title: Veterans walk to beat back pain: study rationale, design and protocol of a randomized trial of a pedometer-based internet mediated intervention for patients with chronic low back pain.
abstract: BACKGROUND
  Chronic back pain is a significant problem worldwide and may be especially prevalent among patients receiving care in the U.S. Department of Veterans Affairs healthcare system. Back pain affects adults at all ages and is associated with disability, lost workplace productivity, functional limitations and social isolation. Exercise is one of the most effective strategies for managing chronic back pain. Yet, there are few clinical programs that use low cost approaches to help patients with chronic back pain initiate and maintain an exercise program.
  
  
  METHODS
  We describe the design and rationale of a randomized controlled trial to assess the efficacy of a pedometer-based Internet mediated intervention for patients with chronic back pain. The intervention uses an enhanced pedometer, website and e-community to assist these patients with initiating and maintaining a regular walking program with the primary aim of reducing pain-related disability and functional interference. The study specific aims are: 1) To determine whether a pedometer-based Internet-mediated intervention reduces pain-related functional interference among patients with chronic back pain in the short term and over a 12-month timeframe. 2) To assess the effect of the intervention on walking (measured by step counts), quality of life, pain intensity, pain related fear and self-efficacy for exercise. 3) To identify factors associated with a sustained increase in walking over a 12-month timeframe among patients randomized to the intervention.
  
  
  CONCLUSIONS
  Exercise is an integral part of managing chronic back pain but to be effective requires that patients actively participate in the management process. This intervention is designed to increase activity levels, improve functional status and make exercise programs more accessible for a broad range of patients with chronic back pain.
  
  
  BACKGROUND
  NCT00694018.
authors.affiliation: VA Ann Arbor Health Services Research and Development Center of Excellence, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA. skrein@umich.edu
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Krein
authors.forename: Tabitha
authors.initials: T
authors.lastname: Metreger
authors.forename: Reema
authors.initials: R
authors.lastname: Kadri
authors.forename: Maria
authors.initials: M
authors.lastname: Hughes
authors.forename: Eve A
authors.initials: EA
authors.lastname: Kerr
authors.forename: John D
authors.initials: JD
authors.lastname: Piette
authors.forename: Hyungjin Myra
authors.initials: HM
authors.lastname: Kim
authors.forename: Caroline R
authors.initials: CR
authors.lastname: Richardson
mesh_terms: D002908:Chronic Disease; D005081:Exercise Therapy / Q000379:methods* / Q000523:psychology; D006801:Humans; D020407:Internet / Q000592:standards*; D017116:Low Back Pain / Q000523:psychology / Q000534:rehabilitation*; D017063:Outcome Assessment, Health Care / Q000379:methods*; D010809:Physical Fitness / Q000502:physiology* / Q000523:psychology; D014728:Veterans / Q000523:psychology; D016138:Walking / Q000502:physiology*