A randomised controlled trial of a lifestyle behavioural intervention for patients with low back pain, who are overweight or obese: study protocol

Williams, Amanda; Wiggers, John; O’Brien, Kate; Wolfenden, Luke; Yoong, Serene; Campbell, Elizabeth; Robson, Emma; McAuley, James H.; Haskins, Robin; Kamper, Steven J.; Williams, Christopher M.

doi:10.1186/s12891-016-0922-1

Cited by 19 publications

(34 citation statements)

References 36 publications

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“…No further studies were found by checking reference lists. Twenty quantitative publications and two qualitative publications were excluded at this stage. Excluded publications are listed with reasons for exclusion (SI4).…”

Section: Resultsmentioning

confidence: 99%

Weight loss interventions for adults with overweight/obesity and chronic musculoskeletal pain: a mixed methods systematic review

et al. 2018

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Worldwide prevalence of adult overweight and obesity is a growing public health issue. Adults with overweight/obesity often have chronic musculoskeletal pain. Using a mixed-methods review, we aimed to quantify the effectiveness and explore the appropriateness of weight loss interventions for this population. Electronic databases were searched for studies published between 01/01/90 and 01/07/16. The review included 14 randomized controlled trials that reported weight and pain outcomes and three qualitative studies that explored perceptions of adults with co-existing overweight/obesity and chronic musculoskeletal pain. The random-effects pooled mean weight loss was 4.9 kg (95%CI:2.9,6.8) greater for intervention vs control. The pooled mean reduction in pain was 7.3/100 units (95%CI:4.1,10.5) greater for intervention vs control. Study heterogeneity was substantial for weight loss (I = 95%, tau = ±3.5 kg) and pain change (I = 67%, tau = ±4.1%). Meta-regression slopes for the predictors of study quality, mean age and baseline mean weight on mean study weight reduction were shallow and not statistically significant (P > 0.05). The meta-regression slope between mean pain reduction and mean weight lost was shallow, and not statistically significant, -0.09 kg per unit pain score change (95%CI:-0.21,0.40, P = 0.54). Meta-synthesis of qualitative findings resulted in two synthesized findings; the importance of healthcare professionals understanding the effects of pain on ability to control weight and developing management/education programmes that address comorbidity.

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Section: Resultsmentioning

confidence: 99%

Weight loss interventions for adults with overweight/obesity and chronic musculoskeletal pain: a mixed methods systematic review

et al. 2018

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“…Regarding socioeconomic impact, overweight and obesity are related not only to chronic pain persistence but also to higher rates of healthcare seeking for pain . Obviously, people with chronic pain who are overweight or obese, are likely to have more complex health needs requiring focus on lifestyle behavioral factors …”

Section: Diet and Related Overweight In People With Chronic Painmentioning

confidence: 99%

“…Taken together, poor diet, overweight, and obesity are increasingly recognized as a plausible therapeutic target for people with chronic pain . Yet few treatment programs take diet or weight status into account, and treatment can be complicated .…”

Section: Diet and Related Overweight In People With Chronic Painmentioning

confidence: 99%

Lifestyle and Chronic Pain across the Lifespan: An Inconvenient Truth?

Nijs

D’Hondt

Clarys

et al. 2019

PM&R

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Chronic pain has a tremendous personal and socioeconomic impact and remains difficult to treat. Therefore, it is important to provide an update on the current understanding regarding lifestyle factors in people with chronic pain across the lifespan. Lifestyle factors such as physical (in)activity, sedentary behavior, stress, poor sleep, unhealthy diet, and smoking are associated with chronic pain severity and sustainment. This applies to all age categories, that is, chronic pain across the lifespan. Yet current treatment options often do not or only partly address the many lifestyle factors associated with chronic pain or attempt to address them in a standard format rather than providing an individually tailored multimodal lifestyle intervention. The evidence regarding lifestyle factors is available in adults, but limited in children and older adults having chronic pain, providing important avenues for future research. In conclusion, it is proposed that treatment approaches for people with chronic pain should address all relevant lifestyle factors concomitantly in an individually‐tailored multimodal intervention. Ultimately, this should lead to improved outcomes and decrease the psychological and socioeconomic burden of chronic pain. Level of Evidence: IV.

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“…We performed an economic evaluation alongside a two-arm pragmatic parallel group RCT, which was part of a cohort multiple RCT (Relton, Torgerson, O'Cathain, & Nicholl, 2010). The study design is described in detail elsewhere (Williams et al, 2016(Williams et al, , 2018. The trial was prospectively registered with the Australian New Zealand Clinical Trials Registry (ACTRN12615000478516).…”

Section: Designmentioning

confidence: 99%

Economic evaluation of a healthy lifestyle intervention for chronic low back pain: A randomized controlled trial

Williams

Dongen

Kamper

et al. 2018

European Journal of Pain

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Background Economic evaluations which estimate cost‐effectiveness of potential treatments can guide decisions about real‐world healthcare services. We performed an economic evaluation of a healthy lifestyle intervention targeting weight loss, physical activity and diet for patients with chronic low back pain, who are overweight or obese. Methods Eligible patients with chronic low back pain (n = 160) were randomized to an intervention or usual care control group. The intervention included brief advice, a clinical consultation and referral to a 6‐month telephone‐based healthy lifestyle coaching service. The primary outcome was quality‐adjusted life years (QALYs). Secondary outcomes were pain intensity, disability, weight and body mass index. Costs included intervention costs, healthcare utilization costs and work absenteeism costs. An economic analysis was performed from the societal perspective. Results Mean total costs were lower in the intervention group than the control group (‐$614; 95%CI: −3133 to 255). The intervention group had significantly lower healthcare costs (‐$292; 95%CI: −872 to −33), medication costs (−$30; 95%CI: −65 to −4) and absenteeism costs (‐$1,000; 95%CI: −3573 to −210). For all outcomes, the intervention was on average less expensive and more effective than usual care, and the probability of the intervention being cost‐effective compared to usual care was relatively high (i.e., 0.81) at a willingness‐to‐pay of $0/unit of effect. However, the probability of cost‐effectiveness was not as favourable among sensitivity analyses. Conclusions The healthy lifestyle intervention seems to be cost‐effective from the societal perspective. However, variability in the sensitivity analyses indicates caution is needed when interpreting these findings. Significance This is an economic evaluation of a randomized controlled trial of a healthy lifestyle intervention for chronic low back pain. The findings suggest that a healthy lifestyle intervention may be cost‐effective relative to usual care.

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A randomised controlled trial of a lifestyle behavioural intervention for patients with low back pain, who are overweight or obese: study protocol

Cited by 19 publications

References 36 publications

Weight loss interventions for adults with overweight/obesity and chronic musculoskeletal pain: a mixed methods systematic review

Weight loss interventions for adults with overweight/obesity and chronic musculoskeletal pain: a mixed methods systematic review

Lifestyle and Chronic Pain across the Lifespan: An Inconvenient Truth?

Economic evaluation of a healthy lifestyle intervention for chronic low back pain: A randomized controlled trial

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