Department of Orthopedic Surgery, Duke Clinical Research Institute, Duke University Medical Center, 2200 W. Main St, Durham, NC 27703 (USA).
Department of Behavioral, Social, and Population Health Sciences, University of South Carolina School of Medicine-Greenville, Greenville, South Carolina; and Department of Family Medicine, Greenville Health System, Greenville, South Carolina.
Phys Ther. 2018 May 1;98(5):369-380. doi: 10.1093/ptj/pzy026.
Chronic low back pain (CLBP) is highly prevalent in older adults, leading to functional decline.
The objective of this study was to evaluate physical activity (PA) only and PA plus cognitive-behavioral therapy for pain (CBT-P) among older adult veterans with CLBP.
This study was a pilot randomized trial comparing a 12-week telephone-supported PA-only intervention group (PA group) or PA plus CBT-P intervention group (PA + CBT-P group) and a wait-list control group (WL group).
The study setting was the Durham Veterans Affairs Health Care System.
The study participants were 60 older adults with CLBP.
The PA intervention included stretching, strengthening, and aerobic activities; CBT-P covered activity pacing, relaxation techniques, and cognitive restructuring.
Feasibility measures included enrollment and completion metrics; acceptability was measured by completed phone calls. Primary outcomes included the Timed "Up & Go" Test and the PROMIS Health Assessment Questionnaire. Generalized linear mixed models were used to estimate changes within and between groups. Effect sizes were calculated with the Cohen d. Adverse effects were measured by self-report.
The mean participant age was 70.3 years; 53% were not white, and 93% were men. Eighty-three percent of participants completed the study, and the mean number of completed phone calls was 10 (of 13). Compared with the results for the WL group, small to medium treatment effects were found for the intervention groups in the Timed "Up & Go" Test (PA group: -2.94 [95% CI = -6.24 to 0.35], effect size = -0.28; PA + CBT-P group: -3.26 [95% CI = -6.69 to 0.18], effect size = -0.31) and the PROMIS Health Assessment Questionnaire (PA group: -6.11 [95% CI = -12.85 to 0.64], effect size = -0.64; PA + CBT-P group: -4.10 [95% CI = -11.69 to 3.48], effect size = -0.43). Small treatment effects favored PA over PA + CBT-P. No adverse effects were noted.
This was a pilot study, and a larger study is needed to verify the results.
This pilot trial demonstrated that home-based telephone-supported PA interventions were feasible, acceptable, and safe for older adult veterans. The results provide support for a larger trial investigating these interventions.
慢性下腰痛（CLBP）在老年人中高发，导致功能下降。
本研究旨在评估针对 CLBP 老年退伍军人的仅身体活动（PA）和 PA 加认知行为疗法（CBT-P）。
这是一项比较为期 12 周电话支持的仅 PA 干预组（PA 组）或 PA 加 CBT-P 干预组（PA + CBT-P 组）和等待名单对照组（WL 组）的试点随机试验。
研究地点为达勒姆退伍军人事务医疗保健系统。
研究参与者为 60 名慢性下腰痛的老年人。
PA 干预包括伸展、强化和有氧运动；CBT-P 涵盖活动节奏、放松技术和认知重构。
可行性措施包括入组和完成指标；可接受性通过完成的电话呼叫来衡量。主要结果包括计时“起身和行走”测试和 PROMIS 健康评估问卷。使用广义线性混合模型估计组内和组间的变化。用 Cohen d 计算效应大小。不良反应通过自我报告进行测量。
参与者的平均年龄为 70.3 岁；53%不是白人，93%是男性。83%的参与者完成了研究，完成的电话通话次数平均为 10 次（共 13 次）。与 WL 组的结果相比，干预组在计时“起身和行走”测试（PA 组：-2.94 [95%CI=-6.24 至 0.35]，效应大小=-0.28；PA + CBT-P 组：-3.26 [95%CI=-6.69 至 0.18]，效应大小=-0.31）和 PROMIS 健康评估问卷（PA 组：-6.11 [95%CI=-12.85 至 0.64]，效应大小=-0.64；PA + CBT-P 组：-4.10 [95%CI=-11.69 至 3.48]，效应大小=-0.43）方面的治疗效果较小。较小的治疗效果倾向于 PA 而不是 PA + CBT-P。未观察到不良反应。
这是一项试点研究，需要更大的研究来验证结果。
本试点研究表明，针对老年退伍军人的基于家庭的电话支持 PA 干预措施是可行、可接受且安全的。结果为更大规模的试验提供了支持，以研究这些干预措施。
