Table 1 An overview of identified change objectives from the literature and group discussions for people with back pain, including potential interventions and the relevant components
Who | What: Change objects | How: Interventions | Intervention components |
|---|---|---|---|
People with back pain | Quality of life | Education, exercises and activity engagement | Sum of all components |
Self-efficacy, and sense of control | Education and exercise | Information about back pain (triggers, prognosis, treatment guidelines, imaging, structures of the back) Promotion of cognitive and behavioural strategies (balancing resources and demands, understanding pain mechanisms, exploring movements, self-management) Reassurance that pain does not mean harm Decreasing fear of movement through increased confidence in physical/back capacity | |
Self-management Disability | Education and exercise | Encouragement to stay physically active and continue with normal/everyday activities Encouragement to explore different ways of moving during exercise Increasing functional activity level via progressive exercises | |
Pain experience and control over pain | Education and exercise | Understanding and accepting pain Use of exercise for pain relief Identifying worsening and easing componentsPromotion of pain coping skills (e.g. goal-setting, action planning, pacing, problem solving, relaxation, distraction, graded exposure) | |
Negative thoughts and beliefs | Education and exercise | Education about changing thought patterns to avoid catastrophising and negative thoughts Experiences of increased physical capacity via progressive exercisesPromotion of a positive and ‘in control’ attitude | |
Structural beliefs | Education and exercise | Encouragement to stay physically active and continue with normal/everyday activities Reassurance about the favourable prognosisReassurance that pain does not mean harm | |
Expectations about exact diagnosis and imaging | Education | Describing back pain as a recurrent condition Explaining that imaging is not generally recommended because findings are unspecific and do not inform care | |
Better interaction with health professionals | Education | Recognition that back pain interacts with many aspects of life | |
Free and natural movements | Education and exercise | Individually adapted level of exercises including strength and flexibility An approach to exercise that does not dictate one correct way Encouragement to explore variation in movement during exercise | |
Fear of movement | Education and exercise | ||
Muscle strength | Exercise | ||
Physical fitness | Education, exercise and physical activity | Explanations of beneficial effects of physical activity and exercise |