A groundbreaking new approach to treating chronic lower back pain, which focuses on a patient's personal exercise preferences and beliefs, has been shown to help people live more actively without necessarily needing physiotherapy.
Shifting the Focus from Treatment to Belief
For years, treatment options for the debilitating condition of chronic lower back pain have been limited, often providing only moderate and short-lived relief. Although clinical guidelines suggest that first-line care should include reassuring patients about their ability to manage symptoms themselves, this advice is frequently overlooked in practice.
Now, research published in the journal JAMA Network Open demonstrates that concentrating on a patient's beliefs about their prognosis and encouraging them to do more physical activity of their choice can be as beneficial as traditional physio, if not more so.
The ETMI Trial: A New Self-Management Model
The study focused on a form of therapy called the enhanced transtheoretical model intervention (ETMI). A trial involving more than 1,600 patients with chronic lower back pain found that ETMI improved patients' overall function in less time than standard physiotherapy.
Typical physiotherapy for back pain often involves a mix of exercise therapy, education, manual treatment, and adjuncts like acupuncture. In contrast, ETMI is a self-management approach that prioritises overcoming unhelpful beliefs about the condition and promoting leisure-time physical activity that the patient enjoys.
The research team collected data on patients' activity levels, physio appointments, and use of ETMI. Participants also tracked changes in their function, pain, and fear-avoidance beliefs. Function was scored on a 0-100 scale, while pain was rated from 0-10.
Significant Results for Patient Function
Of the 1,624 patients, 259 received ETMI while the rest received 'usual care'—whatever their GP recommended or they chose from local services, which could include pain medication, self-management tips, or physio.
The findings were clear: patients receiving ETMI needed fewer treatment sessions than those getting usual care. They also experienced greater improvements in physical function and a stronger reduction in fear-avoidance beliefs—the fear that movement will cause harm.
Results indicated ETMI was more effective than usual care in reducing activity limitations caused by back pain. This held true even for patients who also had depression or anxiety. However, the study noted no significant differences in pain levels across groups, likely because the intervention targets beliefs and activity patterns rather than pain symptoms directly.
Implications for Future Musculoskeletal Care
The researchers concluded that while shifting from a clinician-managed model to one that prioritises patient self-management may be challenging, wider adoption could lead to more sustainable care. They stated: "Whilst the transition from a clinician-managed approach... towards a model that prioritises patient self-management may be challenging, wider adoption could contribute to more sustainable musculoskeletal care."
This study highlights a pivotal move towards empowering patients, suggesting that understanding and addressing their personal beliefs about exercise and recovery could be the key to longer-term mobility and a more active life.
