title: Physiotherapy for sleep disturbance in people with chronic low back pain: results of a feasibility randomized controlled trial.
abstract: OBJECTIVE
  To determine the feasibility of a randomized controlled trial investigating the effectiveness of physiotherapy for sleep disturbance in chronic low back pain (CLBP) (≥12wks).
  
  
  METHODS
  Randomized controlled trial with evaluations at baseline, 3 months, and 6 months.
  
  
  METHODS
  Outpatient physiotherapy department in an academic teaching hospital.
  
  
  METHODS
  Participants with CLBP were randomly assigned to a walking program (n=20; mean age ± SD, 46.4±13.8y), supervised exercise class (n=20; mean age ± SD, 41.3±11.9y), or usual physiotherapy (n=20; mean age ± SD, 47.1±14.3y). The 3-month evaluation was completed by 44 participants (73%), and 42 (70%) participants completed the 6-month evaluation.
  
  
  METHODS
  Participants received a physiotherapy-delivered 8-week walking program, an 8-week group supervised exercise class (1 class/wk), or 1-to-1 usual physiotherapy (advice, manual therapy, and exercise).
  
  
  METHODS
  Sleep was assessed by the self-reported Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Pittsburgh Sleep Diary, and objective actigraphy.
  
  
  RESULTS
  Groups were comparable at baseline. Most (95%, n=57) of the participants had sleep disturbance. The acceptability of actigraphy was excellent at baseline (58 of 60 participants), but dropped at 3 months (26 of 44 participants). There were improvements on the PSQI and ISI in all groups at 3 and 6 months, with predominantly medium effect sizes (Cohen d=0.2-0.5).
  
  
  CONCLUSIONS
  The high prevalence of sleep disturbance indicated the feasibility of good recruitment in future trials. The PSQI would be a suitable screening tool and outcome measure alongside an objective nonobtrusive sleep outcome measure. The effectiveness of physiotherapy for sleep disturbance in CLBP warrants investigation in a fully powered randomized controlled trial.
authors: Institute for Sport and Health, UCD School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland; Physiotherapy Department, Beaumont Hospital, Dublin, Ireland.
authors: Jennifer
authors: J
authors: Eadie
authors: Alexander T
authors: AT
authors: van de Water
authors: Chris
authors: C
authors: Lonsdale
authors: Mark A
authors: MA
authors: Tully
authors: Willem
authors: W
authors: van Mechelen
authors: Colin A
authors: CA
authors: Boreham
authors: Leslie
authors: L
authors: Daly
authors: Suzanne M
authors: SM
authors: McDonough
authors: Deirdre A
authors: DA
authors: Hurley
mesh_terms: D000328:Adult; D002908:Chronic Disease; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D057194:Intention to Treat Analysis; D017116:Low Back Pain / Q000453:epidemiology / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities; D015995:Prevalence; D012893:Sleep Wake Disorders / Q000453:epidemiology / Q000534:rehabilitation*; D016138:Walking
keywords: Actigraphy; CLBP; Dyssomnias; ISI; Insomnia Severity Index; LBP; Low back pain; MCID; PSD; PSQI; Physical therapy specialty; Pittsburgh Sleep Diary; Pittsburgh Sleep Quality Index; RCT; Rehabilitation; SE; SEC; TST; UP; WP; chronic low back pain; low back pain; minimal clinically important difference; randomized controlled trial; sleep efficiency; supervised exercise class; total sleep time; usual physiotherapy; walking program