Abstract
BackgroundLow back pain is one of the most prevalent musculoskeletal conditions and the highest contributor to disability in the world. It is characterized by frequent relapses leading to additional care-seeking. Engagement in leisure physical activity is associated with lower recurrences and better prognosis and potentially reduced care-seeking. Our aim was to investigate the feasibility and preliminary efficacy of a patient-centred physical activity intervention, supported by health coaching and mobile health, to reduce care-seeking, pain and disability in patients with chronic low back pain after treatment discharge.MethodsWe conducted a pilot randomised controlled trial with blinded outcome assessment. Sixty-eight participants were recruited from four public outpatient physiotherapy departments and the general community in Sydney. The intervention group received a physical activity information booklet, plus one face-to-face and 12 telephone-based health coaching sessions. The intervention was supported by an internet-based application and an activity tracker (Fitbit). Control group (standard care) received the physical activity information booklet and advice to stay active. Feasibility measures included recruitment rate, intervention compliance, data completeness, and participant satisfaction. Primary outcomes were care-seeking, pain levels and activity limitation. Outcomes were assessed at baseline, 6-month follow-up and weekly for 6 months.ResultsNinety potential participants were invited over 15 months, with 68 agreeing to take part (75%). Overall, 903 weekly questionnaires were answered by participants from a total of 1107 sent (89%). Participants were largely satisfied with the intervention (mean = 8.7 out of 10 on satisfaction scale). Intervention group participants had a 38% reduced rate of care-seeking (Incidence Rate Ratio (IRR): 0.62, 95% CI: 0.32 to 1.18, p = 0.14, using multilevel mixed-effects Poisson regression analysis) compared to standard care, although none of the estimates was statistically significant. No between groups differences were found for pain levels or activity limitation.ConclusionThe health coaching physical activity approach trialed here is feasible and well accepted by participants and may reduce care-seeking in patients with low back pain after treatment discharge, although further evaluation with an adequately powered trial is needed.Trial registrationAustralian and New Zealand Trial Registry ACTRN12615000189527. Registered prospectively on 26–02–2015.
Highlights
Low back pain is one of the most prevalent musculoskeletal conditions and the highest contributor to disability in the world
[12] For instance, a recent longitudinal study conducted in Denmark involving 1082 participants presenting with non-specific Low back pain (LBP) to general practitioners (GP) and chiropractors showed that over a 1-year follow-up period people still report having mild to moderate LBP, on an average of 3 days per week
[16] most people with chronic LBP tend to become more sedentary during their leisure time than those without chronic LBP. [17, 18] According to qualitative studies exploring the experiences, opinions, and treatment expectations of chronic LBP patients, [19, 20] patients recognise the value of advice and exercise, they usually mistrust the appropriateness of this approach given the fact that a precise diagnosis of their condition is rarely given, and symptoms often recur
Summary
Low back pain is one of the most prevalent musculoskeletal conditions and the highest contributor to disability in the world. Our aim was to investigate the feasibility and preliminary efficacy of a patient-centred physical activity intervention, supported by health coaching and mobile health, to reduce care-seeking, pain and disability in patients with chronic low back pain after treatment discharge. While there is evidence that conservative interventions, such as exercise and spinal manipulative therapy, improve short-term pain and disability in people with chronic LBP, [9, 10] patients typically exhibit a rapid decline in clinical outcomes after treatment discharge, [9, 11] and further care-seeking for LBP is common. We designed a pilot trial to test the feasibility and preliminary efficacy of a patient-centred physical activity intervention, supported by health coaching and m-Health technology to reduce care-seeking, pain and activity limitation in patients with chronic LBP after discharge from conservative treatment, compared to standard care. The secondary aim was to examine the effect of this intervention on physical activity adherence and goal attainment
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