Supported biopsychosocial self-management for back-related leg pain: a randomized feasibility study integrating a whole person perspective
Abstract Background There is limited high-quality research examining conservative treatments for back-related leg pain (BRLP). This feasibility study was done in preparation for a full-scale trial comparing a whole-person supported self-management intervention to medical care for chronic BRLP. Metho...
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BMC
2025-02-01
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| Series: | Chiropractic & Manual Therapies |
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| Online Access: | https://doi.org/10.1186/s12998-025-00570-7 |
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| author | Brent Leininger Roni Evans Carol M. Greco Linda Hanson Craig Schulz Michael Schneider John Connett Francis Keefe Ronald M. Glick Gert Bronfort |
| author_facet | Brent Leininger Roni Evans Carol M. Greco Linda Hanson Craig Schulz Michael Schneider John Connett Francis Keefe Ronald M. Glick Gert Bronfort |
| author_sort | Brent Leininger |
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| description | Abstract Background There is limited high-quality research examining conservative treatments for back-related leg pain (BRLP). This feasibility study was done in preparation for a full-scale trial comparing a whole-person supported self-management intervention to medical care for chronic BRLP. Methods Participants were randomized to 12 weeks of individualized supported self-management delivered by physical therapists and chiropractors or medical care consisting of guideline-based pharmacologic care. Supported self-management was based on a behavioral model that used a whole person approach to enhance participants capabilities, opportunities, and motivations to engage in self-care. It combined BRLP education with psychosocial strategies (e.g., relaxed breathing, progressive muscle relaxation, guided imagery, communication skills) and physical modalities such as exercise and spinal manipulation therapy. Providers were trained to address participants’ individualized needs and use behavior change and motivational communication techniques to develop a therapeutic alliance to facilitate self-management. Feasibility was assessed using pre-specified targets for recruitment and enrollment, intervention delivery, and data collection over the six-month study period. In addition, areas for potential refinement and optimization of processes and protocols for the full-scale trial were assessed. Results We met or exceeded nearly all feasibility targets. Forty-two participants were enrolled over a six-month period in 2022 and very few individuals declined participation due to preferences for one treatment. All but one participant received treatment and 95% of participants attended the minimum number of visits (self-management = 6, medical care = 2). At 12 weeks, 95% of participants in the self-management group reported engaging in self-management practices learned in the program and 77% of medical care participants reported taking medications as prescribed. Satisfaction with the self-management intervention was high with 85% of participants reporting satisfaction with the program overall. Self-management intervention providers delivered all required activities at 72% of visits. Providers also noted some challenges navigating the shared decision-making process and deciding what self-management tools to prioritize. Over the six-month study period, completion rates were 91% for monthly surveys and 86% for weekly surveys. Conclusion We were able to demonstrate that a full-scale randomized trial comparing a whole-person supported self-management intervention to medical care for chronic BRLP is feasible and identified important areas for optimization. |
| format | Article |
| id | doaj-art-adb41931e24a4e50b3ad770efcdaa01b |
| institution | Kabale University |
| issn | 2045-709X |
| language | English |
| publishDate | 2025-02-01 |
| publisher | BMC |
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| series | Chiropractic & Manual Therapies |
| spelling | doaj-art-adb41931e24a4e50b3ad770efcdaa01b2025-02-09T12:47:28ZengBMCChiropractic & Manual Therapies2045-709X2025-02-0133112510.1186/s12998-025-00570-7Supported biopsychosocial self-management for back-related leg pain: a randomized feasibility study integrating a whole person perspectiveBrent Leininger0Roni Evans1Carol M. Greco2Linda Hanson3Craig Schulz4Michael Schneider5John Connett6Francis Keefe7Ronald M. Glick8Gert Bronfort9Integrative Health and Wellbeing Research Program, Earl E. Bakken Center for Spirituality and Healing, University of MinnesotaIntegrative Health and Wellbeing Research Program, Earl E. Bakken Center for Spirituality and Healing, University of MinnesotaSchool of Medicine, Department of Psychiatry, University of PittsburghIntegrative Health and Wellbeing Research Program, Earl E. Bakken Center for Spirituality and Healing, University of MinnesotaIntegrative Health and Wellbeing Research Program, Earl E. Bakken Center for Spirituality and Healing, University of MinnesotaDoctor of Chiropractic Program, School of Health and Rehabilitation Sciences, University of PittsburghSchool of Public Health, Division of Biostatistics, University of MinnesotaPain Prevention and Treatment Research Program, Department of Psychiatry and Behavioral Sciences, Duke Medical Center, Duke University School of MedicineSchool of Medicine, Departments of Psychiatry and Physical Medicine and Rehabilitation, University of PittsburghIntegrative Health and Wellbeing Research Program, Earl E. Bakken Center for Spirituality and Healing, University of MinnesotaAbstract Background There is limited high-quality research examining conservative treatments for back-related leg pain (BRLP). This feasibility study was done in preparation for a full-scale trial comparing a whole-person supported self-management intervention to medical care for chronic BRLP. Methods Participants were randomized to 12 weeks of individualized supported self-management delivered by physical therapists and chiropractors or medical care consisting of guideline-based pharmacologic care. Supported self-management was based on a behavioral model that used a whole person approach to enhance participants capabilities, opportunities, and motivations to engage in self-care. It combined BRLP education with psychosocial strategies (e.g., relaxed breathing, progressive muscle relaxation, guided imagery, communication skills) and physical modalities such as exercise and spinal manipulation therapy. Providers were trained to address participants’ individualized needs and use behavior change and motivational communication techniques to develop a therapeutic alliance to facilitate self-management. Feasibility was assessed using pre-specified targets for recruitment and enrollment, intervention delivery, and data collection over the six-month study period. In addition, areas for potential refinement and optimization of processes and protocols for the full-scale trial were assessed. Results We met or exceeded nearly all feasibility targets. Forty-two participants were enrolled over a six-month period in 2022 and very few individuals declined participation due to preferences for one treatment. All but one participant received treatment and 95% of participants attended the minimum number of visits (self-management = 6, medical care = 2). At 12 weeks, 95% of participants in the self-management group reported engaging in self-management practices learned in the program and 77% of medical care participants reported taking medications as prescribed. Satisfaction with the self-management intervention was high with 85% of participants reporting satisfaction with the program overall. Self-management intervention providers delivered all required activities at 72% of visits. Providers also noted some challenges navigating the shared decision-making process and deciding what self-management tools to prioritize. Over the six-month study period, completion rates were 91% for monthly surveys and 86% for weekly surveys. Conclusion We were able to demonstrate that a full-scale randomized trial comparing a whole-person supported self-management intervention to medical care for chronic BRLP is feasible and identified important areas for optimization.https://doi.org/10.1186/s12998-025-00570-7Back-related leg painSelf-managementFeasibility |
| spellingShingle | Brent Leininger Roni Evans Carol M. Greco Linda Hanson Craig Schulz Michael Schneider John Connett Francis Keefe Ronald M. Glick Gert Bronfort Supported biopsychosocial self-management for back-related leg pain: a randomized feasibility study integrating a whole person perspective Chiropractic & Manual Therapies Back-related leg pain Self-management Feasibility |
| title | Supported biopsychosocial self-management for back-related leg pain: a randomized feasibility study integrating a whole person perspective |
| title_full | Supported biopsychosocial self-management for back-related leg pain: a randomized feasibility study integrating a whole person perspective |
| title_fullStr | Supported biopsychosocial self-management for back-related leg pain: a randomized feasibility study integrating a whole person perspective |
| title_full_unstemmed | Supported biopsychosocial self-management for back-related leg pain: a randomized feasibility study integrating a whole person perspective |
| title_short | Supported biopsychosocial self-management for back-related leg pain: a randomized feasibility study integrating a whole person perspective |
| title_sort | supported biopsychosocial self management for back related leg pain a randomized feasibility study integrating a whole person perspective |
| topic | Back-related leg pain Self-management Feasibility |
| url | https://doi.org/10.1186/s12998-025-00570-7 |
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