Low Back Pain, Low Back Pain, Recurrent
Conditions
Keywords
prevention, exercise, randomized controlled trial, physical activity
Brief summary
The primary objective of this study is to compare the effectiveness and cost-effectiveness of an individualized group based exercise and education program supported in the community to a control group of usual care in preventing back pain flare-ups and to mitigate the negative consequences of subsequent episodes if they occur.
Detailed description
Secondary objectives are to: • To compare the effectiveness of the two interventions in preventing an activity-limiting LBP flare up at 12 and 24 months. Secondary objectives are to: * To compare the effectiveness of the interventions in mitigating the negative consequences of LBP. * To evaluate the cost-effectiveness of the interventions in preventing activity-limiting LBP flare-up. * To identify subgroups of individuals that may best respond to each one of the two interventions. Exploratory objectives include: * evaluate the fluctuating nature of back pain using a smart phone application to collect pain measures once a week for 1 year (trajectories will also be evaluated to compare between group effects) * assess adherence to physical activity using activity monitors. * evaluate the relationship between activity levels and flare-ups as a method for understanding pain triggers and impact of activity pacing.
Interventions
OTHERPhysical activity program
This arm will begin with PT assessment. Following this, participants will meet with a specialist who will design an individualized physical activity program. Classes will include warm up, 40 minutes of individualized exercises and a cool down that will include back pain specific exercises including core strengthening. The first 4 weeks of exercise will include a 30-minute education program. Education comprise information on back pain, efficient use of the back during daily activities, self-management, self-efficacy and pain neurophysiology. Classes will run for a 12-week period. Participants will be encouraged to attend the exercise facility at least 3 times a week. An activity monitor will be provided to all participants. We will use group classes to facilitate the development of social support.
OTHERControl group standard care
Participants from the control group will receive usual care which will often include recommendation to keep activity, home exercise programs and advice to engage in physical activity. Participants in the control group will also receive and activity monitor for collection of physical activity data. This activity monitor may also be used for positive feedback and activity reinforcement
Sponsors
Macquarie University, Australia
University of Alberta
Universidade Federal do Ceara
McMaster University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
DOUBLE (Investigator, Outcomes Assessor)
Masking description
Given that this is an exercise study blinding of participants and those delivering the exercise program will not be possible. Outcome measures will be collected by an investigator not aware of treatment allocation, but most outcome measures will be self-reported and thus, true assessor blinding will no be possible. All statistical analysis will be conducted by a blinded investigator.
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
Participants will be included if they meet the following criteria * Have been discharged \<3 months from physiotherapy, chiropractic or osteopathic care following a course of treatment for LBP (pain in the area between the 12th rib and buttock crease) * Have non-specific LBP which is pain not attributed to a specific diagnosis such as sciatica, ankylosing spondylitis, vertebral fracture, etc. * Non-specific LBP sometimes called mechanical LBP accounts for \ 85% of LBP diagnosis. * Between 18 and 80 years of age
Exclusion criteria
Participants will be excluded if they meet the following criteria: * Ongoing high pain intensity, defined as pain intensity of 6 or more on a 0-10 point scale. The cut off of 6/10 is used in the literature to dichotomise low/moderate to high pain intensity. * Co-morbidity preventing participation in physical activity evaluated using the Physical Activity Readiness Questionnaire (PAR-Q) from the American College of Sports Medicine guidelines * Inadequate English to complete outcome measures * Currently participating in an exercise program similar to the one we will evaluate. * History of spine surgery
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Activity limiting flare-up | 12 months | * flare-up is an increase in pain levels of greater than or equal to 3 on a 0-10 numeric pain scale. The LBP international consensus on minimal important change in pain is 2 on a 0-10 scale and thus a change of 3 is likely be clinically important.15 * activity-limiting LBP will be measured using an adaptation of the item PI9 of the PROMIS item bank. (How much did LBP interfere with your day to day activities?) A score of 3 or greater (representing somewhat impact) on a 1-5 scale will be considered as activity limitation. Participants will fit the criteria for activity-limiting flare-up if pain increases at least 3 points AND pain is identified to be limiting on the PI9 as described above. Flare-up will be collected once a week for 1 year |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Personal Impact of low back pain | 3, 6, 12 months | the outcome combines 9 items from the Patient Reported Outcome Measurement Information System (PROMIS) short form and covers the domains of pain intensity, pain interference with normal activities and functional status widely recommended in consensus documents on outcome measures for back pain |
| Pain intensity _NRS pain | 3, 6, 12 months | Pain intensity over the last week will be measured using a numeric rating scale 0-10 where 0 is not pain and 10 is worse pain |
| Disability | 3, 6, 12 months | Roland Morris Disability Questionnaire is a scale from 0-24 assessing pain related disability where 0 is no disability and 24 is significant disability |
| Activity limiting flare-up | 3 and 6 months | * flare-up is an increase in pain levels of greater than or equal to 3 on a 0-10 numeric pain scale. The LBP international consensus on minimal important change in pain is 2 on a 0-10 scale and thus a change of 3 is likely be clinically important.15 * activity-limiting LBP will be measured using an adaptation of the item PI9 of the PROMIS item bank. (How much did LBP interfere with your day to day activities?) A score of 3 or greater (representing somewhat impact) on a 1-5 scale will be considered as activity limitation. Participants will fit the criteria for activity-limiting flare-up if pain increases at least 3 points AND pain is identified to be limiting on the PI9 as described above. Flare-up will be collected once a week for 1 year |
| Health related Quality of Life: EQ-5D-5L | 3, 6, 12 months (0-100) | EQ-5D-5L |
| Physical activity questionnaire | 3, 6, 12 months | IPAQ\_short form |
| Physical activity level | 3, 6, 12 months | Activity level measured using Garmin physical activity monitor |
| Function | 3, 6, 12 months | Patient Specific Functional Scale is a self reported scale assessing function on a scale from 0-10 where 0 is not able to perform the activity and 10 is able without pain |
Countries
Canada
Outcome results
None listed