A randomized controlled trial investigating effects of an individualized pedometer driven walking program on chronic low back pain

Abstract

Background Walking is an easily prescribed physical activity for people with low back pain (LBP). However, the evidence for its effectiveness to improve pain and disability levels for people with chronic low back pain (CLBP) within a community setting has not been evaluated. This study evaluates the effectiveness of a clinician guided, pedometer-driven, walking intervention for increasing physical activity and improving clinical outcomes compared to education and advice. Methods Randomized controlled trial recruiting N = 174 adults with CLBP. Participants were randomly allocated into either a standardized care group (SG) or pedometer based walking group (WG) using minimization allocation with a 2:1 ratio to the WG. Prior to randomization all participants were given a standard package of education and advice regarding self-management and the benefits of staying active. Following randomization the WG undertook a physiotherapist guided pedometer-driven walking program for 12 weeks. This was individually tailored by weekly negotiation of daily step targets. Main outcome was the Oswestry Disability Index (ODI) recorded at baseline, 12 weeks, 6 and 12 months. Other outcomes included, numeric pain rating, International Physical Activity Questionnaire (IPAQ), Fear-Avoidance Beliefs Questionnaire (FABQ), Back Beliefs questionnaire (BBQ), Physical Activity Self-efficacy Scale, and EQ-5D-5L quality of life estimate. Results N = 138 (79%) participants completed all outcome measures at 12 weeks reducing to N = 96 (55%) at 12 months. Both observed and intention to treat analysis did not show any statistically significant difference in ODI change score between the WG and the SG at all post-intervention time points. There were also no significant between group differences for change scores in all secondary outcome measures. Post hoc sensitivity analyses revealed moderately disabled participants (baseline ODI ≥ 21.0) demonstrated a greater reduction in mean ODI scores at 12 months in the WG compared to SG, while WG participants with a daily baseline step count < 7500 steps demonstrated a greater reduction in mean ODI scores at 12 weeks. Conclusions Overall, we found no significant difference in change of levels of (ODI) disability between the SG and WG following the walking intervention. However, ODI responses to a walking program for those with moderate levels of baseline disability and those with low baseline step count offer a potential future focus for continued research into the benefit of walking as a management strategy for chronic LBP. Trial registration United States National Institutes of Health Clinical Trails registry (http://ClinicalTrials.gov/) No. NCT02284958 (27/10/2014).

The Influence of Wearables on Health Care Outcomes in Chronic Disease: Systematic Review

“…Chronic lower back pain was studied in 10% (3/30) of publications, with a total of 430 adult participants. Both Amorim et al [ 42 ] and Lang et al [ 33 ] used commercially available wearables to observe their effects on care-seeking episodes [ 42 ] and perceived disability [ 33 ], respectively, when compared with usual care. They found no influence on the studied primary outcome.…”

Assessing Walking Programs in Fibromyalgia: A Concordance Study between Measures

“…Firstly, we included pedometers in this study as an objective measure of study, and they were used in a sub-sample. Even though the limitations of the first pedometers have been resolved by technological advances in recent years, this was done because pedometers are a notably efficient tool to achieve an increase in PA [ 36 , 37 , 38 , 39 , 77 ]. Furthermore, the size of the sub-sample was large enough to reach the goal of comparing it with the logbooks.…”

“…According to objective measures, assessment and interpretation of the number of steps taken per day (steps/day), measured by pedometers and accelerometers, have gained increasing acceptance by FM researchers [ 32 ] and have been recommended in international health guidelines for the FM population [ 33 , 34 , 35 , 36 ]. Moreover, pedometers have been included in many randomized controlled trials to analyze the effects of walking interventions in patients with chronic pain [ 19 , 37 , 38 , 39 ]. These electronic devices are becoming useful tools for recording and motivating behaviors related to PA [ 40 ], especially in interventions aimed at increasing PA, focusing on walking behavior [ 31 , 40 , 41 , 42 ].…”

“…Due to this, the assessment of walking in FM patients should not be limited solely to self-reports, and researchers must be mindful of clearly defining operationally how objective measures are assessing PA [ 46 ]. In this regard, researchers have pointed out that pedometers and accelerometers need to be included in multicomponent interventions as main measures related to walking because they provide an accurate and “objective” measure of number of steps [ 47 ] and provide feedback that becomes an important motivational tool to increase walking behavior [ 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 ]. However, these devices are mechanical and do not automatically rule out psychosocial factors that may affect the final performance [ 46 ].…”

Smartphone-Based Unconstrained Step Detection Fusing a Variable Sliding Window and an Adaptive Threshold

“…In addition, smartphones bring many conveniences to people's lives with their rich functions and applications. Among these functions, step detection plays a role in health care for obese patients, has become a physical therapy to control chronic low back pain [8], monitor the Remote Sens. 2022, 14, 2926 2 of 17 fall of the elderly [9], and can also be applied to daily fitness training [10].…”