Assessing the Feasibility and Acceptability of Reframe Your Pain to Enhance Exercise Adherence in People With Chronic Low Back Pain

Approximately one in five Canadians suffer from persistent low back pain (PLBP). Experiencing PLBP limits an individual's independence by impacting their ability to participate in family, social and working life. Canada has the second highest rate of opioid prescribing in the world and this comes with many risks, including an increase in admissions to addiction programs and opioid related deaths. Due to the widespread economic, personal and social impacts, World Health Organization burden of disease profiles have shifted focus from the treatment of communicable disease to the treatment of non-communicable, long term diseases, including non-pharmaceutical treatment of PLBP.

Active treatment, including physical activity and exercise has been shown to effectively reduce pain severity while increasing function and quality of life in patients with PLBP. However, over half of the patients that are prescribed exercises as treatment for their conditions do not adhere and there is a recognized gap in the literature of research exploring exercise adherence in this population.

Preliminary work in this research program included the development and initial testing of a behaviour change intervention to enhance exercise adherence in a population PLBP. Using the intervention development framework Intervention Mapping, a group-based exercise program incorporating an exercise app and one on one psychological support was developed. However, assessment within a Canadian context, its clinical significance and efficacy for wider implementation have not yet been assessed.

The primary objective of the proposed project is to inform progression to a large scale randomized controlled trial of the intervention (vs usual care) through the evaluation of a pilot-feasibility trial and an efficacy trial.The study will employ a two-arm randomized controlled pilot-feasibility study with a nested qualitative interview study.

The purpose of pilot-feasibility trials is to assess feasibility of a protocol to provide estimates for an efficacy trail. Therefore, while the design may look similar to an efficacy trial, clinical outcomes are not the primary outcome. Due to their smaller sample size, pilot-feasibility studies may provide unstable estimate of effect size, however their assessment will determine the sample size needed for the efficacy trial. This study will allow for the feasibility of transferring the program from a UK context (where it was originally tested) to a Winnipeg setting.