preventive effects on low back pain at worksites by providing a participatory occupational safety and health program. Koda, S., Nakagiri, S., Yasuda, N., et al.[2019]

A systematic review of 25 smartphone apps for low back pain management found that while the average quality of these apps was acceptable (mean MARS score of 3.9 out of 5), their potential for supporting self-management and behavior change was low (mean SMS-14 score of 3.4/14 and ABACUS score of 5.4/21).

Clinicians should be cautious when recommending these apps, as they often lack features specifically designed to enhance self-management and behavior change, despite being of average to good quality.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Availability, content and quality of commercially available smartphone applications for the self-management of low back pain: a systematic assessment. Didyk, C., Lewis, LK., Lange, B.[2023]

Individuals with chronic low back pain commonly use self-management strategies such as medication, exercise, and heat application to alleviate their symptoms, reflecting a proactive approach to their condition.

Healthcare professionals, particularly physiotherapists, emphasize exercise—especially core-strengthening routines—as a key strategy, while general practitioners focus on medication management and referrals, highlighting a collaborative approach to managing chronic pain.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Self-management and chronic low back pain: a qualitative study. Crowe, M., Whitehead, L., Jo Gagan, M., et al.[2022]

A self-management program for low-income, urban patients with acute low back pain was developed and tested with 211 participants, revealing that only 29% attended the intervention classes.

Predictors of attendance included being older, having lower income, and being unemployed, indicating that targeted strategies may be necessary to improve participation in such programs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Acute low back pain self-management intervention for urban primary care patients: rationale, design, and predictors of participation. Damush, TM., Weinberger, M., Clark, DO., et al.[2007]

Participants in the study demonstrated adequate self-management behaviors for chronic low back pain, often attempting to manage relapses independently before seeking help from physiotherapists.

To enhance long-term self-management, physiotherapists should encourage sustained health behaviors during pain-free periods and consider integrating features in the e-Exercise app that promote social support.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Self-management behaviour after a physiotherapist guided blended self-management intervention in patients with chronic low back pain: A qualitative study. Achten, JPJ., Mooren-van der Meer, S., Pisters, MF., et al.[2022]

Self-management interventions for persistent low back pain encourage patients to actively engage in managing their condition through behavior change, but the evidence supporting their effectiveness remains inconclusive.

The article highlights the need for improved research methodologies in self-management interventions, including clearer definitions, better theoretical frameworks, and appropriate outcome measures to enhance the understanding of their impact.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Behaviour change and self-management interventions in persistent low back pain. Mansell, G., Hall, A., Toomey, E.[2019]

References

1. United States pubmed.ncbi.nlm.nih.gov

The effect of body mechanics instruction on work performance among young workers. [2019]

2. Italy pubmed.ncbi.nlm.nih.gov

[A workplace intervention aimed at increasing awareness in nursing personnel performing manual handling activities]. [2017]

3. United States pubmed.ncbi.nlm.nih.gov

Participatory ergonomics as a return-to-work intervention: a future challenge? [2017]

4. England pubmed.ncbi.nlm.nih.gov

Designing a workplace return-to-work program for occupational low back pain: an intervention mapping approach. [2021]

5. England pubmed.ncbi.nlm.nih.gov

Outcomes of Participatory Ergonomics and Self-management in Commercial Clam Farmers with Chronic Low Back Pain: A Feasibility Study. [2022]

6. England pubmed.ncbi.nlm.nih.gov

Process evaluation of a participatory ergonomics programme to prevent low back pain and neck pain among workers. [2021]

7. England pubmed.ncbi.nlm.nih.gov

Self-administered preventive programme for sedentary workers: reducing musculoskeletal symptoms or increasing awareness? [2019]

8. United States pubmed.ncbi.nlm.nih.gov

Adding Brief Pain Science or Ergonomics Messages to Guideline Advice Did Not Increase Feelings of Reassurance in People With Acute Low Back Pain: A Randomized Experiment. [2023]

9. Japan pubmed.ncbi.nlm.nih.gov

A follow-up study of preventive effects on low back pain at worksites by providing a participatory occupational safety and health program. [2019]

10. England pubmed.ncbi.nlm.nih.gov

Availability, content and quality of commercially available smartphone applications for the self-management of low back pain: a systematic assessment. [2023]

11. England pubmed.ncbi.nlm.nih.gov

Self-management and chronic low back pain: a qualitative study. [2022]

12. United States pubmed.ncbi.nlm.nih.gov

Acute low back pain self-management intervention for urban primary care patients: rationale, design, and predictors of participation. [2007]

13. Netherlands pubmed.ncbi.nlm.nih.gov

Self-management behaviour after a physiotherapist guided blended self-management intervention in patients with chronic low back pain: A qualitative study. [2022]

14. Netherlands pubmed.ncbi.nlm.nih.gov

Behaviour change and self-management interventions in persistent low back pain. [2019]