Back to Living Well: Implementation of a community-based program for the tertiary prevention of low back pain

Low back pain (LBP) is usually a long-term condition with episodes of improvement, remission, and recurrence. There is evidence that long term exercise combined with education and self-management is effective at reducing the negative consequences of LBP and preventing activity limiting flares. However, problems with uptake and long-term adherence to such programs are often reported in the literature. Using best available evidence, we developed the BackToLivingWell (BLW), a community-based online or in-person program for the tertiary prevention of LBP. This LiveWell program was developed in partnership with a local YMCA, Hamilton Health Sciences and McMaster University. A pilot study of the program demonstrated the intervention to be feasible with high levels of participant's satisfaction. However, to improve the program, it is important to better understand barriers and facilitators to implementation including strategies that could enhance uptake and adherence. Additionally, through the COVID-19 pandemic, it has become apparent the need for evidence on the implementation of online interventions. Thus, the primary aim of this study is to evaluate the implementation context of the BLW program using a theory-based approach. Persons with LBP will be invited to participate in either the in-person or e-health program. We will conduct a mixed-method study with longitudinal assessments at baseline, 3-, 6- and 12- months, as well as longitudinal qualitative interviews at the same time points to assess: 1) barriers and facilitators to the program, 2) factors that contribute to negative and positive responses to the program, including how outcomes are related to the program, personal and contextual factors, and 3) factors that influence the selection of in-person or online intervention. The results of this study will provide evidence to inform future implementation of the program including strategies that could lead to better outcomes.