Booster session prescription and outcomes in adults with chronic low back pain: Secondary analysis of a randomized clinical trial

Abstract

Background

Booster sessions are suggested to maintain self-management behaviors and treatment effects in chronic low back pain (LBP) interventions, but the effects of boosters on outcomes and the best parameters for booster prescription are unclear.

Objectives

(1) Compare booster prescription for two LBP treatments in an RCT where prescription was based on self-management program independence, (2) Determine if participant-specific variables predict requiring additional boosters, (3) Explore effects of boosters on outcomes in those requiring additional boosters.

Methods

Secondary analysis of an RCT where 154 participants with LBP were randomized to motor skill training (MST), MST + Boosters (MST + B), strength/flexibility exercise (SFE), or SFE + B. This analysis focuses only on the + Boosters groups (age: 40.1 ± 11.2 years, 49 female, LBP duration 9.8 ± 8.8 years). Participants received MST or SFE and six months later received up to 3 boosters. Self-management program independence was assessed at the first booster, and those who were not independent required additional (>1) boosters. Chi-square tests were used to analyze booster prescription. Logistic regression analyses were used to examine predictors of requiring additional boosters. Descriptive statistics were calculated for outcomes for participants who did and did not require additional boosters.

Results

MST + B and SFE + B did not significantly differ in returning for the first booster, χ²(1) = 1.76, p = 0.185. SFE + B were over 10 times more likely to require additional boosters than MST + B; OR = 10.9, 95% CI = [3.1, 38.1]. No participant-specific factors were statistically related to needing additional boosters. Attending additional boosters did not appear to change pain or function.

Conclusions

Intervention type, not participant-specific factors, predicted the need for additional boosters. Attending additional boosters did not appear to change pain or function in the current sample.