Low Back Pain
Conditions
Brief summary
Low back pain (LBP) is the most common cause of disability worldwide. Although general activity is encouraged in the treatment of LBP, there is limited empirical information available on the specific types of activities that are beneficial or harmful for patients seen in primary care for LBP. This study will identify those physical activities with short-term (transient) effects on LBP exacerbations (or flares of LBP), as well as identifying the long-term (cumulative) effects of such activities on functional recovery.
Detailed description
This research will use a novel approach to distinguish the short-term effects on LBP of physical activities from the long-term effects of such activities, by conducting a longitudinal case-crossover study nested within a cohort study. This design accounts for measured and unmeasured confounds by using each case as his/her own control- an entirely observational study that is analogous to a crossover experiment- capitalizing on modern mobile health and actigraphy technology. The primary exposures of interest are 10 self-reported physical activities commonly performed during work and activities of daily living, and actigraphy-assessed physical activity. Other exposures of interest include psychological factors, social factors, lifestyle-related factors, and work-related factors. The primary outcomes are participant-reported flares of low back pain (Aim 1) and participant-reported back-related functional limitations (mobility and activities of daily living \[ADLs\]) at 1-year follow-up, as measured by the Roland-Morris Disability Questionnaire. This observational study will include up to 550 Veterans with LBP aged 18 and older recruited from the VA Puget Sound Health Care System (VAPSHCS). The study will not affect participants' medical care in any way. After informed consent, recruitment, and baseline data collection, study participants will complete frequent, serial electronic e-Questionnaires using their own personal electronic devices (personal computer \[PC\], tablet, or smartphone) over the 1-year period of follow-up. Participants may also wear ActiGraph units for the 1st 4 weeks of follow-up. Long-term outcomes will be assessed by extended e-Questionnaires completed at 1-year follow-up. Aim 1 analyses will examine the short-term effects of 10 specific activity categories on participant-reported flares across all study assessments over 1-year follow-up. Aim 2 analyses will examine associations between the frequency of exposure to 10 specific activity categories over weeks 1-4 of follow-up, and long-term functional recovery at 12 months as defined by the RMDQ. All analyses will use a biopsychosocial framework accounting for potential confounders (sociodemographics, psychological factors, etc.) and effect modifiers, and will include sensitivity analyses to examine the robustness of findings and important study assumptions. This study was registered prior to the start of enrollment.
Interventions
None listed
Sponsors
VA Office of Research and Development
Study design
Observational model
CASE_CROSSOVER
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Veterans age 18-65 years seen in VA primary care for LBP * Must have regular access (every day, during most hours of the day) to a computer, tablet, or smartphone with internet access at home or at work * Basic computer literacy * Having a mobile phone capable of receiving alerts using text messages * Must be able to understand and read English, sufficient to provide informed consent and validly complete the study assessments. * Participants must complete basic requirements during a 2-week run-in period, such as completing e-Questionnaires After approval by the study sponsor and IRB, an additional inclusion criterion was added beginning on 3/10/2023, to also allow the inclusion of other patients with low back pain. The inclusion criteria were broadened to include other patients seen for low back pain in the health care system, including three specific subgroups of Veterans with low back pain: (1) Veterans with lumbosacral facet-mediated low back pain; (2) Veterans with sacroiliac joint-mediated low back pain; and (3) Veterans with spondylolytic spondylolistheses.
Exclusion criteria
* Red flag' spine conditions (spinal cord injury, infection, malignancy, fracture) or spondyloarthropathy * Pregnancy * Prisoners or incarcerated * Severe active medical or psychiatric comorbidities likely to be a barrier to study participation including completing frequent, serial assessments (e.g., metastatic cancer). * Thoracolumbar spine surgery in the past 1 year * Other major orthopedic surgery potentially impeding normal physical activities (such as surgeries involving the hip, knee, ankle, shoulder, elbow, wrist joints) within the past 6 months, or major abdominal or chest surgery within the past 6 months.\* * Planned major orthopedic, abdominal, or chest surgery in the next 2 months.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Participant-reported Flares of Low Back Pain (Aim 1) | Flares over 1-year follow-up | At each study assessment, participants are presented with the flare definition used in this study, which was derived from a previously validated flare definition by Costa et al (2000). The definition is: A 'flare' of low back pain is a worsening of your low back pain that lasts from hours to weeks. Participants are then asked to self-report whether a flare of low back pain is currently ongoing, by responding to the question According to the definition above, are you currently experiencing a flare of your low back pain?, with response options of yes or no. These response options define participant-reported flares. |
| Roland-Morris Disability Questionnaire (Aim 2) | 1-year follow-up | Roland-Morris Disability Questionnaire (RMDQ) is a back-specific measure of functional limitations ranging from 0 to 24, where 0 reflects no disability and 24 reflects severe disability. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Observational Cohort This is a case-crossover study nested within a cohort study. | 416 |
| Total | 416 |
Baseline characteristics
| Characteristic | Observational Cohort |
|---|---|
| Age, Continuous | 47.5 years STANDARD_DEVIATION 10.9 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 52 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 328 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 36 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 4 Participants |
| Race (NIH/OMB) Asian | 21 Participants |
| Race (NIH/OMB) Black or African American | 54 Participants |
| Race (NIH/OMB) More than one race | 35 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 5 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 18 Participants |
| Race (NIH/OMB) White | 279 Participants |
| Roland-Morris Disability Questionnaire | 12.2 units on a scale STANDARD_DEVIATION 5.8 |
| Sex: Female, Male Female | 306 Participants |
| Sex: Female, Male Male | 104 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 0 / 0 |
| other Total, other adverse events | 0 / 0 |
| serious Total, serious adverse events | 0 / 0 |
Outcome results
Primary
Participant-reported Flares of Low Back Pain (Aim 1)
At each study assessment, participants are presented with the flare definition used in this study, which was derived from a previously validated flare definition by Costa et al (2000). The definition is: A 'flare' of low back pain is a worsening of your low back pain that lasts from hours to weeks. Participants are then asked to self-report whether a flare of low back pain is currently ongoing, by responding to the question According to the definition above, are you currently experiencing a flare of your low back pain?, with response options of yes or no. These response options define participant-reported flares.
Time frame: Flares over 1-year follow-up
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Observational Cohort | Participant-reported Flares of Low Back Pain (Aim 1) | 7.3 Mean flares per year | Standard Deviation 7.3 |
Primary
Roland-Morris Disability Questionnaire (Aim 2)
Roland-Morris Disability Questionnaire (RMDQ) is a back-specific measure of functional limitations ranging from 0 to 24, where 0 reflects no disability and 24 reflects severe disability.
Time frame: 1-year follow-up
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Observational Cohort | Roland-Morris Disability Questionnaire (Aim 2) | 10.0 Units on a scale | Standard Deviation 6.3 |