An integrated Healthy Lifestyle Program (HeLP) and physiotherapy care for low back pain: a mixed methods process evaluation
Emma K Mudd1,2,3, Cassandra Lane3,4,5, Jenna L Hollis3,4,5
1School of Health Sciences, University of Sydney, Camperdown, NSW 2050, Australia.
Objectives And Importance Of Study:
Integrated lifestyle and low back pain care is a novel treatment approach. This study describes the fidelity and adoption; barriers and facilitators to engagement and delivery; acceptability, appropriateness and feasibility of the Healthy Lifestyle Program (HeLP) intervention.
Study Type:
Mixed-methods process evaluation.
Methods:
Data were included from n = 174 adults with chronic low back pain randomised to HeLP, and delivering clinicians. The 26-week intervention included five consultations , information resources, and referral to telephone support services. We collected quantitative data via fidelity checklists, administrative records and surveys, and qualitative data via semi-structured interviews and focus groups with a subsample of participants and clinicians. We used descriptive statistics, thematic analyses and triangulation to identify meta-themes.
Results:
Intervention fidelity was high (clinicians delivered >90% to protocol). Participants' adoption was moderate attending a mean 3.2 consultations, 54% (referred) engaged with telephone services and 46% used online resources; however, adoption of smoking cessation services was low (6.5% of smokers completed ≥1 call). A total of 23% of participants discontinuted HeLP by 26 weeks. Clinicians and participants considered the intervention acceptable, and addressing lifestyle factors appropriate for low back pain.
Conclusion:
HeLP was acceptable, although uptake varied across components. Improving clinicians' behaviour change communication and personalising care may optimise implementation.