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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

From: GLA:D® Back group-based patient education integrated with exercises to support self-management of back pain - development, theories and scientific evidence -

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
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