Supervised walking in comparison with fitness training for chronic back pain in physiotherapy: results of the SWIFT single-blinded randomized controlled trial (ISRCTN17592092)

• Published in: Pain (Amsterdam) Vol. 156; no. 1; pp. 131 - 147
• Main Authors: Hurley, Deirdre A, Tully, Mark A, Lonsdale, Chris, Boreham, Colin A G, van Mechelen, Willem, Daly, Leslie, Tynan, Aódan, McDonough, Suzanne M
• Format: Journal Article
• Language: English
• Published: United States 01.01.2015
• Subjects: Adult; Back Pain - diagnosis; Back Pain - therapy; Chronic Pain - diagnosis; Chronic Pain - therapy; Exercise Movement Techniques - methods; Exercise Movement Techniques - standards; Exercise Therapy - methods; Exercise Therapy - standards; Female; Follow-Up Studies; Humans; Male; Middle Aged; Pain Measurement - methods; Physical Therapy Modalities - standards; Prospective Studies; Single-Blind Method; Treatment Outcome; Walking - standards
• ISSN: 0304-3959; 1872-6623
• DOI: 10.1016/j.pain.0000000000000013

Effectiveness of brief/minimal contact self-activation interventions that encourage participation in physical activity (PA) for chronic low back pain (CLBP >12 weeks) is unproven. The primary objective of this assessor-blinded randomized controlled trial was to investigate the difference between an individualized walking programme (WP), group exercise class (EC), and usual physiotherapy (UP, control) in mean change in functional disability at 6 months. A sample of 246 participants with CLBP aged 18 to 65 years (79 men and 167 women; mean age ± SD: 45.4 ± 11.4 years) were recruited from 5 outpatient physiotherapy departments in Dublin, Ireland. Consenting participants completed self-report measures of functional disability, pain, quality of life, psychosocial beliefs, and PA were randomly allocated to the WP (n = 82), EC (n = 83), or UP (n = 81) and followed up at 3 (81%; n = 200), 6 (80.1%; n = 197), and 12 months (76.4%; n = 188). Cost diaries were completed at all follow-ups. An intention-to-treat analysis using a mixed between-within repeated-measures analysis of covariance found significant improvements over time on the Oswestry Disability Index (Primary Outcome), the Numerical Rating Scale, Fear Avoidance-PA scale, and the EuroQol EQ-5D-3L Weighted Health Index (P < 0.05), but no significant between-group differences and small between-group effect sizes (WP: mean difference at 6 months, 6.89 Oswestry Disability Index points, 95% confidence interval [CI] -3.64 to -10.15; EC: -5.91, CI: -2.68 to -9.15; UP: -5.09, CI: -1.93 to -8.24). The WP had the lowest mean costs and the highest level of adherence. Supervised walking provides an effective alternative to current forms of CLBP management.