Article Text

Download PDFPDF
98 Improving low back pain management: the enhanced transtheoretical model intervention in reducing overdiagnosis
  1. Ron Feldman1,2,
  2. Tamar Pincus3,
  3. Noa Ben Ami1
  1. 1Ariel University, Ariel, Israel
  2. 2Maccabi Healthcare Services, Tel Aviv, Israel
  3. 3University of Southampton, Southampton, UK


Background low back pain (LBP) is often over-diagnosed and over-treated, leading to unnecessary healthcare costs and patient harm. Major international clinical guidelines recognize that most people with LBP need little or no formal treatment. The evidence-supported self-management of symptoms, reassurance, a normal life routine, and regular physical activity. The Enhanced Transtheoretical Model Intervention (ETMI), which aligns with the clinical guidelines, is based on a behavioral model that helps practitioners with reassurance and enhancing skills in improving patients’ self-efficacy to increase recreational physical activity and self-manage back pain. ETMI proved that training physiotherapists to include behavior change techniques within their practice is feasible within a short time frame and results in considerable improvements in patients with chronic LBP together with a reduction in healthcare utilization.

Objectives To evaluate the feasibility of implementing ETMI for low back pain patients In Public Healthcare Services in Israel.

Methods Feasibility was assessed based on four domains: 1) the number of ETMI trained Physiotherapists who opted to use ETMI in practice, 2) program fidelity, 3) Physiotherapists’ perceptions of ETMI implementation, 4) Patients’ outcomes - (treatment duration, function, pain, and fear avoidance) between patients treated by ETMI and those who weren’t.

Results 109 physiotherapists participated in the ETMI training, and 72 (66%) offered ETMI to their patients. The program was delivered with proper fidelity, and physiotherapists’ interviews revealed facilitators, barriers, and improvement opportunities. Analysis was conducted on 1,120 chronic low back patients who attended physiotherapy sessions (152 in the ETMI group and 968 in the non-ETMI group). The results showed that patients treated with ETMI experienced a significant improvement in function, reduced fear-avoidance beliefs, and shorter treatment sessions (p<0.001), compared to those not treated with ETMI.

Conclusion Based on these domains, implementing ETMI in public healthcare appears feasible. Implementing ETMI demonstrated positive patient outcomes and shorter treatment sessions. Yet, further research is needed to address barriers, facilitators, delivery, and outcomes in different healthcare systems.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.