The WalkBack (walking and education) program for prevention of low back pain is acceptable to physiotherapists but relies on training, flexibility and system-level enablers to optimise implementation: a qualitative study
Seong Kyeong Yeom1, Georgia Fisher2, Mark R Hancock1
1Spinal Pain Research Centre, School of Health Sciences and Nursing, Macquarie University, Sydney, Australia.
Questions:
What are the perceived barriers and facilitators to physiotherapists adopting a prevention-based walking and education program (WalkBack) in routine practice for patients with recurrent low back pain? What refinements to the WalkBack program could enhance future implementation efforts?
Design:
This was a qualitative study using individual, online, semi-structured interviews.
Participants:
Twenty registered physiotherapists practising in Australia, including 10 with previous experience delivering the WalkBack program and 10 without prior exposure. Purposive sampling was used to capture insights from physiotherapists across geographic settings, roles and experience levels. Interview questions were informed by the RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework and analysed using an inductive framework analysis.
Data Analysis:
Themes were iteratively developed through team-based discussions.
Results:
Four themes were identified. First, the WalkBack program is relevant and acceptable to physiotherapists, aligning with the profession's shift towards prevention-based care and further supported by its endorsement by research and professional bodies. Second, the WalkBack training is important for effective delivery and implementation. Its flexible online and face-to-face format facilitated engagement, and forming communities of practice was viewed as critical for sustaining future implementation. Third, flexible delivery and structured resources were seen as critical to enabling scalable implementation. This included developing ready-to-use resources such as referral communication templates and advertising materials. Fourth, successful adoption hinges on system-level enablers, including supportive leadership, funding structures and alignment with service settings.
Conclusion:
Physiotherapists viewed WalkBack as relevant, acceptable and clinically valuable. Future implementation will need to address training needs, enhance resource provision and explore system-level support. Each clinic's unique service and funding structures may support or deter adoption of the WalkBack program. The findings offer transferable insights to inform implementation of similar clinician-delivered programs, particularly in contexts that share similar clinical and organisational characteristics.
Registration:
https://osf.io/t3xbc.
