Leininger, B., Evans, R., Greco, C.M. et al. Supported biopsychosocial self-management for back-related leg pain: a randomized feasibility study integrating a whole person perspective. Chiropr Man Therap 33, 6 (2025).
https://doi.org/10.1186/s12998-025-00570-7
The feasibility study aimed to evaluate the potential for a full-scale trial comparing a whole-person supported self-management intervention to medical care for individuals with chronic back-related leg pain (BRLP). Limited high-quality research exists on conservative treatments for BRLP, making this study a critical step in exploring alternative treatments to pharmacological care.
Participants were randomly assigned to one of two groups: a 12-week individualized supported self-management program, delivered by physical therapists and chiropractors, or medical care, which involved guideline-based pharmacologic treatment. The supported self-management intervention was based on a behavioral model designed to enhance participants’ self-care capabilities, motivation, and opportunities. The program combined BRLP education with psychosocial strategies (e.g., relaxation techniques, guided imagery, communication skills) and physical therapies like exercise and spinal manipulation. Providers were trained to address the individualized needs of each participant and employed behavior change and motivational communication techniques to foster a therapeutic alliance and facilitate self-management.
Feasibility was assessed by monitoring recruitment, enrollment, intervention delivery, and data collection over six months. The study successfully enrolled 42 participants, with few declines due to treatment preferences. Nearly all participants received treatment and 95% attended the required minimum number of visits (6 for self-management and 2 for medical care). After 12 weeks, 95% of the self-management group reported engaging in the practices taught, while 77% of medical care participants adhered to prescribed medications. Satisfaction with the self-management program was high, with 85% reporting overall satisfaction.
While the intervention providers were able to deliver most activities as required (72% of visits), some challenges were identified in the shared decision-making process, particularly in determining which self-management tools to prioritize. Data collection was robust, with completion rates of 91% for monthly surveys and 86% for weekly surveys.
Overall, the study demonstrated the feasibility of conducting a full-scale randomized trial comparing supported self-management to medical care for chronic BRLP. It also highlighted areas where further optimization of processes and protocols could improve the intervention for a larger-scale trial.