The Back 2 Activity Trial: education and advice versus education and advice plus a structured walking programme for chronic low back pain

Abstract

BackgroundCurrent evidence supports the use of exercise-based treatment for chronic low back pain that encourages the patient to assume an active role in their recovery. Walking has been shown it to be an acceptable type of exercise with a low risk of injury. However, it is not known whether structured physical activity programmes are any more effective than giving advice to remain active.Methods/DesignThe proposed study will test the feasibility of using a pedometer-driven walking programme, as an adjunct to a standard education and advice session in participants with chronic low back pain. Fifty adult participants will be recruited via a number of different sources. Baseline outcome measures including self reported function; objective physical activity levels; fear-avoidance beliefs and health-related quality of life will be recorded. Eligible participants will be randomly allocated under strict, double blind conditions to one of two treatments groups. Participants in group A will receive a single education and advice session with a physiotherapist based on the content of the 'Back Book'. Participants in group B will receive the same education and advice session. In addition, they will also receive a graded pedometer-driven walking programme prescribed by the physiotherapist. Follow up outcomes will be recorded by the same researcher, who will remain blinded to group allocation, at eight weeks and six months post randomisation. A qualitative exploration of participants' perception of walking will also be examined by use of focus groups at the end of the intervention. As a feasibility study, treatment effects will be represented by point estimates and confidence intervals. The assessment of participant satisfaction will be tabulated, as will adherence levels and any recorded difficulties or adverse events experienced by the participants or therapists. This information will be used to modify the planned interventions to be used in a larger randomised controlled trial.DiscussionThis paper describes the rationale and design of a study which will test the feasibility of using a structured, pedometer-driven walking programme in participants with chronic low back pain.Trial Registration[ISRCTN67030896]

Efeito de um programa cinesioterapêutico de grupo, aliado à escola de postura, na lombalgia crônica

“…Evidências científicas atuais indicam que programas de exercícios baseados em tratamento para lombalgia crônica por pelo menos 12 semanas encorajam o paciente a assumir um papel ativo na sua recuperação (14).…”

“…Portanto, apesar dos bons resultados encontrados nos estudos, considera-se que é um desafio incentivar as pessoas com dor lombar crônica a se tornarem fisicamente ativas porque esta é uma população que apresenta um comportamento de medo; as intervenções é que potencialmente promovem e incentivam, em longo prazo, mudanças de comportamento necessárias (14).…”

A systematic review of studies using pedometers as an intervention for musculoskeletal diseases

“…In addition, a number of studies describe a variety of pedometer-driven walking research protocols for adults with low back pain [42,43] designed to assess the effects on pain-related disability and functional interference.…”

Using Pedometer Step-Count Goals to Promote Physical Activity in Cardiac Rehabilitation: A Feasibility Study of a Controlled Trial

“…Intervention groups, based on a previous community-based study of rehabilitation for patients with back pain [13] were asked to wear the pedometer, record daily step-counts in a diary and meet a facilitator weekly to review their progress. At each meeting the facilitator checked diary records against pedometer memory values and helped individuals to set realistic step-count goals for the following week, encouraging a gradual 10% increase in average daily count, aiming for 10,000 steps/ day.…”