Short-term outcomes of a micro-choice-based intervention for chronic low back pain: a quasi-experimental study

TL;DR

A group-based intervention combining goal setting, exercise, education, and small decisions improved pain and function in people with chronic low back pain.

Contribution

A concentrated micro-choice-based intervention showed short-term improvements in disability, pain, and work ability for hard-to-treat chronic low back pain patients.

Findings

Disability decreased by 18% and pain intensity by 21% after the intervention.

Work ability improved by 22%, and 17% of participants returned to work.

Physical performance increased, and 18% stopped using pain medication.

Abstract

Chronic low back pain (CLBP) is a leading cause of disability and reduced work participation worldwide. Its multifactorial nature—often lacking a clear pathological cause—poses significant challenges for effective treatment. This study reports short-term outcomes from a concentrated, interdisciplinary group-based intervention targeting patients with hard-to-treat CLBP.

This study reports outcomes from the CLBP arm of a nonrandomized five-armed transdiagnostic, pre-post intervention trial (2020–2022); no control group or between-group comparisons are included. The intervention comprised SMART (Specific, Measurable, Achievable, Relevant, Time-bound) goal setting, multilevel exercise, patient education, and micro-choice strategies—small, intentional decisions aimed at enhancing functional capacity and reducing symptom-related vigilance—delivered in a concentrated group format. Outcomes were evaluated three months post-intervention and included disability (Oswestry Disability Index, ODI), pain intensity (NRS-11), work ability, medication use, sick leave status, and physical performance tests. Continuous outcomes were analysed using mixed-effects regression models to account for repeated measures, while categorical changes were assessed using symmetry tests for ordinal variables and McNemar’s test for binary variables.

The majority in our cohort had low educational levels, were overweight, and welfare recipients, many had multisite pain, used daily pain medication and had a history of back surgery. At follow-up, most outcomes showed statistically significant improvement. Disability decreased by 5.9 points (-18%, 95% CI: 4.1–7.7), and low back pain intensity decreased by 1.3 points (-21%, 95% CI: 0.9–1.7). Work ability increased by 0.9 points (+ 22%, 95% CI: 0.4–1.5) and sit-to-stand repetitions increased by 3.6 (+ 27%, 95% CI: 2.6–4.7). Fifteen (17%) participants transitioned from sick leave to work, and 16 (18%) discontinued pain medication.

Patient education, structured exercise, and the concentrated micro-choice-based intervention was associated with improved pain, disability, work ability, and physical function in a hard-to-treat CLBP population. Improvements due to regression to the mean are a possibility, therefore a randomized controlled trial is warranted to confirm efficacy.

Clinicaltrials.gov (Identifier: NCT05234281), first submitted 26. May 2021.

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