College of Medicine, University of Saskatchewan, Saskatoon, Canada.
School of Health Sciences, University of Nottingham, Nottingham, UK.
BMC Musculoskelet Disord. 2021 Feb 19;22(1):206. doi: 10.1186/s12891-021-04060-8.
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.
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.
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.
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.
United States National Institutes of Health Clinical Trails registry (http://ClinicalTrials.gov/) No. NCT02284958 (27/10/2014).
行走是一种对腰痛（LBP）患者易于开具的身体活动。然而，在社区环境中，针对慢性腰痛（CLBP）患者，其提高疼痛和残疾水平的有效性证据尚未得到评估。本研究评估了临床医生指导、计步器驱动的行走干预对增加身体活动和改善临床结果的有效性，与教育和建议相比。
这是一项招募了 174 名 CLBP 成年人的随机对照试验。参与者采用最小化分配，按照 2:1 的比例随机分配到标准化护理组（SG）或计步器步行组（WG）。在随机分组之前，所有参与者都接受了有关自我管理和保持活动的益处的标准教育和建议包。随机分组后，WG 接受了 12 周的物理治疗师指导的计步器驱动的行走计划。这是通过每周协商每日目标步数来个性化定制的。主要结果是在基线、12 周、6 个月和 12 个月时记录的 Oswestry 残疾指数（ODI）。其他结果包括数字疼痛评分、国际体力活动问卷（IPAQ）、恐惧回避信念问卷（FABQ）、背部信念问卷（BBQ）、身体活动自我效能量表和 EQ-5D-5L 生活质量估计。
在 12 周时，有 N=138（79%）名参与者完成了所有结局测量，在 12 个月时减少到 N=96（55%）名参与者。观察和意向治疗分析均显示，在所有干预后时间点，WG 和 SG 之间的 ODI 变化评分均无统计学意义上的差异。在所有次要结局测量的变化评分中也没有显著的组间差异。事后敏感性分析显示，基线 ODI≥21.0 的中度残疾参与者在 WG 中，12 个月时 ODI 评分的平均降低幅度大于 SG，而 WG 中基线每日步数<7500 步的参与者在 12 周时 ODI 评分的平均降低幅度更大。
总体而言，我们发现步行干预后，SG 和 WG 之间（ODI）残疾水平的变化没有显著差异。然而，对于基线残疾程度中等和基线步数较低的人，步行计划对 ODI 的反应为慢性 LBP 管理策略中行走的益处提供了未来进一步研究的潜在重点。
美国国立卫生研究院临床试验注册处（http://ClinicalTrials.gov/）号 NCT02284958（2014 年 10 月 27 日）。
