UNASSIGNED: Non-specific low back pain (NLBP) exerts a profound impact on global health and economics. In the era of Web 3.0, digital therapeutics offer the potential to improve NLBP management. The Rise-uP trial introduces a digitally anchored, general practitioner (GP)-focused back pain management approach with the Kaia back pain app as the key intervention. Here, we present the 12-months evaluation of the Rise-uP trial including clinical and economic outcomes, patient satisfaction and behavioral tracking analysis.
UNASSIGNED: The cluster-randomized controlled study (registration number: DRKS00015048) enrolled 1237 patients, with 930 receiving treatment according to the Rise-uP approach and 307 subjected to standard of care treatment. Assessments of pain, psychological state, functional capacity, and well-being (patient-reported outcome measures; PROMs) were collected at baseline, and at 3-, 6-, and 12-months follow-up intervals. Health insurance partners AOK, DAK, and BARMER provided individual healthcare cost data. An artificial intelligence (AI)-driven behavioral tracking analysis identified distinct app usage clusters that presented all with about the same clinical outcome. Patient satisfaction (patient-reported experience measures; PREMs) was captured at the end of the trial.
UNASSIGNED: Intention-to-treat (ITT) analysis demonstrated that the Rise-uP group experienced significantly greater pain reduction at 12 months compared to the control group (IG: -46% vs CG: -24%; p < 0.001) with only the Rise-uP group achieving a pain reduction that was clinically meaningful. Improvements in all other PROMs were notably superior in patients of the Rise-uP group. The AI analysis of app usage discerned four usage clusters. Short- to long-term usage, all produced about the same level of pain reduction. Cost-effectiveness analysis indicated a substantial economic benefit for Rise-uP.
UNASSIGNED: The Rise-uP approach with a medical multimodal back pain app as the central element of digital treatment demonstrates both, clinical and economic superiority compared to standard of care in the management of NLBP.

Background: Chronic non-specific low back pain is a non-harmous condition often found in the general population. It is one of the most significant disabilities and needs different treatment modalities. This study investigates the effects of pain neuroscience education and physiotherapy on pain intensity, fear of movement and functional status in a Lithuanian cohort with non-specific low back pain. Methods: The study was performed at the primary health care unit in Kaunas, Lithuania. The key inclusion criterion was persistent non-specific low back pain longer than three months and which affects daily life functions. Thirty participants (mean 33.47, SD 4.38 years age, 70% women) were randomised into two training groups with and without pain neuroscience education (for a total of 60 min of teaching). Physiotherapy was performed twice per week during 45 min/session for a period of 10 weeks with exercises which strengthen, stabilize, and stretch the spinal cord muscles. Outcomes included pain intensity, kinesiophobia and disability and these were measured by self-scored questionnaires (numeric rating scale, Tampa scale for kinesiophobia-11, Oswestry disability index and the Roland-Morris questionnaire, respectively). Results: The results indicate that both groups improved in the measured outcomes, with the only difference between them being a better improvement in kinesiophobia in the group receiving physiotherapy and pain neuroscience education. Conclusions: The results of this study confirm that a relatively short intervention of pain neuroscience education enhances the effects of physiotherapy and should be implemented in clinical practice.

We aimed to determine the effects of three-direction movement control focus complex pain program (3D-MCE) and neurodynamic focus complex pain program (NDT) on pain, mechanosensitivity, and body function in Taekwondo athletes with non-specific low back pain. This study used a two-group pretest-posttest design and was conducted at a university physiotherapy lab and training center. It included 21 Taekwondo athletes with non-specific low back pain from a Taekwondo studio and a University in Busan. Participants were divided into a 3D-MCE group (n = 10) and an NDT group (n = 10). The numerical rating pain scale (NRPS), pain pressure threshold (PPT), movement analysis, and Oswestry Disability Index (ODI) were measured before and after the intervention. The intervention was performed for 45 min twice a week for 4 weeks. Each group performed movement control exercises and neurodynamic techniques. The NRPS, motion analysis, and ODI were significantly changed after the intervention in the 3-DMCE group. The NRPS, PPT, and ODI changed significantly after the intervention in the NDT group. Moreover, the PPT and motion analysis showed significant differences between the two groups. For Taekwondo athletes with non-specific low back pain, 3D-MCE improved the stability control ability of the lumbar spine. It was confirmed that neurodynamic techniques reduce muscle and nerve mechanosensitivity.

BACKGROUND: Lumbar disc herniation and non-specific low back pain are common conditions that seriously affect patients\' health-related quality of life (HRQoL). Although empirical evidence has demonstrated that novel Thermobalancing therapy and Dr Allen\'s Device can relieve chronic low back pain, there have been no randomised controlled trials for these indications.
OBJECTIVE: To evaluate the efficacy of Dr Allen\'s Device in lumbar disc herniation (LDH) and non-specific low back pain (NSLBP).
METHODS: A randomised clinical trial was conducted investigating 55 patients with chronic low back pain due to LDH (n = 28) or NSLBP (n = 27), out of which 15 were randomly assigned to the control group and 40 were assigned to the treatment group. The intervention was treatment with Dr Allen\'s Device for 3 mo. Changes in HRQoL were assessed using the Numerical Pain Rating Scale and the Japanese Orthopedic Association Back Pain Questionnaire.
RESULTS: Thermobalancing therapy with Dr Allen\'s Device showed a significant reduction in pain in the treatment group (P < 0.001), with no recorded adverse effects. Both pain assessment scales showed a significant improvement in patients\' perception of pain indicating improvement in HRQoL.
CONCLUSIONS: The out-of-hospital use of Thermobalancing therapy with Dr Allen\'s Device for Low Back Treatment relieves chronic low back pain significantly and without adverse effects, improves the level of activity and HRQoL among patients with LDH and NSLBP. This study demonstrates the importance of this safe first-line therapy that can be used for effective at-home management of chronic low back pain.

BACKGROUND: Low back pain (LBP) is one of the most disabling diseases and a major health issue. Despite the evidence of a link between paraspinal and gluteal muscle dysfunction and LBP, it is unknown whether aquatic exercises can lead to improvements in paraspinal and gluteal muscle morphology and function, and whether improvements in overall muscle health are associated with improvements in patients\' outcomes. The unique properties of water allow a water-based exercise program to be tailored to the needs of those suffering from LBP. This study uses magnetic resonance imaging (MRI) to investigate the effect of an aquatic exercise program versus standard exercise on 1) paraspinal and gluteal muscle size, quality and strength and 2) pain, disability, and psychological factors (pain related fear, depression, anxiety, sleep quality) in chronic LBP.
METHODS: This study will include 34 participants with chronic non-specific LBP and moderate to severe disability, aged between 18 and 65, who will be randomly assigned (1:1) to the aquatic exercise group or land-based standard care exercise group. Both groups will receive 20 supervised sessions, twice per week over 10 weeks. MRIs will be obtained along the lumbosacral spine (L1-L5) and pelvis at the start and end of the intervention to assess the effect of each exercise intervention on paraspinal and gluteal muscle size and quality. Pre- to post-intervention changes in all outcomes between each group will be assessed, and the association between the changes in back muscle quality and clinical outcomes will be examined. Between-subjects repeated measure analysis of variance will be used to examine the changes in paraspinal muscle morphology over the different time points. Linear mixed models will be used to assess whether baseline scores can modify the response to the exercise therapy treatment.
CONCLUSIONS: This study will determine if water-based exercises targeting the lower back and gluteal muscles can lead to important changes in muscle quality and function, and their possible relation with patients\' pain and functional improvements. Our findings will have strong clinical implications and provide preliminary data to design a community program to better support individuals with chronic LBP.
BACKGROUND: NCT05823857, registered prospectively on April 27th, 2023.

UNASSIGNED: Long-term effectiveness of physiotherapy (PT) for low back pain (LBP) depends on the adherence of patients. Objectives: (1) Identify aspects associated with the adherence of patients with LBP to physiotherapy, and (2) identify factors to facilitate adherence of patients with LBP to PT.
UNASSIGNED: Focus group interviews were conducted with 10 patients with LBP (n = 10, 5 women) and 11 physiotherapists (5 women) from Germany and Switzerland, treating patients with LBP. Data analysis was based on structured content analysis. Deductive and inductive categories were identified and coded.
UNASSIGNED: Patients with LBP requested more and effective home programs, long-term rehabilitation management, and individualized therapy to achieve a higher level of adherence. Physiotherapists requested more time for patient education. Communication, quality of the therapist-patient relationship, and individualized therapy were identified as essential factors by both representatives.
UNASSIGNED: Patients and physiotherapists identified aspects contributing to adherence. These may guide the development of multidimensional measurement tools for adherence. In addition, this information can be used to develop PT approaches to facilitate the level of adherence.

BACKGROUND: Non-specific low back pain is a common musculoskeletal condition that often requires the involvement of physiotherapists for effective management. However, there is limited understanding of the factors influencing physiotherapists\' implementation of high-value care in the management of non-specific low back pain (NSLBP), particularly in Indian healthcare settings.
OBJECTIVE: The aim of this study was to explore the barriers and facilitators of implementation of high-value care in managing NSLBP from the perspective of physiotherapists practicing in Indian healthcare settings.
METHODS: Descriptive qualitative design.
METHODS: We adopted a descriptive phenomenological approach and purposefully selected physiotherapists (N = 15) from diverse healthcare settings, encompassing varying years of clinical experience, to capture a broad range of perspectives. Semi-structured face-to-face interviews were conducted via the Zoom video conferencing platform. Each interview lasted on average for 30-45 min, and no follow-up interviews were conducted. Data were analyzed using thematic analysis with an inductive approach.
RESULTS: Our analysis revealed three major themes and seven sub-themes uncovering barriers and facilitators of implementation of high-value care. These themes include misconceptions about low back pain and its management among physiotherapists, their perceived lack of autonomy in clinical decision-making due to external influences, and the significance of aligning treatment plans with patient goals while considering evidence-based care.
CONCLUSIONS: The study results provide insights into the unique challenges associated with implementation of high-value care for non-specific low back pain in Indian healthcare settings.

Research has shown that the course of non-specific low back pain (LBP) is influenced by, among other factors, patients\' self-management abilities. Therefore, clinical guidelines recommend stimulation of self-management. Enhancing patients\' self-management potentially can improve patients\' health outcomes and reduce future healthcare costs for non-specific LBP.
Which characteristics and health outcomes are associated with activation for self-management in patients with non-specific LBP?
Cross-sectional study.
Patients with non-specific LBP applying for primary care physiotherapy were asked to participate. Multivariable linear regression analysis was performed to analyze the multivariable relationship between activation for self-management (Patient Activation Measure, range 0-100) and a range of characteristics, e.g., age, gender, and health outcomes, e.g., self-efficacy, pain catastrophizing.
The median activation for self-management score of the patients with non-specific LBP (N = 208) was 63.10 (IQR = 19.30) points. The multivariable linear regression analysis revealed that higher self-efficacy scores (B = 0.54), female gender (B = 3.64), and a middle educational level compared with a high educational level (B = -5.47) were associated with better activation for self-management in patients with non-specific LBP. The goodness-of-fit of the model was 17.24% (R2 = 0.17).
Patients with better activation for self-management had better self-efficacy, had a higher educational level, and were more often female. However, given the explained variance better understanding of the factors that influence the complex construct of self-management behaviour in patients who are not doing well might be needed to identify possible barriers to engage in self-management.

OBJECTIVE: Non-specific low back pain (NLBP) is a common clinical condition that affects approximately 60-80% of adults worldwide. However, there is currently a lack of scientific prediction and evaluation systems in clinical practice. The purpose of this study was to analyze the risk factors of NLBP and construct a risk prediction model.
METHODS: We collected baseline data from 707 patients who met the inclusion criteria and were treated at the Sixth Hospital of Ningbo from December 2020 to December 2022. Logistic regression and LASSO regression were used to screen independent risk factors that influence the onset of NLBP and to construct a risk prediction model. The sensitivity and specificity of the model were evaluated by tenfold cross-validation, and internal validation was performed in the validation set.
RESULTS: Age, gender, BMI, education level, marital status, exercise frequency, history of low back pain, labor intensity, working posture, exposure to vibration sources, and psychological status were found to be significantly associated with the onset of NLBP. Using these 11 predictive factors, a nomogram was constructed, and the area under the ROC curve of the training set was 0.835 (95% CI 0.756-0.914), with a sensitivity of 0.771 and a specificity of 0.800. The area under the ROC curve of the validation set was 0.762 (95% CI 0.665-0.858), with a sensitivity of 0.800 and a specificity of 0.600, indicating that the predictive value of the model for the diagnosis of NLBP was high. In addition, the calibration curve showed a high degree of consistency between the predicted and actual survival probabilities.
CONCLUSIONS: We have developed a preliminary predictive model for NLBP and constructed a nomogram to predict the onset of NLBP. The model demonstrated good performance and may be useful for the prevention and treatment of NLBP in clinical practice.

BACKGROUND: We designed a quick simple exercise program that can be performed in a short period of time in real-world occupational health settings and investigated the effects of three months of program implementation on non-specific low back pain (NSLBP).
METHODS: Participants were 136 individuals working in the manufacturing industry. The quick simple exercise program was designed to be doable in three minutes and consisted of two exercises: a hamstring stretch and a lumbar spine rotation with forward, backward, and lateral flexion. This was a randomized controlled trial incorporating an intervention group to whom the exercises were recommended within a leaflet, and a control group to whom the exercises were not recommended. NSLBP was evaluated at baseline and after three months using numerical rating scale (NRS) scores, ranging from 0 points (no pain at all) to 10 points (worst pain imaginable). The percentages of cases that improved by a minimal clinically important difference (two points or above) were compared.
RESULTS: Overall, 76.1% of the intervention group participants performed the quick simple exercises at least once every one or two days. Three months after baseline, a significantly higher percentage of participants in the intervention group (17 participants: 25%) had NSLBP improvement of two or more points on the NRS compared to that in the control group (8 participants, 12%) (P = 0.047). The average NRS score decreased significantly from 1.87 ± 1.86 to 1.33 ± 1.60 in the intervention group but showed no significant change in the control group, transitioning from 1.46 ± 1.73 to 1.52 ± 1.83. A significant interaction was also observed between the intervention and control groups (F = 6.550, P = 0.012).
CONCLUSIONS: Three months of a quick simple exercise program among workers in the manufacturing industry increased the percentage of workers with improvement in the NRS scores. This suggests that the program is effective in managing NSLBP in workers in the manufacturing industry.
BACKGROUND: UMIN-CTR UMIN000024117.