Chronic Low Back Pain, Physical Activity and the Role of Shared Familial Factors

Low back pain (LBP) is the leading cause of global disability, with the majority of disease burden accounted for by people with chronic LBP. Current intervention and prevention strategies are failing to reduce the substantial burden of LBP and there are numerous topic areas that warrant further investigation to increase our understanding of how to improve outcomes for this population. The broad aims of this thesis were to investigate the role of shared familial factors (including genetics) in the development, recovery and management of chronic LBP; and to investigate the feasibility and clinical effects of a novel home-based exercise program. Chapter Two showed that individuals with recent chronic LBP are less likely to be active compared to those without chronic LBP, while Chapter Three showed that the relationship between LBP and physical activity is moderated by the built environment. Chapter Four identified that females with low educational attainment are at increased risk of developing chronic LBP, but a co-twin control analysis suggested that these findings (like the findings in Chapter Two) are confounded by shared familial factors. Chapters Five and Six investigated factors influencing the recovery from chronic LBP and the response to increased physical activity, and showed that shared familial factors are an important contributor. Finally, Chapters Seven and Eight outlined the design and findings of a randomised controlled trial investigating the feasibility and clinical effects of home-based video-game exercises for older people with chronic LBP. High recruitment and response rates, and adherence to the intervention showcased trial feasibility, while home-based video-game exercises led to significant improvements in pain self-efficacy, pain and function compared to usual care. Home-based video-game exercises are therefore a promising self-management strategy for older people with chronic LBP that could improve outcomes and reduce health-care costs

Effect of diagnostic labelling on management intentions for non-specific low back pain: a randomised scenario-based experiment

BACKGROUND: Diagnostic labels may influence treatment intentions. We examined the effect of labelling low back pain (LBP) on beliefs about imaging, surgery, second opinion, seriousness, recovery, work, and physical activities. METHODS: Six‐arm online randomized experiment with blinded participants with and without LBP. Participants received one of six labels: ‘ disc bulge’, ‘ degeneration’, ‘ arthritis’, ‘ lumbar sprain’, ‘ non‐specific LBP’, ‘ episode of back pain’. The primary outcome was the belief about the need for imaging. RESULTS: A total of 1375 participants (mean [SD] age, 41.7 years [18.4 years]; 748 women [54.4%]) were included. The need for imaging was rated lower with the labels ‘ episode of back pain’ (4.2 [2.9]), ‘ lumbar sprain’ (4.2 [2.9]) and ‘ non‐specific LBP’ (4.4 [3.0]) compared to the labels ‘ arthritis’ (6.0 [2.9]), ‘ degeneration’ (5.7 [3.2]) and ‘ disc bulge’ (5.7 [3.1]). The same labels led to higher recovery expectations and lower ratings of need for a second opinion, surgery and perceived seriousness compared to ‘ disc bulge’, ‘ degeneration’ and ‘ arthritis’. Differences were larger amongst participants with current LBP who had a history of seeking care. No differences were found in beliefs about physical activity and work between the six labels. CONCLUSIONS: ‘ Episode of back pain’, ‘ lumbar sprain’ and ‘ non‐specific LBP’ reduced need for imaging, surgery and second opinion compared to ‘ arthritis’, ‘ degeneration’ and ‘ disc bulge’ amongst public and patients with LBP as well as reducing the perceived seriousness of LBP and enhancing recovery expectations. The impact of labels appears most relevant amongst those at risk of poor outcomes (participants with current LBP who had a history of seeking care)