The standardised effect size of the intervention on this outcome (g = 0.7) was moderate to large. At 12 weeks the coaching group had significantly higher recovery expectation (mean difference of 3.4 points, 95% CI 1.1 to 5.7) than the usual care group, and the standardised effect size for this outcome was large (g = 1.2). There was no significant difference between groups on the Pain Self Efficacy Questionnaire with

a medium standardised effect size (g = 0.6) in favour of the coaching group. Telephone coaching selleck kinase inhibitor added to usual physiotherapy care resulted in clinically significantly increased levels of self-reported activity and improved recovery expectation at 12 weeks in people with

non-chronic non-specific low back pain and low to moderate Natural Product Library recovery expectation. The intervention had a large effect on both patient-specific and region-specific measures of activity limitation. The mean difference on the Patient Specific Functional Scale was larger than the minimum clinically important difference (Maughan and Lewis, 2010) and the mean difference on the Oswestry, although not statistically significant, was 14.1 – larger than the minimum clinically important difference of 10 points (Ostelo and de Vet, 2005). Participants in this study were at risk of developing chronic activity limitation and effective interventions in this population are particularly important, as the majority of resources devoted to non-specific low back pain are consumed by the small proportion of people experiencing ongoing disability (Shaw et al 2001, Truchon and Fillion, no 2000). For the addition of an average of less than 90 minutes of therapy time, health coaching via the telephone may represent a cost-effective addition to usual physiotherapy care. For every 3 people who received the coaching intervention,

1 more successful return to primary non-leisure activity was achieved than would have been with usual care alone. Furthermore, the indication that the intervention may be able to change expectations regarding return to usual activities may be important, since low recovery expectations have been found to be a strong predictor of poor outcome in non-specific low back pain (Iles et al 2008). The mechanism behind the impact of coaching on return to activity is likely to be a result of the increased emphasis on self management and empowerment of the participant. Increased self management is seen as a goal for those with chronic conditions, but this is traditionally not a focus of health care during the earlier stages of a condition (Lawn and Schoo, 2010). Coaching has been identified as a means to help patients take greater responsibility for the achievement and maintenance of treatment goals (Vale et al 2002) and this seems to be the case for return to activity.