Abstract
Background:
Chronic low back pain (CLBP) is a leading cause of disability and reduced work participation worldwide. Its multifactorial nature—often lacking a clear pathological cause—poses significant challenges for effective treatment. This study reports short-term outcomes from a concentrated, interdisciplinary group-based intervention targeting patients with hard-to-treat CLBP.
Methods:
This study reports outcomes from the CLBP arm of a nonrandomized five-armed transdiagnostic, pre-post intervention trial (2020–2022); no control group or between-group comparisons are included. The intervention comprised SMART (Specific, Measurable, Achievable, Relevant, Time-bound) goal setting, multilevel exercise, patient education, and micro-choice strategies—small, intentional decisions aimed at enhancing functional capacity and reducing symptom-related vigilance—delivered in a concentrated group format. Outcomes were evaluated three months post-intervention and included disability (Oswestry Disability Index, ODI), pain intensity (NRS-11), work ability, medication use, sick leave status, and physical performance tests. Continuous outcomes were analysed using mixed-effects regression models to account for repeated measures, while categorical changes were assessed using symmetry tests for ordinal variables and McNemar’s test for binary variables.
Results:
The majority in our cohort had low educational levels, were overweight, and welfare recipients, many had multisite pain, used daily pain medication and had a history of back surgery. At follow-up, most outcomes showed statistically significant improvement. Disability decreased by 5.9 points (-18%, 95% CI: 4.1–7.7), and low back pain intensity decreased by 1.3 points (-21%, 95% CI: 0.9–1.7). Work ability increased by 0.9 points (+ 22%, 95% CI: 0.4–1.5) and sit-to-stand repetitions increased by 3.6 (+ 27%, 95% CI: 2.6–4.7). Fifteen (17%) participants transitioned from sick leave to work, and 16 (18%) discontinued pain medication.
Conclusions:
Patient education, structured exercise, and the concentrated micro-choice-based intervention was associated with improved pain, disability, work ability, and physical function in a hard-to-treat CLBP population. Improvements due to regression to the mean are a possibility, therefore a randomized controlled trial is warranted to confirm efficacy.
Keywords:
Behaviour change techniques; Concentrated treatment format; Functional recovery; GLA:D® Back; PUSH project; Patient activation; Rehabilitation adherence; Self-management strategies; Work ability.
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