Implementation of a Self-Management Approach for Low Back Pain in a Public Health Care System

Area of Science:

• Health Services Research
• Physical Therapy
• Pain Management

Background:

• Self-management is the recommended first-line care for chronic low back pain (CLBP).
• Structured self-management models are underutilized in large public health maintenance organizations (HMOs).

Purpose of the Study:

• To assess the feasibility of implementing the enhanced transtheoretical model intervention (ETMI) in an Israeli public HMO.
• To compare clinical outcomes between ETMI-guided care and usual physiotherapy for CLBP patients.

Main Methods:

• A cohort study involving physiotherapists trained in ETMI across 13 clinics within a public HMO.
• Data collected from CLBP patients (aged 18+) between January 2022 and July 2023.
• ETMI is a self-management approach emphasizing reassurance, addressing unhelpful beliefs, and promoting physical activity without passive treatments or prescribed exercises.

Main Results:

• 85.1% of invited physiotherapists attended ETMI training, with 64.0% delivering the intervention.
• 17.0% of eligible CLBP patients received ETMI-guided care.
• ETMI patients showed greater improvements in function (aMD 3.3) and fear-avoidance beliefs (aMD -4.3) compared to usual care, with similar pain reduction and fewer sessions (aMD 1.3).

Conclusions:

• The implementation of ETMI in a public HMO setting is feasible.
• ETMI is associated with improved patient outcomes and reduced treatment sessions compared to usual physiotherapy.
• The reach of ETMI implementation was limited, indicating a need for further optimization.