# MyBack - effectiveness and implementation of a behavior change informed exercise programme to prevent low back pain recurrences: a hybrid effectiveness-implementation randomized controlled study protocol

## TL;DR

This study tests a tailored exercise and behavior change program to prevent low back pain recurrences and assess its real-world implementation in primary care.

## Contribution

This is the first study to evaluate both the effectiveness and implementation of a behavior change-informed exercise program for preventing low back pain recurrences.

## Key findings

- The study will assess the risk of low back pain recurrence and related outcomes over one year.
- Implementation strategies will be evaluated using mixed methods to inform future adoption of the program.
- Data on cost-effectiveness and healthcare use will be collected to evaluate broader impacts.

## Abstract

Low back pain (LBP) is a common health condition and the leading cause of years lived with disability worldwide. Most LBP episodes have a favourable prognosis, but recurrences within a year are common. Despite the individual and societal impact related to LBP recurrences, there is limited evidence on effective strategies for secondary prevention of LBP and successful implementation of intervention programmes in a real-world context. The aim of this study is to analyse the effectiveness of a tailored exercise and behavioural change programme (MyBack programme) in the secondary prevention of LBP; and evaluate acceptability, feasibility and determinants of implementation by the different stakeholders, as well as the implementation strategy of the MyBack programme in real context.

This protocol describes a hybrid type I, randomized controlled trial to evaluate the effectiveness and implementation of MyBack programme in the context of primary health care. The Behaviour Change Wheel framework and FITT-VP principles will inform the development of the behaviour change and exercise component of MyBack programme, respectively. Patients who have recently recovered from an episode of non-specific LBP will be randomly assigned to MyBack and usual care group or usual care group. The primary outcome will be the risk of LBP recurrence. The secondary outcomes will include disability, pain intensity, musculoskeletal health, and health-related quality of life. Participants will be followed monthly for 1 year. Costs data related to health care use and the MyBack programme will be also collected. Implementation outcomes will be assessed in parallel with the effectiveness study using qualitative methods (focus groups with participants and health providers) and quantitative data (study enrolment and participation data; participants adherence).

To our knowledge, this is the first study assessing the effectiveness and implementation of a tailored exercise and behaviour change programme for prevention of LBP recurrences. Despite challenges related to hybrid design, it is expected that data on the effectiveness, cost-effectiveness, and implementation of the MyBack programme may contribute to improve health care in patients at risk of LBP recurrences, contributing to direct and indirect costs reduction for patients and the health system.

NCT05841732.

• LBP recurrences are common and account for a significant proportion of the costs and disability associated with low back pain. However, evidence on secondary prevention of LBP remains scarce.• A hybrid effectiveness-implementations design will be used to analyse the effectiveness, cost-effectiveness, and implementation of an exercise and behavior change programme in primary care.• Mixed method will used to analyze the implementation strategies. This data could inform the refinement of the implementation strategy and promote the adoption of the MyBack programme in the future.• This study data may improve the delivery of care in people at risk of recurrence and bring important benefits to individuals and society.

• LBP recurrences are common and account for a significant proportion of the costs and disability associated with low back pain. However, evidence on secondary prevention of LBP remains scarce.

• A hybrid effectiveness-implementations design will be used to analyse the effectiveness, cost-effectiveness, and implementation of an exercise and behavior change programme in primary care.

• Mixed method will used to analyze the implementation strategies. This data could inform the refinement of the implementation strategy and promote the adoption of the MyBack programme in the future.

• This study data may improve the delivery of care in people at risk of recurrence and bring important benefits to individuals and society.