Increasing recreational physical activity in patients with chronic low back pain: A pragmatic controlled clinical trial
Increasing recreational physical activity in patients with chronic low back pain: A pragmatic controlled clinical trial
Background: Clinical guidelines recommend physical activity for the treatment of chronic low back pain. But engaging patients in physical activity has proven difficult. Known obstacles to physical activity include low self-efficacy and fear avoidance.
Objectives: This study tested the effectiveness of an enhanced transtheoretical model intervention (ETMI) aimed at increasing recreational physical activity in patients with chronic low back pain, in comparison to usual physical therapy.MethodsPatients (n = 220) referred to physical therapy for chronic low back pain were allocated to ETMI or to a control group. The ETMI was delivered by physical therapists and based on behavior-change principles, combined with increased reassurance, therapeutic alliance, and exposure to reduce fear avoidance. The primary outcome was back pain-related disability (Roland-Morris Disability Questionnaire). Secondary outcomes included pain intensity, mental and physical health, and levels of physical activity.
Results: Intention-to-treat analysis in 189 patients at 12 months indicated that patients in the ETMI group had significantly lower disability compared to usual physical therapy. The difference in mean change from baseline between the interventions was 2.7 points (95% confidence interval: 0.9, 4.5) on the Roland-Morris Disability Questionnaire. At 12 months, worst pain, physical activity, and physical health were all significantly better in patients receiving ETMI. The average number of sessions was 3.5 for the ETMI group and 5.1 for controls.
Conclusion: Targeting obstacles to physical activity with an intervention that includes components to address self-efficacy and fear avoidance appears to be more effective than usual physical therapy care in reducing long-term disability. Further research is needed to explore the mechanisms that impact outcomes in this intervention package.
57-66
Ben Ami, Noa
8e090dff-7876-4b1d-9e02-ec5e800174a9
Chodick, Gabriel
ae5cab8d-476b-4d42-a53a-242c0fadeecf
Mirovsky, Yigal
f8348bae-4b18-4710-a38e-3a53e47d5ddb
Pincus, Tamar
55388347-5d71-4fc0-9fd2-66fbba080e0c
Shapiro, Yair
bf5f3d17-985c-4af3-b1f7-62be9c38c35d
1 February 2017
Ben Ami, Noa
8e090dff-7876-4b1d-9e02-ec5e800174a9
Chodick, Gabriel
ae5cab8d-476b-4d42-a53a-242c0fadeecf
Mirovsky, Yigal
f8348bae-4b18-4710-a38e-3a53e47d5ddb
Pincus, Tamar
55388347-5d71-4fc0-9fd2-66fbba080e0c
Shapiro, Yair
bf5f3d17-985c-4af3-b1f7-62be9c38c35d
Ben Ami, Noa, Chodick, Gabriel, Mirovsky, Yigal, Pincus, Tamar and Shapiro, Yair
(2017)
Increasing recreational physical activity in patients with chronic low back pain: A pragmatic controlled clinical trial.
Journal of Orthopaedic & Sports Physical Therapy, 47 (2), .
(doi:10.2519/jospt.2017.7057).
Abstract
Background: Clinical guidelines recommend physical activity for the treatment of chronic low back pain. But engaging patients in physical activity has proven difficult. Known obstacles to physical activity include low self-efficacy and fear avoidance.
Objectives: This study tested the effectiveness of an enhanced transtheoretical model intervention (ETMI) aimed at increasing recreational physical activity in patients with chronic low back pain, in comparison to usual physical therapy.MethodsPatients (n = 220) referred to physical therapy for chronic low back pain were allocated to ETMI or to a control group. The ETMI was delivered by physical therapists and based on behavior-change principles, combined with increased reassurance, therapeutic alliance, and exposure to reduce fear avoidance. The primary outcome was back pain-related disability (Roland-Morris Disability Questionnaire). Secondary outcomes included pain intensity, mental and physical health, and levels of physical activity.
Results: Intention-to-treat analysis in 189 patients at 12 months indicated that patients in the ETMI group had significantly lower disability compared to usual physical therapy. The difference in mean change from baseline between the interventions was 2.7 points (95% confidence interval: 0.9, 4.5) on the Roland-Morris Disability Questionnaire. At 12 months, worst pain, physical activity, and physical health were all significantly better in patients receiving ETMI. The average number of sessions was 3.5 for the ETMI group and 5.1 for controls.
Conclusion: Targeting obstacles to physical activity with an intervention that includes components to address self-efficacy and fear avoidance appears to be more effective than usual physical therapy care in reducing long-term disability. Further research is needed to explore the mechanisms that impact outcomes in this intervention package.
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e-pub ahead of print date: 31 January 2017
Published date: 1 February 2017
Identifiers
Local EPrints ID: 469472
URI: http://eprints.soton.ac.uk/id/eprint/469472
ISSN: 0190-6011
PURE UUID: 9055e435-c407-4ad6-a5d1-c79408e3407a
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Date deposited: 15 Sep 2022 16:41
Last modified: 17 Mar 2024 04:11
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Author:
Noa Ben Ami
Author:
Gabriel Chodick
Author:
Yigal Mirovsky
Author:
Tamar Pincus
Author:
Yair Shapiro
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