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

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial seeks the best way to help nursery and landscape workers manage lower back pain without medication. It compares two groups: one using self-management videos and another using videos plus additional support, such as checklists, personal work videos, and text reminders. Participants will learn to manage pain through simple ergonomic strategies at work and home. Those who work full-time in physically demanding nursery or landscape jobs and have experienced back pain for over three months might be a good fit for this trial. As an unphased trial, it offers participants the chance to contribute to innovative pain management strategies without relying on medication.

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 prior data suggests that these self-management strategies are safe for managing lower back pain?

Research has shown that ergonomic changes at work are generally safe and can reduce muscle strain and pain. For example, one study found that workers using ergonomic methods reported less pain than those who did not, highlighting benefits without harmful effects. Adjusting a job to fit a person can reduce tiredness and lower the risk of work-related injuries.

Practices like meditation and mindfulness, which individuals can do independently, also appear safe with few risks. Although research on side effects is limited, these practices are usually considered low-risk. Other studies have shown that self-management programs can help manage pain, and participants generally tolerate them well.

Overall, both ergonomic and self-management approaches are well-tolerated, with few negative effects reported in studies. Participants in similar studies have successfully used these strategies to manage pain without major safety concerns. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about these treatments for lower back pain because they focus on empowering individuals to manage their pain through self-guided strategies rather than relying on medication. Unlike traditional treatments that often involve painkillers or physical therapy sessions, these interventions use video modules to teach participants self-management techniques and ergonomic adjustments tailored to their specific work activities. The standout feature is the use of personalized support, such as checklists and video feedback, to help participants identify and modify problem areas in their daily routines. This approach aims to provide sustainable, long-term relief by integrating pain management into everyday life.

What evidence suggests that this trial's self-management strategies could be effective for lower back pain?

Research has shown that self-care methods can reduce pain and disability in people with long-term lower back pain. In this trial, one group of participants will review self-management videos focusing on techniques like relaxation and ergonomic work adjustments. Studies indicate that these techniques can improve pain levels and mobility. Another group will receive the same self-management videos plus multimodal personalized support, such as checklists and video reviews of work movements. Evidence suggests that changes to the work environment, like adjusting a desk or chair, can significantly reduce lower back pain. Specifically, one study found that these workplace changes led to less reported pain and a higher chance of improvement compared to not making these adjustments. Overall, combining self-care and workplace changes can effectively manage lower back pain for many people. ^{1 2 4 6 7}

Who Is on the Research Team?

Kim Dunleavy, PT, PhD

Principal Investigator

University of Florida

Are You a Good Fit for This Trial?

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

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

Workers seeking disability or workman's compensation

Timeline for a Trial Participant

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

What Are the Treatments Tested in This Trial?

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.

How Is the Trial Designed?

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+

Published Research Related to This Trial

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]

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]

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]

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 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]

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]

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 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]

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 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]

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