A walking programme and a supervised exercise class versus usual physiotherapy for chronic low back pain: a single-blinded randomised controlled trial. (The Supervised Walking In comparison to Fitness Training for Back Pain (SWIFT) Trial)

Deirdre A Hurley,Leslie Daly,Jennifer Klaber Moffett,Grainne O'Donoghue,Mark A Tully,Colin Ag Boreham,Willem Van Mechelen,Suzanne M Mcdonough

doi:10.1186/1471-2474-10-79

Abstract

BackgroundChronic low back pain (CLBP) is a persistent disabling condition with rising significant healthcare, social and economic costs. Current research supports the use of exercise-based treatment approaches that encourage people with CLBP to assume a physically active role in their recovery. While international clinical guidelines and systematic reviews for CLBP support supervised group exercise as an attractive first-line option for treating large numbers of CLBP patients at low cost, barriers to their delivery include space and time restrictions in healthcare settings and poor patient attendance. The European Clinical Guidelines have identified the need for research in the use of brief/minimal contact self-activation interventions that encourage participation in physical activity for CLBP. Walking may be an ideally suited form of individualized exercise prescription as it is easy to do, requires no special skills or facilities, and is achievable by virtually all ages with little risk of injury, but its effectiveness for LBP is unproven.Methods and designThis study will be an assessor-blinded randomized controlled trial that will investigate the difference in clinical effectiveness and costs of an individualized walking programme and a supervised general exercise programme compared to usual physiotherapy, which will act as the control group, in people with chronic low back pain. A sample of 246 patients will be recruited in Dublin, Ireland through acute general hospital outpatient physiotherapy departments that provide treatment for people with CLBP. Patients will be randomly allocated to one of the three groups in a concealed manner. The main outcomes will be functional disability, pain, quality of life, fear avoidance, back beliefs, physical activity, satisfaction and costs, which will be evaluated at baseline, and 3, 6 and 12 months [follow-up by pre-paid postage]. Qualitative telephone interviews and focus groups will be embedded in the research design to obtain feedback about participants' experiences of the interventions and trial participation, and to inform interpretation of the quantitative data. Planned analysis will be by intention to treat (quantitative data) and thematic analysis (qualitative data)DiscussionThe trial will evaluate the effectiveness of a walking programme and a supervised general exercise programme compared to usual physiotherapy in people with CLBP.Trial registrationCurrent controlled trial ISRCTN17592092

Highlights

IntroductionChronic low back pain (CLBP) is a persistent disabling condition with rising significant healthcare, social and economic costs [1,2]
Chronic low back pain (CLBP) is a persistent disabling condition with rising significant healthcare, social and economic costs [1,2]. Current research and both European and American Clinical Guidelines supports the use of exercise-based treatment approaches that encourage people with chronic low back pain to assume a physically active role in their recovery [3,4,5,6]
Given that the majority of patients with CLBP currently receive a range of interventions within the scope of 'usual' physiotherapy

Summary

Introduction

Chronic low back pain (CLBP) is a persistent disabling condition with rising significant healthcare, social and economic costs [1,2] Current research and both European and American Clinical Guidelines supports the use of exercise-based treatment approaches that encourage people with chronic low back pain (pain >3 months) to assume a physically active role in their recovery [3,4,5,6]. These patients often report decreased habitual physical activity levels, believing that if movement hurts they may be re-injuring themselves, termed 'fear avoidance'[7,8]. A national survey by the Principal Investigator of public general hospitals in the Republic of Ireland (ROI), found that only 39% of responding physiotherapy departments were delivering group-based exercise programmes for CLBP, the main barriers being space and time restrictions, and insufficient staffing levels [12]

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