From research to practice: adapting graded sensorimotor retraining for people with chronic low back pain

Low back pain is a leading cause of disability worldwide, yet translation of evidence-based interventions into clinical practice remains limited. Graded sensorimotor retraining, also known as the RESOLVE program, is a complex rehabilitation intervention for people with chronic low back pain that demonstrated clinically meaningful and sustained benefits in a sham-controlled, randomised controlled trial. This study aimed to adapt the RESOLVE program for implementation into a pragmatic clinical practice setting. We conducted a two-stage adaptation study guided by established frameworks. Stage 1 involved formation of an adaptation working group, review of evidence relevant to the RESOLVE program, qualitative interest-holder engagement, and ad hoc expert consultation. Findings from Stage 1 were used to identify core and adaptable components of the intervention and contextual determinants of implementation. Adaptations (or implementation strategies) to address the adaptable intervention components and contextual determinants were proposed to a consensus group meeting during Stage 2. During this stage, a structured consensus process finalised 8 adaptations, which target intervention content, delivery, resources, and clinician training. The adaptations focus on refining and streamlining existing components to improve fit rather than removing or introducing entire new elements. Our approach provides practical guidance for future adaptations of the RESOLVE program, and other complex treatments, for clinical implementation to ultimately improve the translation of evidence-based interventions for improved patient outcomes.