Early Implementation Research of a Walking and Education Intervention (WalkBack) for Preventing Low Back Pain Recurrence

Low back pain is a common and recurrent condition and remains the leading cause of disability worldwide. Preventing the recurrence of low back pain is essential to reducing the health and economic burden of this prevalent condition. Evidence indicates that exercise combined with education is the most effective approach for preventing recurrence. A recently published trial found the WalkBack program, a physiotherapist-facilitated walking and education intervention, to be effective in preventing low back pain recurrences while also being cost-effective. However, the implementation of prevention-focused programs within routine physiotherapy practice remains complex and challenging. Therefore, the research presented in this thesis aimed to advance understanding of how the WalkBack program could be effectively implemented in routine physiotherapy practice.Chapter Two presents a qualitative study exploring physiotherapists’ perspectives on the barriers, facilitators, and potential refinements to implementing the WalkBack program in routine physiotherapy practice. Semi-structured interviews were conducted with 20 physiotherapists practising across Australia, including those with and without prior exposure to the WalkBack program. Four overarching themes were identified: (1) the WalkBack program is relevant and acceptable to physiotherapists; (2) WalkBack training is important to effective delivery and implementation; (3) flexible delivery and structured resources enable engagement and scalability; and (4) successful adoption hinges on system-level enablers, including leadership, funding structures, and alignment with the service seting. These findings highlighted key determinants of effective implementation and informed several refinements incorporated into the WalkBack training and delivery package described in Chapter Three.Chapter Three outlines the protocol for a mixed-methods study designed to assess the feasibility and acceptability of implementing the WalkBack program in routine physiotherapy practice. Insights from Chapter Two informed refinements to the program’s training and delivery package. The study will recruit 20 physiotherapists from private practices across Australia. Participants will complete training and receive resources to deliver the WalkBack program to suitable patients who have largely recovered from an episode of low back pain. Quantitative outcomes, guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework, will assess program uptake, including the proportion of eligible patients offered the intervention, the proportion who accept, and the average number of sessions attended. Qualitative interviews will explore implementation experiences informed by the Theoretical Domains Framework.In summary, this thesis advances understanding of how the WalkBack program can be translated into routine physiotherapy practice. Some of the insights identified may also generalise to other prevention-focused, exercise-based interventions that share similar delivery mechanisms and implementation contexts.