Background Low back pain (LBP) and knee osteoarthritis (OA) are major contributors to disability worldwide. These conditions result in a significant burden at both individual and societal levels. Engagement in regular physical activity and exercise programs are known to improve physical function in both chronic LBP and knee OA populations. For people residing in rural areas, musculoskeletal conditions are often more frequent and disabling compared to urban populations, which could be the result of reduced access to appropriate health services and resources in rural settings. EHealth is an innovative solution to help provide equitable access to treatment for people with musculoskeletal pain living in rural settings. Methods/design We will conduct a randomised clinical trial investigating the effects of an eHealth intervention compared to usual care, for people with chronic non-specific LBP or knee OA in rural Australia. We will recruit 156 participants with non-specific chronic LBP or knee OA. Following the completion of baseline questionnaires, participants will be randomly allocated to either the eHealth intervention group, involving a tailored physical activity and progressive resistance exercise program remotely delivered by a physiotherapist (n = 78), or usual care (n = 78) involving referral to a range of care practices in the community. Outcomes will be measured at baseline, 3 and 6 months post-randomisation. The primary outcome will be physical function assessed by the Patient-Specific Functional Scale (PSFS). Secondary outcomes include pain intensity, physical activity levels, activity limitations, quality of life, pain coping. We will also collect process evaluation data such as recruitment rate, attendance and adherence, follow-up rate, participants’ opinions and any barriers encountered throughout the trial. Discussion The findings from this trial will establish the effectiveness of eHealth-delivered interventions that are known to be beneficial for people with LBP and knee OA when delivered in person. As a result, this trial will help to inform health care policy and clinical practice in Australia and beyond for those living in non-urban areas. Trial registration This study was prospectively registered on the Australian New Zealand Clinical Trials Registry (ACTRN12618001494224) registered 09.05.2018.
Are people in the bush really physically active? A systematic review and meta-analysis of physical activity and sedentary behaviour in rural Australians populations Background Physical inactivity is a major risk factor for non-communicable disease and premature mortality. People who live in rural settings are usually regarded as more physically active than those living in urban areas, however, direct comparisons between these populations are scarce. We aimed to summarise the prevalence of physical inactivity and sedentary behaviour in rural settings in Australia, compared to urban counterparts. MethodsWe searched six databases (AMED, Embase, Medline; CINAHL, SPORTDiscus; and RURAL) and identified 28 observational studies that investigated the levels of physical inactivity and/or sedentary behaviour in adults aged 18 years and over in rural Australia. Random effects meta-analysis was used to generate pooled prevalence estimates. ResultsPhysical inactivity was four percentage points (95% confidence interval (CI) = 0.4 to 8) higher in rural populations compared to urban populations. There was a one percentage point (95% CI = -3 to 5) prevalence difference of physical activity in the rural populations. Rural populations reported on average 7.8 hours of sedentary time per day (95% CI = 5 to 10) and the prevalence of high levels of sedentary behaviour (≥to 8 hours per day) was 7% (95% CI = -8 to -7) greater in urban areas compared to rural areas.Conclusions People living in rural areas are just as physically inactive as people who live in urban areas. Our findings challenge the popular views that rural lifestyles result in people engaging more frequently in physical activity. Public health campaigns promoting physical activity in rural settings are just as necessary as in urban settings. Electronic supplementary material:The online version of this article contains supplementary material.
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