Hurley Deirdre A, Tully Mark A, Lonsdale Chris, Boreham Colin A G, van Mechelen Willem, Daly Leslie, Tynan Aódan, McDonough Suzanne M
UCD School of Public Health, Physiotherapy & Population Science, University College Dublin, Dublin, Ireland Institute for Sport and Health, UCD School of Public Health, Physiotherapy & Population Science, University College Dublin, Dublin, Ireland UKCRC Centre of Excellence for Public Health, Institute of Clinical Science B, Royal Victoria Hospital, Queen's University Belfast, Belfast, Northern Ireland Faculty of Health Sciences, Institute for Positive Psychology and Education, Australian Catholic University, Strathfield, Australia Department of Public Health and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands European Access to Medicines Centre of Excellence, GlaxoSmithKline, Brentford, Middlesex, United Kingdom Health and Rehabilitation Sciences Research Institute, University of Ulster, Antrim, Northern Ireland.
Pain. 2015 Jan;156(1):131-147. 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.
鼓励慢性下腰痛（CLBP>12周）患者参与体育活动（PA）的简短/最少接触自我激活干预措施的有效性尚未得到证实。这项评估者盲法随机对照试验的主要目的是研究个性化步行计划（WP）、团体运动课程（EC）和常规物理治疗（UP，对照组）在6个月时功能障碍平均变化方面的差异。从爱尔兰都柏林的5个门诊物理治疗科室招募了246名年龄在18至65岁之间的CLBP患者（79名男性和167名女性；平均年龄±标准差：45.4±11.4岁）。同意参与的参与者完成了功能障碍、疼痛、生活质量、心理社会信念和PA的自我报告测量，然后被随机分配到WP组（n = 82）、EC组（n = 83）或UP组（n = 81），并在3个月（81%；n = 200）、6个月（80.1%；n = 197）和12个月（76.4%；n = 188）时进行随访。在所有随访中都完成了成本日记。使用混合组内重复测量协方差分析的意向性分析发现，随着时间的推移，在奥斯威斯残疾指数（主要结局）、数字评分量表、恐惧回避-PA量表和欧洲生活质量EQ-5D-3L加权健康指数上有显著改善（P < 0.05），但组间无显著差异，组间效应量较小（WP：6个月时平均差异，6.89个奥斯威斯残疾指数点，95%置信区间[CI] -3.64至-10.15；EC：-5.91，CI：-2.68至-9.15；UP：-5.09，CI：-1.93至-8.24）。WP的平均成本最低，依从性最高。监督下的步行是目前CLBP管理形式的一种有效替代方法。
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