A feasibility implementation trial for the English version of GLA:D® Back

  • Author / Creator
    Lemieux, James. A
  • Background
    Low back pain is common, costly, and considered the number one disability in the world. As a result, evidence-based clinical guidelines for the treatment of low back pain (LBP) have been developed to steer clinicians towards educating patients about their back pain, its natural course, and providing advice to keep active and continue working. Guidelines also recommend first-line care of patient education and exercise therapy as an intervention for persistent LBP. Despite this evidence, clinicians routinely do not follow these recommendations resulting in ineffective and fragmented care. To address this problem, GLA:D® Back, a standardized 8-week group exercise and education care package, was originally developed in Denmark to assist clinicians in implementing evidence-based care into clinical practice.

    The overall objective of this thesis was to determine if group exercise programs were equally effective as non-pharmacological interventions for chronic LBP; and to determine if it was feasible to implement an English translated evidenced-based group education and exercise program, GLA:D® Back, into clinical practice.

    Specifically, this thesis had four objectives:1) to assess whether group exercise programs are as effective as individual non-pharmacological interventions for chronic LBP; 2) to evaluate the ability of clinicians to implement a translated English version of GLA:D® Back into clinical practice; 3) to assess clinician’s confidence, attitudes, and beliefs before and after implementation of GLA:D® Back; 4) to assess the success of GLA:D® back on patient pain and disability.

    To address the first objective, a systematic review involving four electronic databases were searched by two independent reviewers. Only randomized controlled trials that compared group-based exercise with other non-pharmacological interventions for chronic LBP were eligible. The study quality was assessed using the Cochrane Handbook for systematic reviews of Interventions by two independent reviewers.

    To address objectives 2-4, thirty-five clinicians from nineteen clinics in Alberta, Canada participated in the GLA:D Back feasibility study. Feasibility of program implementation, our primary objective, was evaluated in terms of percent adoption with a 50% adoption rate (clinics/clinicians) set as our success criterion. Our secondary objectives included collecting data pertaining to clinician confidence, attitudes, and behaviour of treating patients involved in the program in addition to collecting patient- data regarding pain and disability.


    The results of the systematic review found no significant differences between group exercise and other non-pharmacologic interventions in disability levels or pain scores at 3-months post-intervention in patients with chronic LBP. Furthermore, we were unable to find any evidence for or against the use of group-based exercise in the rehabilitation of people with chronic back pain at other time points and for other health measurement outcomes. Additionally, we found no clinically significant differences in disability scores, quality of life, or pain scores between the individual or group non-pharmacological interventions that included exercise.

    The results of our feasibility study at 4-months post course found that 79% of the clinics offered GLA:D® Back to their patients within the study period. Of the participating clinicians, GLA:D® Back was delivered by 71% of clinicians. In total, 78 patients were recruited to participate in the program and 88% of the participants attended the final assessment. Additionally, clinicians exhibited high levels of confidence on the PCS (MD: -1.5, p<0.001), and a combined biomedical PABS subscale (MD: 4, p=0.005) and behavioral PABS subscale orientation (MD: 2.5, p=0.023). Patients had observed minimal median improvements of -5 (p<0.001) on the ODI and moderate median improvement of 2 (p<0.001) for back pain and moderate improvement of 1 (p<0.001) for leg pain from baseline to 3-months post GLA:D Back.

    GLA:D® Back has been thoughtfully designed to assist clinicians in delivering well established evidence-based group exercise programs to people suffering from persistent recurrent LBP. The English translation of the Danish GLA:D® Back program was found feasible to implement into practice in both urban and rural settings throughout Alberta. Subsequently, GLA:D® Back represents a potential opportunity for stakeholders to shift away from “low-value” care to “high-value”, cost-effective, evidence-based care.

  • Subjects / Keywords
  • Graduation date
    Fall 2021
  • Type of Item
  • Degree
    Master of Science
  • DOI
  • License
    This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.