Title: Internet Intervention Supporting Management of Low Back Pain in Primary Care: a feasibility study (Project short name: SUPPORT BACK study)
Funder: Department of Health (England)

Abstract: Background The majority of patients who present in primary care with acute low back pain will experience recurrent episodes, and 5-15% will go on to develop chronic conditions. As for other long-term conditions, effective patient self-management underpins the management of low back pain and aims to help patients cope with their condition. Effective self-management may prevent the onset of chronicity, or limit severity and progression where chronic pain is already present. Evidence suggests that whilst clinician-led self-management interventions can be effective, they are resource intensive, and their availability is limited thus restricting access and delaying treatment. We propose developing an internet self-management intervention that can be delivered with or without support, allowing GPs to offer patients an evidenced-based, structured programme at potentially low per-patient costs. The intervention will be designed as a supplementary educational package to be used in conjunction with usual care for low back pain. Aim To develop an internet intervention for low back pain to be used in UK primary care and explore the feasibility of performing a future randomised trial. Plan of investigation Phase I (0-12 months): Intervention development. We will recruit a panel of patients with low back pain to be consulted as part of an iterative process of development and feedback. Qualitative methods will be used to elicit reactions to intervention modules from a diverse sample of patients. The phase will end with a fully tested internet intervention developed. Phase II (13-32 months): Feasibility trial. We will recruit approximately 90 patients (3 groups, 30 in each). Inclusion criteria: patients will have current low back pain and no ‘red flags’. Patients will be randomised (stratified by severity using a cut off of 7 on the Roland Morris Disability Questionnaire) to receive either the internet intervention with telephone physiotherapy support plus usual care or unsupported use of the internet intervention plus usual care or usual care alone. We will evaluate feasibility outcomes including uptake/recruitment, adherence, attrition and patient experience. Potential Impact Our intervention will provide patients with convenient access to tailored educational advice and support for self-management. Our project will address both NICE recommendations for encouraging self-management of low back pain, and recommendations for research on education delivery methods. As well as producing an acceptable internet intervention, we will provide information regarding the feasibility of different levels of support as part of the intervention. If effectiveness is demonstrated in a future phase III RCT, the intervention could be rolled out rapidly for use by GPs throughout the country as a first step, low resource use intervention, with the potential to substantially decrease the burden of low back pain.


Research activity codes: 7.1 INDIVIDUAL CARE NEEDS
Health categories: MUSCULOSKELETAL