Ziegler Anna-Marie L, Thorpe Don, Kennedy Douglas, Schulz Craig, Salsbury Stacie A, Bronfort Gert, Evans Roni
Integrative Health and Wellbeing Research Program Earl E. Bakken Center for Spirituality & Healing, University of Minnesota, Mayo Memorial Building C504, 420 Delaware Street, Minneapolis, MN, 55414, USA.
Palmer Center for Chiropractic Research, Palmer College of Chiropractic, 741 Brady Street, Davenport, IA, 52803, USA.
Chiropr Man Therap. 2025 May 5;33(1):17. doi: 10.1186/s12998-025-00578-z.
Back related leg pain (BRLP) is a problematic subset of low back pain, leading to greater pain, loss of function and health related care costs. While evidence suggests self-management is effective, patient implementation can be sub-optimal. The purpose of this study is to identify barriers and facilitators to self-management for persons experiencing BRLP within the context of a controlled clinical trial and to map these to theory-informed intervention elements that can be addressed by front-line healthcare providers, informing the design and implementation of future theory-driven self-management interventions for this population.
This study was a qualitative secondary analysis of a 2-site, pragmatic, parallel group, randomized clinical trial (participants enrolled 2007-10) of spinal manipulative therapy (SMT) and home exercise and advice (HEA) compared to HEA alone for persons with subacute or chronic BRLP. We used deductive and inductive content analysis, to describe self-management facilitators and barriers among trial participants, map these to behavior change elements in the Behavior Change Wheel (BCW) Framework, and identify potentially modifiable, theory-intervention elements which may be addressed with guidance by healthcare providers. Baseline characteristics of participants were descriptively analyzed using SAS (University Edition).
Of 40 participants, the majority identified as white (n = 24, 85%) and of non-Hispanic or Latino ethnicity (n = 38, 95%). Average participant age was 57 years old (range 29-80). Frequent facilitators included ease of exercises, knowing how to manage condition, atmosphere created by staff, therapeutic alliance, effectiveness of exercises or treatment, goal of reducing pain, and intentions of continuing exercises. Frequent barriers included time constraints, pain, and lacking confidence in treatment. Barriers were mapped to all 9 Intervention Functions, most common being modelling and education. Frequently identified Behavior Change Techniques included information, feedback, self-monitoring, graded tasks, restructuring, social support, goal setting, reviewing goals, and action planning.
This study identified barriers and facilitators to engaging in self-management for participants in a pragmatic, randomized clinical trial. A rigorous systematic intervention mapping process utilizing the BCW was used for describing what participants need and how their needs may be met. These findings may support the design of future self-management interventions for persons experiencing BRLP.
腰源性腿痛（BRLP）是腰痛问题中的一个特定类型，会导致更严重的疼痛、功能丧失以及与健康相关的护理成本增加。虽然有证据表明自我管理是有效的，但患者的实施情况可能并不理想。本研究的目的是在一项对照临床试验的背景下，确定腰源性腿痛患者自我管理的障碍和促进因素，并将这些因素映射到理论指导的干预要素上，以便一线医疗保健提供者能够解决这些问题，为该人群未来理论驱动的自我管理干预措施的设计和实施提供参考。
本研究是对一项在两个地点进行的实用、平行组、随机临床试验（2007 - 2010年招募参与者）的定性二次分析，该试验比较了脊柱手法治疗（SMT）与家庭锻炼及建议（HEA）与单独的HEA对亚急性或慢性腰源性腿痛患者的效果。我们采用演绎和归纳内容分析法，描述试验参与者自我管理的促进因素和障碍，将这些因素映射到行为改变轮（BCW）框架中的行为改变要素上，并确定可能可修改的、理论干预要素，这些要素可在医疗保健提供者的指导下得到解决。使用SAS（大学版）对参与者的基线特征进行描述性分析。
在40名参与者中，大多数为白人（n = 24，85%），非西班牙裔或拉丁裔（n = 38，95%）。参与者的平均年龄为57岁（范围29 - 80岁）。常见的促进因素包括锻炼的简易性、知道如何管理病情、工作人员营造的氛围、治疗联盟、锻炼或治疗的有效性、减轻疼痛的目标以及继续锻炼的意愿。常见的障碍包括时间限制、疼痛以及对治疗缺乏信心。障碍被映射到所有9种干预功能上，最常见的是示范和教育。经常确定的行为改变技术包括信息、反馈、自我监测、分级任务、重构、社会支持、目标设定、回顾目标和行动计划。
本研究确定了实用随机临床试验中参与者进行自我管理的障碍和促进因素。利用BCW进行了严格的系统干预映射过程，以描述参与者的需求以及如何满足他们的需求。这些发现可能支持为腰源性腿痛患者设计未来的自我管理干预措施。
