Effect of a Walking Plus Education Program on the Duration and Severity of Recurrences of Low Back Pain: A Secondary Exploratory Analysis of the WalkBack Trial

OBJECTIVE: To explore the effect of the WalkBack intervention on the duration and severity of low back pain in participants who reported a recurrence. DESIGN: Secondary exploratory analysis of the WalkBack randomized controlled trial. METHODS: The WalkBack trial compared an individualized and progressive walking plus education program delivered by physiotherapists, to a no-treatment control group for preventing new recurrences of low back pain. In this study, we analyzed the first recurrence of low back pain (n = 596). The primary outcome for this analysis was the duration of the recurrence (time to recovery in days). The secondary outcomes were the level of interference with daily activity caused by the recurrence, and pain intensity (average and worst). Survival analysis, linear, and ordinal regression were used to compare outcomes between groups. RESULTS: Walking plus education was associated with a shorter duration of pain recurrence compared to control: median time to recovery 3 days (95% confidence interval [CI]: 3, 4) versus 4 days (95% CI: 4, 5); hazard ratio 1.30 (95% CI: 1.10, 1.53; P = .002). There was no between-group difference in interference with daily activity or average pain intensity. The intervention group reported lower worst pain intensity on average than the control group (−0.34 on a numerical pain-rating scale from 0 to 10; 95% CI: −0.65, −0.03; P = .03). CONCLUSION: Participants who received a tailored and progressive walking plus education program reported shorter and milder back pain recurrences than participants in the control group. However, the benefits were small and of uncertain clinical relevance. J Orthop Sports Phys Ther 2025;55(9):596-601. Epub 6 August 2025. doi:10.2519/jospt.2025.13361