Optimising exercise for chronic back pain

This is a randomised controlled trial of Education + Motivational Interviewing-Cognitive Behavioural Therapy (Edu + MI-CBT) to support an education and exercise programme compared to Usual Care (education and exercise) for people with chronic low back pain. The Edu + MI-CBT intervention consists of five weekly 1:1 sessions with an investigator trained in MI-CBT techniques. Each session will be approximately 30 minutes duration. Throughout the intervention the principles of the MI spirit (collaboration, evocation, acceptance, and compassion) are central to all interactions, fostering a supportive and non-judgmental environment. Participants will receive the ‘Navigating Pain’ booklet (NZ Pain Society) and evidence-based exercise programmes previously validated by the research group for people with cLBP, in addition to the supporting ‘homework book’. These resources are intended for collaborative engagement during the sessions. The exercise programme involves calisthenic (i.e., bodyweight only) exercises commonly recommended for people with chronic low back pain, which the research group have provided quantitative evidence to support in multiple trials. Exercises include the bird-dog (aka, quadruped), partial curl-up, side bridge, in addition to body weight squat and lunge variations. The homework book is to be completed between sessions 1 and 2, and involves five sections (developed with feedback from patients) addressing beliefs about pain, beliefs about physical activity, descriptions around what a normal sleep routine looks like, thoughts around types of treatment they like to use or engage with for their symptoms, and self-directed action-planning to help manage their ongoing symptoms. Each 30-minute session can be conducted face-to-face or via telecommunication (e.g., Zoom). The sessions cover: 1) rapport development, exploration of patient history, motivation assessment, and goal-setting; 2) examination of maladaptive pain beliefs and discussion about physical activity; 3) review of previous discussions, focus on physical activity, sleep routines; 4) review, discussion of treatment engagement and mental health factors; 5) review and development of a patient-directed action plan for sustained well-being. The intervention is guided by MI techniques, including open-ended questions, affirmations, reflections, and summaries, to facilitate discussions on managing cLBP. CBT strategies, such as shared goal setting, problem-solving, coping strategies, and relapse planning, are delivered within this MI framework. Self-report data will be collected at baseline, after the intervention (5-weeks) and at 3 and 12 months. Measures will include the Oswestry Disability Index, Numeric Pain Rating Scale, Pain Catastrophizing Scale, Fear-Avoidance Beliefs Questionnaire, Pain Self-Efficacy Questionnaire, and Hospital Anxiety and Depression Scale. Additionally, demographic information and participant self-reports of ongoing physical activity, treatment engagement, medication use, and employment status will be collected. The intervention will be delivered by post-graduate qualified allied health professionals who have received specific training in the MI-CBT intervention to be delivered in this study. This entails training with experienced health psychologists in the skills of MI-CBT, which was delivered over a 6-month period in 2023, in addition to post-graduate level training including MI-CBT training. The direct familiarisation with specifics of the intervention will be provided over a 4-week period for 4-hours per week, prior to commencing recruitment for the main study. In addition, both health professionals in this study have greater than 5 years clinical experience. Session attendance checklists will be maintained throughout the study, in addition to noting completion of the homework book (at session 2). Fidelity of the interventions will be checked by random recording of sessions to ensure both groups are receiving the intervention as designed. This study is based at the University of Auckland, NZ, and the New Zealand College of Chiropractic (Mt Wellington, Auckland NZ).