The effectiveness of adding an additional intervention to a pain management program in people with chronic low back pain

Both groups will receive a 12-14 week multi-disciplinary pain management program aiming to improve quality of life through a goal oriented graded activity/exercise program provided by registered medical, physiotherapy, psychology and dietitian practitioners with a special interest in chronic pain. There will be approximately 12 individual psychology sessions (1 hour each), 16 group psychology sessions (2 x 60 minutes per week over the final 8 weeks), 32 x 45 minute individual physiotherapy sessions, 4 x 60 minute group dietitian sessions ± 4 x 30 minute individual dietitian sessions (if indicated), >4 x 30 minute individual medical sessions over 12 weeks. Group sessions would have no more than 10 participants. The program may be delivered face to face or via telehealth based on participant preference. Each session in both groups will focus on goal setting and scheduling activities and exercises that enable achievement of short, medium and long term goals. Common goals and associated activities would include hobbies (eg playing local football), relationships (eg communicating positively with partner over dinner) and work (eg returning to normal duties/hours). Common exercises between groups include walking and standing functional exercises (eg bicep curls, front raises, squats, step ups). Biological, psychological and social barriers to achieving goals would be addressed through education and a cognitive behavioural approach. Adherence would be checked through electronic records of completed sessions as well as goal/rehabilitation sheet analysis tracking daily activity/exercise/goal achievement. Following discharge from the program there would be low frequency (typically monthly for 6 sessions) physiotherapy ± psychology/medical sessions up to 52 weeks to support achievement of long term goals. Both groups will receive treatment based on the participant's goals and the barriers to recovery identified by the practitioners. The difference between the groups relates to the approach used in the physiotherapy sessions (both in the 12 week program and in sessions up to 52 weeks) whereby the intervention group will include the provision of specific training to optimise posture, movement and muscle activation in low load positions, prior to commencement of upright functional exercises) and subsequently integrated in daily activities (Hodges 2013). The exercises chosen as part of the MInS intervention will depend on the patient's presenting problems and functional task goals, and will be chosen by the individual therapist after a structured and detailed assessment of posture, movement and muscle activation while completing various functional tasks. There is no standard set of exercises for practitioners to choose from in the MInS intervention, and the dosages will vary based on the results of the detailed assessment of posture, movement and muscle activation (ie. this cannot be outlined a priori given it is individualised). The number and length of physiotherapy sessions will be similar between groups (as outline above), with the MInS treatment integrated within those standard sessions. Intervention (MInS) group practitioners will be trained before the trial commences according to a specific clinical protocol including assessment of competency prior to providing treatment to intervention group participants.