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Walking program effective for chronic low back pain

Walking program effective for chronic low back pain



Clinical Question

For adults with chronic low back pain, is a prescribed walking program as effective as physical therapy?

Bottom Line

Giving patients a pedometer, a walking diary, and instructions to walk at least 4 days per week then gradually increase the walk’s duration and intensity (see synopsis) results in improvement in pain and disability similar to usual physical therapy or a group exercise program. Patient satisfaction and days lost from work are similar, and patients are more likely to continue treatment for at least 1 year. In our office, many clinicians wear a pedometer and we have a box of inexpensive ($1) ones available to give to patients with low back pain and other problems that would benefit from some get-up-and-go. (LOE = 1b)

Reference

Hurley DA, Tully MA, Lonsdale C, et al. Supervised walking in comparison with fitness training for chronic back pain in physiotherapy: results of the SWIFT single-blinded randomized controlled trial (ISRCTN17592092).Pain 2015;156(1):131-147.




Study Design

Randomized controlled trial (nonblinded)

Funding

Foundation

Setting

Outpatient (specialty)

Allocation

Concealed

Synopsis

These Irish researchers enrolled 246 patients referred for physical therapy for the treatment of low back pain that was either chronic (at least 3 months) or recurrent (3 or more episodes in the past year). Patients also reported low levels of physical activity and 76% were overweight or obese. The patients were randomized, using concealed allocation, to receive 1 of 3 interventions for up to 8 weeks: (1) standard tailored physical therapy; (2) a weekly exercise class specifically aimed at patients with back pain; or (3) a tailored graduated program of walking. The patients in the walking program were given a walking diary and a pedometer and asked to walk at least 4 days per week. Patients started with at least a 10-minute walk (1200 steps daily) with the goal of achieving 30 minutes of moderate-intensity physical activity (such as a brisk walk) 5 days per week. They we re supported by weekly telephone calls. All patients also were given a booklet that explains back pain. Using intention-to-treat analysis, pain and function as measured by the Oswestry Disability Index similarly improved an average 6 points in all groups (from an average 35 points of a possible 100). Significantly more walkers, though, achieved a clinically important difference in the score. Scores were higher in all 3 groups in the patients who adhered to treatment. Patient satisfaction with treatment was similar among the groups. Cost was lowest for the walking program and sustained adherence with treatment was highest. Time lost from work was similar among the 3 groups. These were likely highly motivated patients

Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA