An individualised self-management exercise and education program did not prevent recurrence of low back pain but may reduce care seeking: a randomised trial

Question: What is the effect of a McKenzie-based self-management exercise and education program on the risk of recurrence of low back pain (LBP) and on the impact of LBP? Design: Randomised controlled trial with concealed allocation, blinded assessors and intention-to-treat analysis. Participants: 262 adults recently recovered from an episode of LBP. Intervention: The experimental group received a McKenzie-based self-management exercise and education program delivered over two individual sessions of 30 to 45 minutes with a physiotherapist, approximately 2 weeks apart. The control group received a single advice session over the phone. Outcome measures: The primary outcome was time to first recurrence of an episode of activity-limiting LBP. Secondary outcomes included time to recurrence of any LBP, time to a recurrence causing care seeking and a composite measure of pain and function (`impact of LBP'). Participants were followed-up monthly for > 12 months. Results: The estimated effect of the experimental intervention on the risk of recurrence of an episode of: activity-limiting LBP was HR 1.11 (95% CI 0.80 to 1.54), any LBP was HR 0.95 (95% CI 0.72 to 1.26), and LBP for which care was sought was HR 0.69 (95% CI 0.46 to 1.04). The quarterly estimates of the experimental intervention's effect on impact of LBP and their 95% CIs were all within 4 points above or below 0 (no effect) on this scale from 8 to 50. Conclusion: This study's best estimate is that a McKenzie-based self-management exercise and education program does not produce a worthwhile reduction in the risk of an activity-limiting episode of LBP; however, modestly reduced or moderately increased risk cannot be ruled out. It may markedly reduce the risk of an episode of LBP resulting in care seeking, but does not have any worthwhile effect on the impact of LBP over 12 months. (C) 2020 Australian Physiotherapy Association. Published by Elsevier B.V.