WalkBack - Effectiveness and cost-effectiveness of a progressive individualised walking and education program for the prevention of a recurrence of low back pain.

Participants allocated to the walking and education program will attend 3 face-to-face visits (baseline, 1 month and 3 months) with a trained physiotherapist. During the COVID-19 pandemic, these sessions will be available in a telehealth format (i.e. online video call) for participants who preference avoiding face-to-face contact during the pandemic, or who are not geographically located near our trained clinicians, the content of these session will remain the same and be delivered by the same clinicians. These sessions will be one-on-one (whether done via video-call or face-to-face), with the initial consult (baseline) taking approximately 45 minutes, whilst proceeding sessions (month 1 and 3) will take approximately 30 minutes. These sessions will require assessment of current walking capacity to enable tailoring of an individualised walking program. All programs will be tailored in collaboration with each participant, with the expectation that the walking program is carried out independently (i.e. in own time at home or location of their choice). The program will be progressed via either an increase in duration, number of steps, cadence or intensity (using Borg's RPE scale) - dependent on the participants preference with the aim of walking a minimum 5 times per week for 30 minutes by the end of the program. This is only a guide and can be exceeded or re-assessed based on each individuals capacity. Participants will also receive education regarding strategies to prevent recurrences of low back pain (LBP) and pain education. These will be delivered both in the face-to-face/video sessions with the physiotherapist and over the phone. Participants will receive telephone-based health coaching (approximately 15 minutes) at 2 weeks, 9 weeks and a reinforcement session at 6 months, delivered by the same clinician who conducts the face-to-face/video sessions. Health coaching will be used to identify barriers and facilitators for compliance with the walking program and advice on how to address these. The health coaching will also focus on behaviour-change techniques, motivational interviewing, goal-setting and emphasis on enhancing engagement of individuals with the program based on their personal goals and priorities. The program will include 2 core elements: 1. An individualised progressive walking program: Participants will be progressed individually based on their baseline walking level and fitness and on how they respond during the program. Initially participants will be encouraged to walk at a comfortable convenient pace with the emphasis on volume. As the participant progresses, they will be encouraged to increase the speed. All participants will be provided with a pedometer and walking calendar to act as motivators in completing the program. The results recorded in the walking calendar will be used by the physiotherapist at face to face visits and over the phone coaching sessions, to help progress an individual’s walking program, discuss barriers and motivate compliance. 2. Education focusing on simple daily strategies to reduce the risk of a recurrence of LBP will also be provided. The strategies will be individualised based on the lifestyle of the individual and factors triggering previous episodes. However, based on evidence of risk factors the education will typically involve advice and strategies for avoiding sustained sitting, awkward positions and heavy lifting and education in optimal lifting techniques. The education will also provide a modern understanding of LBP that reduces the threat and fear associated with pain. This aspect of the education is aimed at providing participants with the confidence and skills to manage small recurrences independently without the recurrence causing a significant impact on daily activities or need to seek care. Throughout the 6-month intervention period, the physiotherapist will work with the participant to establish long-term goals and maintenance plans. This may include joining already-established recreational walking groups (e.g. Park Run, The Heart Foundation, etc).