Pedometer-Based Internet-Mediated Intervention For Adults With Chronic Low Back Pain: Randomized Controlled Trial

Abstract

BackgroundChronic pain, especially back pain, is a prevalent condition that is associated with disability, poor health status, anxiety and depression, decreased quality of life, and increased health services use and costs. Current evidence suggests that exercise is an effective strategy for managing chronic pain. However, there are few clinical programs that use generally available tools and a relatively low-cost approach to help patients with chronic back pain initiate and maintain an exercise program.ObjectiveThe objective of the study was to determine whether a pedometer-based, Internet-mediated intervention can reduce chronic back pain-related disability.MethodsA parallel group randomized controlled trial was conducted with 1:1 allocation to the intervention or usual care group. 229 veterans with nonspecific chronic back pain were recruited from one Department of Veterans Affairs (VA) health care system. Participants randomized to the intervention received an uploading pedometer and had access to a website that provided automated walking goals, feedback, motivational messages, and social support through an e-community (n=111). Usual care participants (n=118) also received the uploading pedometer but did not receive the automated feedback or have access to the website. The primary outcome was measured using the Roland Morris Disability Questionnaire (RDQ) at 6 months (secondary) and 12 months (primary) with a difference in mean scores of at least 2 considered clinically meaningful. Both a complete case and all case analysis, using linear mixed effects models, were conducted to assess differences between study groups at both time points.ResultsBaseline mean RDQ scores were greater than 9 in both groups. Primary outcome data were provided by approximately 90% of intervention and usual care participants at both 6 and 12 months. At 6 months, average RDQ scores were 7.2 for intervention participants compared to 9.2 for usual care, an adjusted difference of 1.6 (95% CI 0.3-2.8, P=.02) for the complete case analysis and 1.2 (95% CI -0.09 to 2.5, P=.07) for the all case analysis. A post hoc analysis of patients with baseline RDQ scores ≥4 revealed even larger adjusted differences between groups at 6 months but at 12 months the differences were no longer statistically significant.ConclusionsIntervention participants, compared with those receiving usual care, reported a greater decrease in back pain-related disability in the 6 months following study enrollment. Between-group differences were especially prominent for patients reporting greater baseline levels of disability but did not persist over 12 months. Primarily, automated interventions may be an efficient way to assist patients with managing chronic back pain; additional support may be needed to ensure continuing improvements.Trial RegistrationClinicalTrials.gov NCT00694018; http://clinicaltrials.gov/ct2/show/NCT00694018 (Archived by WebCite at http://www.webcitation.org/6IsG4Y90E).

Internet-based interventions for pain management: A systematic review of randomised controlled trial (RCTs) conducted from 2010 to 2014

“…Table 1 shows the result of scoring. Most of the studies included in our review had scored 3 (Gerber, 2006;Lamb et al, 2010, Stinson et al, 2010Elander et al, 2011;Bromberg et al, 2012;Carpenter et al, 2012;Krein et al, 2013;Kroenke et al, 2012;Law et al, 2012;Martorella et al, 2012;Ruehlman et al, 2012) as blinding was not possible in most of the studies. Only two studies scored less on Jadad score (Miller et al, 2011;Shigaki et al, 2013) ( Table 2).…”

“…All these studies reported reduction in pain and improvement in both functional activity and psychological well being. A study by Sarah et al only reported on the reduction in pain in treatment arm when compared to the usual care control arm (Krein et al, 2013). Study by Nazzal et al reported 25 and 45% reduction in pain on different scales in treatment group and 49 and 25% reduction in disability.…”

An Evaluation of the Effectiveness of the Modalities Used to Deliver Electronic Health Interventions for Chronic Pain: Systematic Review With Network Meta-Analysis (Preprint)

“…While the majority of intervention arms were compared with control arms, one study involved the comparison of two active treatments [51]. The 30 studies encompassed 60 arms; 25 internet delivered arms [5,6,7,8 A total of 4,500 participants were included in the review. There were 2,575 randomised to interventions delivered via a technological modality; internet (n=2,260), telephone (n=124), video teleconferencing (n=65), virtual reality (n=53), mobile applications (n=47), and interactive voice response (n=26).…”

“…Typically, an eHealth modality is considered to be some specific form of technology that is applied in the context of healthcare [2,3,4]. Examples of eHealth modalities include, internet-based [5,6,7,8,9], telephone supported [10], interactive voice response [11,12], virtual reality [13,14], video teleconferencing [15] and mobile phone applications [16,17].…”

Opioid use and walking among patients with chronic low back pain

“…The design, rationale, and main results for the primary study are described in detail elsewhere [21][22]. Briefly, we recruited patients with back pain from one VA healthcare system.…”