Active Back Programme

NICE has stated that “staying physically active is likely to be beneficial.” A key message in the NICE guidelines is the importance of helping people with persistent non-specific back pain to self-manage their condition.

The Active Back Programme at the Royal National Orthopaedic Hospital (RNOH) aims to achieve this. The guidelines stress the importance of regular physical activity and exercise in combination with education.

The NICE guidelines recommend the following:

Physical activity:

• A structured exercise programme tailored to the patient
• A supervised exercise programme in a group of up to eight patients
• A combined physical and psychological treatment including cognitive behavioural approach and exercise, comprising 100 hours over a maximum of eight weeks

Exercise programmes:

• Aerobic activity
• Muscle strengthening
• Postural control
• Stretching

Education:

• Advice and information to promote self-management
• Information about the nature of chronic back pain
• Information regarding the importance of being physically active and continuing normal activities as far as possible

The Active Back Programme includes all of the components recommended in the NICE guidelines for back pain. The treatment received on the Active Back Programme is also consistent with the recommendations as set out in other national and international guidelines for the management of chronic low back pain lasting longer than three months.

The Active Back Programme runs over two years and is based on a multi-disciplinary approach. It involves an initial three week residential, intensive exercise and educational programme with an emphasis on pacing of activities, long term self-management and goal planning. Further activities including courses and outpatient appointments extend over the two years.

Patients attend the Active Back Programme Monday to Friday (finishes Thursday in the final week) from 09.00 to 17.00 and go home at weekends. Due to the residential element of the programme, patients will stay in a hotel during the week, the cost of which is funded by the NHS.

Treatment is group based and up to eight patients can attend a session. There are two follow-up sessions with the therapists during the year and patients’ progress is evaluated.

There is no individual hands-on treatment and you will not see a doctor or undergo any further medical investigations. The Active Back Programme moves away from seeking a medical cure or reduction in pain intensity, focusing instead on self-management through education sessions, tailored exercises, psychological support and practical coping and problem-solving strategies.

The Active Back Programme aims to:

• Decrease the effects of pain on your lifestyle
• Increase physical fitness
• Restore confidence in performing activities that you enjoy
• Improve your understanding of how to manage your back
• Improve your quality of life
• Enable you to manage your back problem independently

To achieve these objectives you must:

• Want to regain control of your life by applying self-management skills through individual and group activities
• Be willing to assess your lifestyle and think about relevant and realistic adaptations in your daily activities that could help manage your pain
• Be motivated to attend all sessions and put in the effort to achieve your goals

The course combines the following components:

• Education: Advice on anatomy, posture, good seating, pacing activities, fitness, how the body heals, lifting and handling, dealing with a flare up, relaxation, acute versus persistent pain, effects of exercise on the body and problem solving
• Physical: Stretching, exercising in water, postural and strength muscle retraining, use of the fitness gym, use of the gym ball and returning to gentle recreational activity
• Coping skills: Addressing the emotional and behavioural effects of long-term pain, understanding pain, stress and anxiety, mood management, communicating with friends and family, maintaining change, assertiveness and the use of goal setting to improve coping strategies

The Active Back Programme treats patients with chronic back pain who have not responded to treatment. Patients need to have a good understanding of spoken English and be prepared to stay at or near the hospital for three weeks to participate in a group based programme (accommodation will be provided as part of the programme).

Because of the physical nature of the programme, patients must be able to perform personal care, for example, independent washing and dressing, be able to walk independently for 15 minutes or 500 metres and have good general medical health.

The programme is not suitable for patients seeking a medical or surgical cure for their pain.

Before you start the three-week course, you will need to attend a half-day assessment, which gives you the opportunity to:

• Meet the team
• Discuss whether the programme is suitable for you
• Have a tour of the facilities
• Meet other people who are considering the programme
• Discuss arrangements that may need to be considered prior to your attendance, for example, childcare, booked holidays and work

The Active Back Programme has been running for more than 10 years and the team collects feedback from all participants.

The formal outcome measures that are used by the RNOH demonstrate statistically significant improvements in pain, disability, physical function, mental function and job status.

• 86% of participants rated the programme as excellent or very good
• 92% of participants rated group work as excellent or very good
• More than half of the patients on long term sick-leave return to work
• The majority of patients struggling to remain at work because of back pain are able to do so

    The programme helped me cope with my pain.
    It was very helpful to talk and listen to people who understand.

    My problem [back pain] is still there but this has helped me with my
    fear of exercise and increased my activity.

    I think the course definitely addresses how to cope with the pain
    both physically and psychologically.

    I think it helped me to understand my condition and some methods of coping with pain. Also, seeing people deal with their pain and how they cope helps.

Your doctor can make a referral to:

Dr Roxaneh Zarnegar, Consultant in Anaesthesia and Pain Management
Helen Nafis, Consultant Physiotherapist
Integrated Back Unit
Royal National Orthopaedic Hospital
Brockley Hill
Stanmore
Middlesex
HA7 4LP

Telephone: 020 3947 0100

The treatment approach offered on the Active Back Programme is supported by:

• The National Institute for Clinical Excellence (NICE), Early Management of Persistent Non-Specific Low Back Pain (2009)
• European Guidelines for Chronic Low Back Pain (2004)
• Clinical Guidelines for the Physiotherapy Management of Persistent Low Back Pain – Chartered Society of Physiotherapy (CSP) 2009
• The Musculoskeletal Services Framework - A Joint Responsibility: Doing it Differently, Department of Health (DOH) 2006