Non-chronic Low Back Pain Research Articles

Moderators of treatment effect of non-steroidal anti-inflammatory drugs for patients with (sub) acute low back pain: Protocol for a systematic review with individual participant data meta-analysis

A Cochrane review found that non-steroidal anti-inflammatory drugs (NSAIDs) are slightly more effective than placebo on acute and subacute low back pain (LBP) outcomes (pain intensity, disability, and global improvement). Our objectives are: (1) to assess the overall treatment effect of NSAIDs in adults with acute and subacute LBP; (2) to identify the moderation of baseline patients’ characteristics on treatment effect. We will conduct a systematic search of RCTs on effectiveness of NSAIDs compared with placebo in adults with non-chronic LBP in Medline ALL, Embase, Cochrane Central Register of Controlled Trials*. We will screen the records after January 2020, and include eligible RCTs before January 2020 screened by the Cochrane review mentioned above. Our primary outcomes are pain intensity, disability, and health-related quality of life, secondary outcomes are adverse events. Our IPD dataset will consist of the information on each eligible trial characteristics and included variables according to a predefined coding scheme. We will assess risk-of-bias of included RCTs with the Cochrane Risk Of Bias (RoB)-2 assessment tool. We will perform power calculations with closed-form solutions and prioritize a one-stage approach for IPD-MA. For reporting the results, we will adhere to the PRISMA-IPD statement.

Risk Factors in Patients with Low Back Pain Under 40 Years Old: Quantitative Analysis Based on Computed Tomography and Magnetic Resonance Imaging mDIXON-Quant.

While low back pain (LBP) constitutes a global life disorder cause, the contribution of paraspinal muscles to its pathogenicity remains elusive. We characterized the paraspinal muscles of patients with LBP using lumbar three-dimensional computed tomography (CT) and magnetic resonance imaging (MRI) mDIXON-Quant, and evaluated the risk factors combined with clinical data. A retrospective study involving 181 patients (10-40 years) who underwent lumbar 3D-CT and MRI mDIXON from January 1, 2021 to December 31, 2022, and divided into normal, non-chronic LBP [non-CLBP], and CLBP groups. Clinical data, paraspinal muscle cross-sectional area, Hounsfield unit for CT values, and fat fraction derived from mDIXON-Quant were compared. Three readers analyzed the images independently; intra- and interobserver agreement was measured. Spearman analysis and multiple logistic regression were used to analyze the correlation between clinical data, radiologic and paraspinal muscle parameters. A nomogram was constructed for individualized prediction. Correlation analysis revealed that body mass index, visual analog scale score, Pfirrmann grade, annulus fibrosus tear, lumbar lordosis (LL), and Modic changes correlated with LBP (all P<0.05). The Pfirrmann grade and annulus fibrosus tear showed positive correlation (r=0.673, 0.559), whereas LL was negatively correlated (r=-0.469). The multifidus CT values were negatively correlated with LBP at L4-5/L5-S1; the multifidus fat fraction was positively correlated at L4-5/L5-S1 (r=0.734, r=0.584, P<0.001). The multiple logistic regression showed that L4-5 multifidus fat fraction (P=0.046, OR=1.167), Pfirrmann grade (P=0.017, OR=0.063), LL (P=0.002, OR=0.828) and annulus fibrosus tear (P=0.005, OR=0.024) were risk factors for predicting LBP in the non-CLBP group; in the CLBP group, BMI (P=0.048 OR=1.225), L4-5 multifidus fat fraction (P=0.001 OR=1.299), LL (P=0.003, OR=0.841) and Pfirrmann classification (P=0.009, OR=0.046) were risk factors. BMI, L4-5 multifidus fat fraction, LL, and Pfirrmann grade are risk factors for CLBP in patients under 40; whereas annulus fibrosus tear is an independent risk factor for non-CLBP, nomograms derived from these parameters can help predict LBP and MRI mDIXON-Quant is recommended for quantitatively analyzing paraspinal muscle fat infiltration.

Association of non-chronic low back pain with physical function, endurance, fatigability, and quality of life in middle- and older-aged adults: Findings from Baltimore Longitudinal Study of Aging.

Low back pain (LBP) is an important condition associated with high healthcare burden. However, the relationship of this condition with physical function (PF) and health-related quality of life (HRQoL) remains unclear. This is a cross-sectional study that aims to investigate the association between presence and intensity of non-chronic LBP with PF and HRQoL in middle-and older-aged adults. Participants answered questions about presence and intensity of LBP in the previous year, self-reported their PF and HRQoL (SF-12), and underwent objective measures of PF ([ExSPPB] including usual gait speed, narrow walk, chair stands, and standing balance), endurance performance ([EP] long-distance corridor walk) and fatigability. Generalized linear models and logistic regression models were performed. A total of 1500 participants (52.5% women, 70.3% white) aged 69.0 (SD 13.1) years were included. Of those, 642 (42.8%) reported LBP and the mean pain intensity was 4.1 (SD 2.2). After adjustments for potential confounders, presence of LBP was associated with lower self-reported PF (OR 1.73, 95% CI 1.27 to 2.37), lower physical component of HRQoL (β -0.03, 95% CI -0.04 to -0.02) and poorer chair stand performance (β -0.05, 95% CI -0.09 to -0.008). Higher intensity of LBP was associated with lower physical component of HRQoL (β -0.01, 95% CI -0.02 to -0.007), poorer ExSPPB performance (β -0.01, 95% CI -0.02 to -0.004), slower usual gait speed (β -0.01, 95% CI -0.02 to -0.004), lower total standing balance time (β -0.01, 95% CI -0.02 to -0.001) and higher fatigability (OR 1.13, 95% CI 1.01 to 1.25). The presence of non-chronic LBP was more consistently associated with lower self-reported PF, while higher intensity non-chronic LBP was associated with poorer objectively measured PF and fatigability. Collectively, this evidence suggests that although presence of pain may affect perception of function, greater pain intensity appears more strongly associated with unfavorable functional performance in mid-to-late life.

Low Back Pain as a Risk Factor for Recurrent Falls in People With Knee Osteoarthritis.

Knee osteoarthritis (OA) has been suggested to increase the risk of falls. Low back pain (LBP) is a potential risk factor for falls in people with knee OA, but this issue has not been addressed adequately in previous studies. The objective of this study was to investigate the relationship between LBP and falls in people with knee OA in a 12-month period. Participants with knee OA (Kellgren/Lawrence [K/L] grade ≥1) completed questionnaires for LBP and falls that occurred in the preceding 12 months. Binary and ordinal logistic regression analyses were performed to assess the relationship between LBP or moderate-to-severe LBP (numeric rating scale ≥4 points) and any fall (≥1 fall) or recurrent falls (≥2 falls) after adjustment for age, sex, K/L grade, knee pain severity, and quadriceps strength. Sensitivity analyses were performed excluding people with sciatica, nonchronic LBP, K/L grade 1, and those receiving pain medications. We included 189 participants (ages 61-90 years, 78.3% women) in this study. Of these participants, 41 (21.6%) reported falls in the preceding 12 months. People with any LBP (n = 101) and those with moderate-to-severe LBP (n = 45) had 2.7- and 3.7-times higher odds of recurrent falls, respectively. Sensitivity analyses revealed a strong correlation between moderate-to-severe LBP and recurrent falls. Thorough investigation of LBP as a risk factor for recurrent falls in people with knee OA may provide a novel insight into the pathomechanics of recurrent falls in this population.

THE RELATIONSHIP BETWEEN CHRONIC LOW BACK PAIN AND PHYSICAL FACTORS IN COLLEGIATE POLE VAULTERS: A CROSS-SECTIONAL STUDY

The low back is the most common injury location in pole vaulters, and low back pain (LBP) can easily become chronic. Therefore, knowing the physical characteristics of athletes experiencing repeated LBP may be beneficial for recovery and injury prevention. The purpose of this study was to describe and analyze the physical characteristics of pole vaulters with chronic LBP. A cross-sectional study. Twenty male pole vaulters participated in this study. A questionnaire was used to garner descriptive and personal data, including personal best performance in the pole vault. Additionally, the following physical characteristics were measured: 1) isokinetic muscle strength of hip and knee flexors and extensors, 2) active/passive range of motion and muscle flexibility in multiple joints and regions, 3) performance on the Functional Movement Screen™ (FMS™) and 4) spinal column alignment. Subjects were categorized using the questionnaire and divided into two groups, one with and one without chronic LBP. The personal best performance and angle on the active straight leg raise test (SLR) were significantly lower and smaller, respectively, in the chronic LBP group than in the non-chronic LBP group. Additionally, the difference between the passive SLR angle and active SLR angle (ΔSLR) was significantly larger in the chronic LBP group than in the non-chronic LBP group. Those with chronic LBP had were more likely to have a FMS™ composite score ≤14. The active SLR angle and ΔSLR were significantly smaller and larger, respectively, in the chronic LBP group than in the non-chronic LBP group. This may be because of the poor stability of trunk or incompetence of the kinetic chain required for raising the lower limbs. The chronic LBP group had a significantly higher probability of having an FMS™ composite score of ≤14. it may be important to examine the active straight leg raise (vs. passive only), and fundamental movements as screened by the FMS ™ in pole vaulters. 2b.

The relationship between indicators of lumbo-pelvic coordination and pain, disability, pain catastrophizing and depression in patients presenting with non-chronic low back pain

This study examined associations and changes overtime in low back kinematics and disability, pain, pain catastrophizing, and depression and assessed whether associations and changes overtime varied between individuals who meet the classification criteria for chronic low back pain at 6 months and those who do not. Findings suggested that those persons with a higher ratio of lumbar contribution to thorax motion and smaller pelvic tilt during forward bending had higher scores on measures of disability, pain and pain catastrophizing. This same association was found in those who met classification criteria for chronic low back pain at 6 months. Opposing associations were found in the group not meeting classification criteria for chronic low back pain, specifically, increased pelvic tilt was positively associated with higher pain catastrophizing scores. Practitioner summary This study examined associations and changes overtime in low back kinematics and psychosocial and clinical factors and whether associations and changes overtime varied between individuals who meet the classification criteria for chronic low back pain at 6 months and those who do not, Results suggest that associations exist between psychological factors and kinematic changes during the time between an acute low back pain episode to meeting classification for chronic low back pain at 6 months.

A prospective study of lumbo-pelvic coordination in patients with non-chronic low back pain

Despite the current knowledge about abnormalities in the lumbo-pelvic coordination of patients with non-specific low back pain (LBP), it is unclear how such abnormalities change with time. Timing and magnitude aspects of lumbo-pelvic coordination during a trunk forward bending and backward return task along with subjective measures of pain and disability were collected at three-time points over a six-month period from 29 patients who had non-chronic LBP at the time of enrollment in the study. To enable investigation of abnormalities in lumbo-pelvic coordination of patients, we also included lumbo-pelvic coordination data of age and gender-matched back healthy individuals from an earlier study of our group. Finally, differences in lumbo-pelvic coordination between patients with moderate-severe LBP (i.e., those whose level of pain was ≥ 4 (out of 10) at all three data collection sessions; n = 8) and patients with low-moderate LBP (n = 21) were investigated. There were clear distinctions in measures of lumbo-pelvic coordination between patients with low-moderate and moderate-severe LBP. Contrary to our expectation, however, the abnormalities in magnitude aspects of lumbo-pelvic coordination were larger (F > 4.84, P < 0.012) in patients with low-moderate LBP. These abnormalities in patients with low-moderate LBP, compared to controls, included larger (>12°) pelvic and thoracic rotations as well as smaller (>10°) lumbar flexion. The abnormal lumbo-pelvic coordination of patients with non-specific LBP, observed at baseline, persisted (F < 1.96, P > 0.156) or worsen (F > 3.48, P < 0.04) over the course of study period despite significant improvement in their pain (18% decrease; F = 12.10, P < 0.001) and disability (10% decrease; F = 4.39, P = 0.017). Distinct but lingering abnormalities in lumbo-pelvic coordination, observed in patients with low-moderate and moderate-severe LBP, might have a role in persistence and/or relapse of symptoms in patients with non-specific LBP. Such inferences, however, should further be studied in future via investigation of the relationship between abnormalities in lumbo-pelvic coordination and clinical presentation of LBP.

Immediate effect of pain neuroscience education for recent onset low back pain: an exploratory single arm trial

ABSTRACTStudy Design: A prospective, single-arm, pre-postintervention study.Objective: To determine the preliminary usefulness of providing pain neuroscience education (PNE) on improving pain and movement in patients presenting with non-chronic mechanical low back pain (LBP).Background: PNE has been shown to be an effective intervention for the treatment of chronic LBP but its usefulness in patients with non-chronic LBP has not been examined.Methods: A single group cohort pilot study was conducted. Eighty consecutive patients with LBP < 3 months completed a demographics questionnaire, leg and LBP rating (Numeric Pain Rating Scale – NPRS), disability (Oswestry Disability Index), fear-avoidance (Fear-Avoidance Beliefs Questionnaire), pain catastrophizing (Pain Catastrophizing Scale), central sensitization (Central Sensitization Inventory), pain knowledge (Revised Neurophysiology of Pain Questionnaire), risk assessment (Keele STarT Back Screening Tool), active trunk flexion and straight leg raise (SLR). Patients received a 15-minute verbal, one-on-one PNE session, followed by repeat measurement of LBP and leg pain (NPRS), trunk flexion and SLR.Results: Immediately after intervention, LBP and leg pain improved significantly (p < 0.001), but the mean change did not exceed minimal clinically important difference (MCID) of 2.0. Active trunk flexion significantly improved (p < 0.001), with the mean improvement (4.7 cm) exceeding minimal detectible change (MDC). SLR improved significantly (p = 0.002), but mean change did not exceed MDC.Conclusions: PNE may be an interesting option in the treatment of patients with non-chronic mechanical LBP. The present pilot study provides the rationale for studying larger groups of patients in controlled studies over longer periods of time.

The effectiveness of shared decision-making followed by positive reinforcement on physical disability in the long-term follow-up of patients with nonspecific low back pain in primary care: a clustered randomised controlled trial

BackgroundAlthough the recovery of patients suffering from low back pain is highly context dependent, patient preferences about treatment options are seldom incorporated into the therapeutic plan. Shared decision-making (SDM) offers a tool to overcome this deficiency. The reinforcement by the general practitioner (GP) of a ‘shared’ chosen therapy might increase patients’ expectations of favourable outcomes and thus contribute to recovery.MethodsIn the Netherlands, a clustered randomised controlled trial was performed to assess the effectiveness of shared decision-making followed by positive reinforcement of the chosen therapy (SDM&PR) on patient-related clinical outcomes. Overall, 68 GPs included 226 patients visiting their GP for a new episode of non-chronic low back pain. GPs in the intervention group were trained in implementing SDM&PR using a structured training programme with a focus on patient preferences in reaching treatment decisions. GPs in the control group provided care as usual. The primary outcome was the change in physical disability measured with the Roland-Morris disability questionnaire (RMD) during the six-month follow-up after the first consultation. Physical disability (RMD), pain, adequate relief, absenteeism and healthcare consumption at 2, 6, 12 and 26 weeks were secondary outcomes. A multivariate analysis with a mixed model was used to estimate the differences in outcomes.ResultsOf the patients in the intervention and the control groups, 66 and 62%, respectively, completed the follow-up. Most patients (77%) recovered to no functional restrictions due to back pain within 26 weeks. No significant differences in the mean scores for any outcome were observed between intervention patients and controls during the follow-up, and in multivariate analysis, there was no significant difference in the main outcome during the six-month follow-up. Patients in the intervention group reported more involvement in decision-making.ConclusionThis study did not detect any improvement in clinical outcome or in health care consumption of patients with non-chronic low back pain after the training of GPs in SDM&PR. The implementation of SDM merely introduces task-oriented communication. The training of the GPs may have been more effective if it had focused more on patient-oriented communication techniques and on stressing the expectation of favourable outcomes.Trial registrationThe Netherlands National Trial Register (NTR) number: NTR1960. The trial was registered in the NTR on August 20, 2009.

Mechanical demands on the lower back in patients with non-chronic low back pain during a symmetric lowering and lifting task

There is limited information in the literature related to the lower back loading in patients with LBP, particularly those with non-chronic LBP. Toward addressing such a research gap, a case-control study was conducted to explore the differences in lower back mechanical loads between a group of females (n=19) with non-chronic, non-specific LBP and a group of asymptomatic females (n=19). The differences in lower back mechanical loads were determined when participants completed one symmetric lowering and lifting of a 4.5kg load at their preferred cadence. The axial, shearing, and moment components of task demand at the time of peak moment component as well as measures of peak trunk kinematics were analyzed. Patient vs. asymptomatic group performed the task with smaller peak thoracic rotation and peak lumbar flexion. While no differences in the moment component of task demand on the lower back between the patients and controls were found, the shearing (40–50 age group) and axial components of task demand were, respectively, larger and smaller in patients vs. controls. Whether alterations in lower back loads in patients with non-chronic LBP are in response to pain or preceded the pain, the long-term exposure to abnormal lower back mechanics may adversely affect spinal structure and increase the likelihood of further injury or pain. Therefore, the underlying reason(s) as well as the potential consequence(s) of such altered lower back mechanics in patients with non-chronic LBP should to be further investigated.

Complementary therapies in addition to medication for patients with nonchronic, nonradicular low back pain: a systematic review

BackgroundA total of 2.7 million patients present to US emergency departments annually for management of low back pain (LBP). Despite optimal medical therapy, more than 50% remain functionally impaired 3 months later. We performed a systematic review to address the following question: Among patients with nonchronic LBP, does spinal manipulation, massage, exercise, or yoga, when combined with standard medical therapy, improve pain and functional outcomes more than standard medical therapy alone? MethodsWe used published searches to identify relevant studies, supplemented with our own updated search. Studies were culled from the Cochrane Register of Controlled Trials, Medline, EMBASE, CINAHL, and the Index to Chiropractic Literature. Our goal was to identify randomized studies that included patients with nonradicular LBP of <12 weeks’ duration that compared the complementary therapy to usual care, sham therapy, or interventions known not to be efficacious, while providing all patients with standard analgesics. The outcomes of interest were improvement in pain scores or measures of functionality. ResultsWe identified 2 randomized controlled trials in which chiropractic manipulation + medical therapy failed to show benefit vs medical therapy alone. We identified 4 randomized controlled trials in which exercise therapy + medical therapy failed to show benefit vs medical therapy alone. We did not identify any eligible studies of yoga or massage therapy. ConclusionsIn conclusion, for patients with nonchronic, nonradicular LBP, available evidence does not support the use of spinal manipulation or exercise therapy in addition to standard medical therapy. There is insufficient evidence to determine if yoga or massage is beneficial.

Interventions focusing on psychosocial risk factors for patients with non-chronic low back pain in primary care--a systematic review

Low back pain (LBP) is a problem that is frequently encountered in primary care, and current guidelines encourage care providers to take into account psychosocial risk factors in order to avoid transition from acute to chronic LBP. To review the effectiveness of interventions focusing on psychosocial risk factors for patients with non-chronic LBP in primary care. A systematic search was undertaken for controlled trials focusing on psychosocial factors in adult patients with non-chronic, non-specific LBP in primary care by exploring Medline, Embase, PsycInfo, Francis, Web of Sciences and The Cochrane Library. The methodological quality of the studies included was assessed before analysing their findings. Thirteen studies were selected, seven being considered as having a low risk of bias. Information strategies were assessed by eight trials, with high-quality evidence of no effectiveness for pain, function, work issues and health care use, low-quality evidence of no effectiveness for self-rated overall improvement, satisfaction and pain beliefs and lack of evidence in terms of quality of life. Cognitive behavioural therapy was assessed by three trials, with very low-quality evidence of moderate effectiveness for pain, function, quality of life, work issues and health care use. There was lack of evidence concerning the effectiveness of individual and group education intervention or work coordination. Among the wide range of psychosocial risk factors, research has focused mainly on pain beliefs and coping skills, with disappointing results. Extended theoretical models integrating several psychosocial factors and multicomponent interventions are probably required to meet the challenge of LBP.

Should physical activity recommendation depend on state of low back pain?

Leisure time physical activity is recommended for preventing long-term sickness absence (LTSA). Although low back pain (LBP) is a risk factor for sickness absence and physical activity is recommended for people with LBP, it is unknown if leisure time physical activity prevents LTSA among persons with different levels of LBP. Prospective cohort study among 8655 Danish female healthcare workers responding to a questionnaire in 2004-2005 on leisure time physical activity and LBP, and subsequently followed for 1 year on periods with LTSA ∼2 consecutive weeks or more of sickness absence in a national register of social transfer payments (DREAM). Multi-adjusted Cox regression analysis was used to model risk estimates for LTSA associated with low, moderate, high and very high leisure time physical activity at baseline among healthcare workers with no LBP (0 days past 12 months, n = 2761), non-chronic LBP (1-30 days the past 12 months, n = 3942) and persistent LBP (>30 days the past 12 months, n = 1952). A strongly reduced risk for LTSA from high leisure time physical activity was found among healthcare workers with no LBP [hazard ratio (HR): 95% confidence interval (CI) 0.47:0.23-0.97 for low vs. very high activity] and non-chronic LBP (HR: 95%CI 0.43:0.23-0.84 of low vs. very high activity), but not among healthcare workers with persistent LBP (HR: 95%CI 1.15:0.55-2.44 of low vs. very high activity). Leisure time physical activity is a strong predictive factor on LTSA among female healthcare workers with no and non-chronic LBP, but not among those with more persistent LBP.

Does Self-Assessed Physical Capacity Predict Development of Low Back Pain Among Health Care Workers? A 2-Year Follow-up Study

Prospective cohort study. To determine the prognostic value of self-assessed physical capacity for the development of low back pain (LBP) among female health care workers without LBP. High physical capacities in terms of strength, endurance, flexibility, and balance are assumed to prevent LBP among persons with high physical work demands. However, the few existing studies investigating this relationship show contrasting findings. Female health care workers answered a questionnaire about physical capacity in 2004, and days with LBP in 2005 and 2006. The odds ratios (ORs) for developing nonchronic (1-30 d of the past 12 mo) and persistent (>30 d of the past 12 mo) LBP in 2006 from self-assessed physical capacity were investigated with multiadjusted logistic regressions among female health care workers without LBP in 2005 (n = 1612). Health care workers with low and medium physical capacity had increased risk of developing nonchronic LBP (OR = 1.52 [CI = 1.05-2.20] and OR = 1.37 [CI = 1.01-1.84], respectively), and health care workers with low physical capacity had an increased risk of developing persistent LBP (OR = 2.13 [CI = 1.15-3.96]), referencing those with high physical capacity. Self-assessed low physical capacity is a strong predictor for developing nonchronic and persistent LBP among pain-free female health care workers. Future intervention studies should investigate whether increased physical capacity, for example, through exercise training prevents development of LBP among female health care workers.

Risk for low back pain from different frequencies, load mass and trunk postures of lifting and carrying among female healthcare workers

To investigate the risk of developing non-chronic and chronic low back pain (LBP) from frequency, load mass and trunk postures of occupational lifting and carrying among female healthcare workers. A total of 9,847 workers in eldercare answered a questionnaire about occupational lifting and carrying frequency (rarely, occasionally and frequently), load mass (low: 1-7 kg, moderate: 8-30 kg and heavy: >30 kg), trunk posture (upright or forward bent back), and days with LBP in 2005. The odds ratio (OR) for developing non-chronic (1-30 days the last 12 months) and chronic (>30 days the last 12 months) LBP reported in 2006 from these characteristics of occupational lifting and carrying was investigated with multi-adjusted logistic regressions among female healthcare workers without LBP in 2005 (n = 1,612). Frequently lifting and carrying low load mass with forward bent back doubled the risk for developing chronic LBP (OR: 2.14; 95 % CI: 1.02-4.50). Occasionally and frequently lifting or carrying of any load mass with upright back did not increase the risk for chronic LBP. Lifting and carrying did not increase the risk for non-chronic LBP. Preventive initiatives for LBP among healthcare workers ought to pay attention to frequent lifting and carrying of low load mass with forward bent back.

Telephone coaching can increase activity levels for people with non-chronic low back pain: a randomised trial

Does the addition of telephone coaching to usual physiotherapy care improve activity for people with non-chronic low back pain and low to moderate recovery expectations? Randomised trial with concealed allocation and intention-to-treat analysis. People attending the physiotherapy department of a public hospital for treatment within eight weeks of onset of non-specific low back pain. Eligible participants had low to moderate recovery expectations, defined as a response of 7 or less to the question 'How certain are you that you will return to all of your usual activities one month from today?' on a scale from 0 (not certain at all) to 10 (completely certain). Five sessions of telephone coaching by a physiotherapist trained in health coaching techniques in addition to usual physiotherapy compared to usual physiotherapy alone. The Patient Specific Functional Scale, Oswestry Disability Index, Pain Self Efficacy Questionnaire, and recovery expectation were measured at baseline, 4, and 12 weeks. 30 participants were recruited, with 26 completing all measures at 12 weeks. There were no significant differences between groups at 4 weeks. After 12 weeks the coaching group improved significantly more than the control group on two 10-point scales: the Patient Specific Functional Scale (mean difference 3.0 points, 95% CI 0.7 to 5.4) and recovery expectation (mean difference 3.4 points, 95% CI 1.1 to 5.7). Estimates of effect sizes were moderate to large in favour of the intervention. The addition of telephone health coaching to usual physiotherapy care for people with non-chronic non-specific low back pain led to clinically important improvements in activity and recovery expectation. ACTRN12607000458437.