Walking away from Low Back Pain: The New Zealand Back to Activity Trial

Participants will be randomly allocated to one of two groups: either standard care or a walking group. Following randomisation, members of the walking group will undergo an initial physiotherapy assessment (as for standard care), and then be prescribed an individualised pedometer-driven walking programme by a trained physiotherapist. At week 1 each participant will complete a 20-step test with the physiotherapist to ensure that the pedometer is recording, and that they can use it correctly. Each participant in this group will wear a pedometer for a minimum of 5 consecutive days per week of the 8-week clinical trial; they will also record their daily steps and other activities in a diary. In the first week, patients will undertake usual daily activity without any predetermined increase in steps. At the week 2 appointment the step target for the subsequent week will be agreed between the physiotherapist and the participant by referring to (1) the mean daily step count for the previous week calculated from the walking diary, and (2) the number of steps accumulated during the 10-minute “self-efficacy walk”, which will be performed by the participant, accompanied by the physiotherapist, to demonstrate number of steps accrued in 10 minutes of walking. There will no further face-to-face appointments: between weeks 3 and 8 the physiotherapist will phone the participant at a prearranged time, each week, to discuss their progress, document their mean daily step count (recorded in diaries) for the previous week, and to agree to a new daily step target for the subsequent week. In this way the walking programme will be tailored to the individual and progressed on a weekly basis. An evidence-based approach to behavior change via promotion of activity in the community (the 5As approach: assess, advise, agree, assist, and arrange) will be adopted in order to structure the consultation between the physiotherapist and the patient, and enhance adherence to the walking programme. Adherence will be measured from the pedometer data, and calculated as a percentage of the prescribed number of steps and number of active days; participants will then be followed up after 6 and 12 months following completion of the programme. The initial assessment and 'Week 2' appointments will be approximately 1 hour in duration. Weekly telephone follow-up calls are anticipated to be around 30 minutes maximum duration.