OBJECTIVES: This project aimed to promote running as the best treatment for lower back pain (LBP) in an outpatient setting. INTRODUCTION: LBP is one of the most prevalent conditions worldwide. Sixty-two percent of all Germans experience episodes of non-specific back pain at least once a year, with one-fifth developing chronic conditions. Intervertebral disc (IVD) degeneration is a natural process, contributing to periods of acute LBP. However, the scientific literature and guidelines partially overlook the significance of water management in IVD. This implementation project sought to address this gap by educating patients about this process. Running and/or walking were chosen as general approaches for treatment rather than specific disease-related approaches. METHODS: This implementation project was conducted in an outpatient physiotherapy clinic in Brandenburg, Germany, utilizing the JBI Evidence Implementation Framework. An evidence-informed clinical audit and feedback strategy was used to measure compliance with ten audit criteria. Five physiotherapists and 20 patients took part in the audits. RESULTS: At baseline, only 20% of participating physiotherapists screened for yellow flags regarding psychological issues. However, after project implementation, this criterion scored 100% compliance. Some patients performed exercises independently, but confusion persisted regarding the choice of beneficial exercises. Patients continued running, but those who took a break due to pain expressed uncertainty about resuming. CONCLUSIONS: The project highlighted the effectiveness of collaborative efforts between patients and therapists to address the issue. The project team's conviction in action and solution strategies serves as the foundation for this collaboration. This implementation strategy provided "running" patients with the confidence to either resume or reintegrate running after an extended break. SPANISH ABSTRACT: http://links.lww.com/IJEBH/A222.

Center of Evidence based Education and Arts Therapies A JBI Affiliated Group Faculty of Education Palacký University Olomouc Czech Republic

Center of Orthopaedics and Traumatology University Hospital Brandenburg Havel Brandenburg Medical School Theodor Fontane Brandenburg a d H Germany

Chair of Epidemiology and Preventive Medicine Department of Hygiene and Dietetics Jagiellonian University Medical College Kraków Poland

Cochrane Czech Republic Czech Republic A JBI Centre of Excellence Czech GRADE Network Institute of Health Information and Statistics of the Czech Republic Prague Czech Republic

Department of Prosthodontics Study of Dental Medicine University of Split School of Medicine Split Croatia

Ergonomics and Biomedical Monitoring Laboratory Department of Physiotherapy Faculty of Health Sciences Wrocław Medical University Wrocław Poland

Evidence Based Practice in Brandenburg A JBI Affiliated Group Brandenburg Medical School Theodor Fontane Brandenburg a d H Germany

Faculty of Health Sciences Brandenburg Brandenburg Medical School Theodor Fontane Brandenburg a d H Germany

Institute of Biostatistics and Analyses Faculty of Medicine Masaryk University Brno Czech Republic

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Maselli F, Storari L, Barbari V, Colombi A, Turolla A, Gianola S, et al. Prevalence and incidence of lower back pain among runners: a systematic review. BMC Musculoskelet Disord 2020; 21 (1):343.

Von Der Lippe E, Krause L, Prost M, Wengler A, Leddin J, Müller A, et al . Prävalenz von Rücken- und Nackenschmerzen in Deutschland. Ergebnisse der Krankheitslast-Studie BURDEN 2020. 2021 [cited 2021 Apr 18]. Available from: https://edoc.rki.de/handle/176904/7893

Pergolizzi JV, LeQuang JA. Rehabilitation for lower back pain: a narrative review for managing pain and improving function in acute and chronic conditions. Pain Ther 2020; 9 (1):83–96.

Baumgartner L, Wuertz-Kozak K, Le Maitre CL, Wignall F, Richardson SM, Hoyland J, et al. Multiscale regulation of the intervertebral disc: achievements in experimental, in silico, and regenerative research. IJMS 2021; 22 (2):703.

Antoniou J, Steffen T, Nelson F, Winterbottom N, Hollander AP, Poole RA, et al. The human lumbar intervertebral disc: evidence for changes in the biosynthesis and denaturation of the extracellular matrix with growth, maturation, ageing, and degeneration. J Clin Invest 1996; 98 (4):996–1003.

Risbud MV, Shapiro IM. Role of cytokines in intervertebral disc degeneration: pain and disc content. Nat Rev Rheumatol 2014; 10 (1):44–56.

Casazza BA. Diagnosis and treatment of acute lower back pain. Am Fam Physician 2012; 85:8.

Slade S. JBI evidence summary. Lower back pain: initial management. The JBI EBP Database. 2020;3.

Will JS, Bury DC, Miller JA. Mechanical lower back pain. Am Fam Physician 2018; 98 (7):421–428.

Pamaiahgari P. JBI evidence summary. Back pain (acute low) and sciatica: bed rest vs keeping active. The JBI EBP Database. 2019;2.

Pamaiahgari P. Evidence summary. Non-specific chronic lower back pain: exercise. The JBI EBP Database. 2020;4.

Sitthipornvorakul E, Klinsophon T, Sihawong R, Janwantanakul P. The effects of walking intervention in patients with chronic lower back pain: a meta-analysis of randomized controlled trials. Musculoskelet Sci Pract 2018; 34:38–46.

Vanti C, Andreatta S, Borghi S, Guccione AA, Pillastrini P, Bertozzi L. The effectiveness of walking versus exercise on pain and function in chronic lower back pain: a systematic review and meta-analysis of randomized trials. Disabil Rehabil 2019; 41 (6):622–632.

Belavý DL, Quittner MJ, Ridgers N, Ling Y, Connell D, Rantalainen T. Running exercise strengthens the intervertebral disc. Sci Rep 2017; 7 (1):45975.

Porritt K, McArthur A, Lockwood C, Munn Z. JBI's approach to evidence implementation: a 7-phase process model to support and guide getting evidence into practice. JBI Evid Implement 2023; 21 (1):3–13.

Verhagen AP, Downie A, Popal N, Maher C, Koes BW. Red flags presented in current lower back pain guidelines: a review. Eur Spine J 2016; 25 (9):2788–2802.

Vong SK, Cheing GL, Chan F, So EM, Chan CC. Motivational enhancement therapy in addition to physical therapy improves motivational factors and treatment outcomes in people with lower back pain: a randomized controlled trial. Archiv Phys Med Rehabil 2011; 92 (2):176–183.

van den Heuvel C, van der Horst J, Winkelhorst E, Roelofsen E, Hutting N. Experiences, barriers and needs of physiotherapists with regard to providing self-management support to people with lower back pain: a qualitative study. Musculoskelet Sci Pract 2021; 56:102462.

Belavy DL, Tagliaferri SD, Buntine P, Saueressig T, Ehrenbrusthoff K, Chen X, et al. Interventions for promoting evidence-based guideline-consistent surgery in lower back pain: a systematic review and meta-analysis of randomised controlled trials. Eur Spine J 2022; 31 (11):2851–2865.

Prill R, Karlsson J, Ayeni OR, Becker R. Author guidelines for conducting systematic reviews and meta-analyses. Knee Surg Sports Traumatol Arthrosc 2021; 29 (9):2739–2744.

Prill R, Mouton C, Klugorová J, Królikowska A, Karlsson J, Becker R. Implementation of evidence-based medicine in everyday clinical practice. Knee Surg Sports Traumatol Arthrosc 2023; 31 (8):3034–3036.