Walking away from back pain: one step at a time – a community-based randomised controlled trial

BMC Public Health, Feb 2015

Background Low back pain is highly prevalent and a significant public health burden in Western society. Feasibility studies suggest personalised pedometer-driven walking is an acceptable and effective motivating tool in the management of chronic low back pain (CLBP ≥ 12 weeks). The proposed study will investigate pedometer-driven walking as a low cost, easily accessible, and sustainable means of physical activity to improve disability and clinical outcomes for people with CLBP in Saskatchewan, Canada. Methods/design A fully-powered single-blinded randomised controlled trial will compare back care advice and education with back care advice and education followed by a 12-week pedometer-driven walking programme in adults with CLBP. Adults with self-reported CLBP will be recruited from the community and screened for elibility. Two-hundred participants will be randomly allocated to one of two intervention groups. All participants will receive a single back care advice and education session with a physiotherapist. Participants in the walking group will also receive a physiotherapist-facilitated pedometer based walking programme. The physiotherapist will facilitate the participant to monitor and progress the walking programme, by phone, on a weekly basis over 10 weeks following two face-to-face sessions. Outcome measures of self-reported disability, physical activity, participants’ low back pain beliefs/perceptions, quality of life and direct/indirect cost estimates will be gathered at baseline, three months, six months, and 12 months by a different physiotherapist blinded to group allocation. Following intervention, focus groups will be used to explore participants’ thoughts and experiences of pedometer-driven walking as a management tool for CLBP. Discussion This paper describes the design of a community-based RCT to determine the effectiveness of a pedometer-driven walking programme in the management of CLBP. Trial registration United States National Institutes of Health Clinical Trails registry (http://ClinicalTrails.gov/) No. NCT02284958. Registered on 27th October 2014).

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Walking away from back pain: one step at a time – a community-based randomised controlled trial

Milosavljevic et al. BMC Public Health Walking away from back pain: one step at a time - a community-based randomised controlled trial Stephan Milosavljevic 0 Lynne Clay 0 Brenna Bath 0 Catherine Trask 2 Erika Penz 1 Sam Stewart 2 Paul Hendrick 6 G David Baxter 5 Deirdre A Hurley 4 Suzanne M McDonough 3 0 University of Saskatchewan, School of Physical Therapy , 1121 College Drive, Saskatoon, SK S7N 0W3 , Canada 1 Respirology, Critical Care and Sleep Medicine, Department of Medicine, University of Saskatchewan and Saskatoon Health Region, Royal University Hospital , 103 Hospital Drive, Saskatoon, SK S7N 0W8 , Canada 2 University of Saskatchewan, Canadian Centre for Health and Safety in Agriculture , 104 Clinic Place, PO Box 23, Saskatoon, SK S7N 2Z4 , Canada 3 School of Health Sciences, Institute of Nursing and Health Research, University of Ulster , Shore Road, Belfast BT37 0QB , UK 4 School of Public Health, Physiotherapy and Population Science, UCD Health Sciences Centre, University College Dublin , Belfield, Dublin 4 , Ireland 5 Centre for Health, Activity, and Rehabilitation Research, University of Otago , PO Box 56, Dunedin 9054 , New Zealand 6 Division of Physiotherapy and Rehabilitation Sciences, School of Health Sciences, The University of Nottingham , B90 , Clinical Sciences Building, City Hospital Campus , Nottingham NG5 1PB , UK Background: Low back pain is highly prevalent and a significant public health burden in Western society. Feasibility studies suggest personalised pedometer-driven walking is an acceptable and effective motivating tool in the management of chronic low back pain (CLBP 12 weeks). The proposed study will investigate pedometer-driven walking as a low cost, easily accessible, and sustainable means of physical activity to improve disability and clinical outcomes for people with CLBP in Saskatchewan, Canada. Methods/design: A fully-powered single-blinded randomised controlled trial will compare back care advice and education with back care advice and education followed by a 12-week pedometer-driven walking programme in adults with CLBP. Adults with self-reported CLBP will be recruited from the community and screened for elibility. Two-hundred participants will be randomly allocated to one of two intervention groups. All participants will receive a single back care advice and education session with a physiotherapist. Participants in the walking group will also receive a physiotherapist-facilitated pedometer based walking programme. The physiotherapist will facilitate the participant to monitor and progress the walking programme, by phone, on a weekly basis over 10 weeks following two face-to-face sessions. Outcome measures of self-reported disability, physical activity, participants' low back pain beliefs/perceptions, quality of life and direct/indirect cost estimates will be gathered at baseline, three months, six months, and 12 months by a different physiotherapist blinded to group allocation. Following intervention, focus groups will be used to explore participants' thoughts and experiences of pedometer-driven walking as a management tool for CLBP. Discussion: This paper describes the design of a community-based RCT to determine the effectiveness of a pedometer-driven walking programme in the management of CLBP. Trial registration: United States National Institutes of Health Clinical Trails registry (http://ClinicalTrails.gov/) No. NCT02284958. Registered on 27th October 2014). Chronic low back pain; Physical activity; Pedometer-driven walking - Background Chronic low back pain (CLBP) back pain present for greater than three months [1] is a prevalent, disabling, and costly musculoskeletal disorder in need of effective, efficient, and accessible interventions [2]. Low back pain (LBP) is a substantial public health burden in western society [3]. In Canada, the cost of medical expenditure for low back pain is estimated at up to $12 billion annually with additional costs linked to loss in worker productivity, lost work time, and associated disability payments [4,5]. Although research describes an episode of acute LBP as predominantly self-limiting [6], it is also known to be the most significant predictor of CLBP [7,8]. Four out of five Canadians will experience at least one episode of LBP at some point in their life and one in five adult Canadians will report the presence of CLBP at any given time [9]. CLBP is also significantly associated with a range of psychological and physical comorbidities and lower socioeconomic status [10]. Being overweight or obese increases the risk of LBP, and has the strongest association with seeking care for CLBP [11]. In contrast, reduction in weight improves outcomes for patients with musculoskeletal disorders [12]. Although the relationship between weight and physical activity is mediated by a variety of factors, the modern Canadian lifestyle is more sedentary with many people working in seated positions and a greater use of vehicles for (...truncated)


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Stephan Milosavljevic, Lynne Clay, Brenna Bath, Catherine Trask, Erika Penz, Sam Stewart, Paul Hendrick, G Baxter, Deirdre A Hurley, Suzanne M McDonough. Walking away from back pain: one step at a time – a community-based randomised controlled trial, BMC Public Health, 2015, pp. 144, 15, DOI: 10.1186/s12889-015-1496-9