An integrated Healthy Lifestyle Program (HeLP) and physiotherapy care for low back pain: a mixed methods process evaluation

Objectives and importance of study Integrated lifestyle and low back pain care is a novel treatment approach. This study describes the fidelity and adoption; barriers and facilitators to engagement and delivery; acceptability, appropriateness and feasibility of the Healthy Lifestyle Program (HeLP) intervention. Study type Mixed-methods process evaluation. Methods Data were included from n = 174 adults with chronic low back pain randomised to HeLP, and delivering clinicians. The 26-week intervention included five consultations , information resources, and referral to telephone support services. We collected quantitative data via fidelity checklists, administrative records and surveys, and qualitative data via semi-structured interviews and focus groups with a subsample of participants and clinicians. We used descriptive statistics, thematic analyses and triangulation to identify meta-themes. Results Intervention fidelity was high (clinicians delivered >90% to protocol). Participants’ adoption was moderate attending a mean 3.2 consultations, 54% (referred) engaged with telephone services and 46% used online resources; however, adoption of smoking cessation services was low (6.5% of smokers completed ≥1 call). A total of 23% of participants discontinuted HeLP by 26 weeks. Clinicians and participants considered the intervention acceptable, and addressing lifestyle factors appropriate for low back pain. Conclusion HeLP was acceptable, although uptake varied across components. Improving clinicians’ behaviour change communication and personalising care may optimise implementation.