title: Supervised walking in comparison with fitness training for chronic back pain in physiotherapy: results of the SWIFT single-blinded randomized controlled trial (ISRCTN17592092).
abstract: Effectiveness of brief/minimal contact self-activation interventions that encourage participation in physical activity (PA) for chronic low back pain (CLBP >12 weeks) is unproven. The primary objective of this assessor-blinded randomized controlled trial was to investigate the difference between an individualized walking programme (WP), group exercise class (EC), and usual physiotherapy (UP, control) in mean change in functional disability at 6 months. A sample of 246 participants with CLBP aged 18 to 65 years (79 men and 167 women; mean age ± SD: 45.4 ± 11.4 years) were recruited from 5 outpatient physiotherapy departments in Dublin, Ireland. Consenting participants completed self-report measures of functional disability, pain, quality of life, psychosocial beliefs, and PA were randomly allocated to the WP (n = 82), EC (n = 83), or UP (n = 81) and followed up at 3 (81%; n = 200), 6 (80.1%; n = 197), and 12 months (76.4%; n = 188). Cost diaries were completed at all follow-ups. An intention-to-treat analysis using a mixed between-within repeated-measures analysis of covariance found significant improvements over time on the Oswestry Disability Index (Primary Outcome), the Numerical Rating Scale, Fear Avoidance-PA scale, and the EuroQol EQ-5D-3L Weighted Health Index (P < 0.05), but no significant between-group differences and small between-group effect sizes (WP: mean difference at 6 months, 6.89 Oswestry Disability Index points, 95% confidence interval [CI] -3.64 to -10.15; EC: -5.91, CI: -2.68 to -9.15; UP: -5.09, CI: -1.93 to -8.24). The WP had the lowest mean costs and the highest level of adherence. Supervised walking provides an effective alternative to current forms of CLBP management.
authors.affiliation: UCD School of Public Health, Physiotherapy & Population Science, University College Dublin, Dublin, Ireland Institute for Sport and Health, UCD School of Public Health, Physiotherapy & Population Science, University College Dublin, Dublin, Ireland UKCRC Centre of Excellence for Public Health, Institute of Clinical Science B, Royal Victoria Hospital, Queen's University Belfast, Belfast, Northern Ireland Faculty of Health Sciences, Institute for Positive Psychology and Education, Australian Catholic University, Strathfield, Australia Department of Public Health and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands European Access to Medicines Centre of Excellence, GlaxoSmithKline, Brentford, Middlesex, United Kingdom Health and Rehabilitation Sciences Research Institute, University of Ulster, Antrim, Northern Ireland.
authors.forename: Deirdre A
authors.initials: DA
authors.lastname: Hurley
authors.forename: Mark A
authors.initials: MA
authors.lastname: Tully
authors.forename: Chris
authors.initials: C
authors.lastname: Lonsdale
authors.forename: Colin A G
authors.initials: CAG
authors.lastname: Boreham
authors.forename: Willem
authors.initials: W
authors.lastname: van Mechelen
authors.forename: Leslie
authors.initials: L
authors.lastname: Daly
authors.forename: Aódan
authors.initials: A
authors.lastname: Tynan
authors.forename: Suzanne M
authors.initials: SM
authors.lastname: McDonough
mesh_terms: D000328:Adult; D001416:Back Pain / Q000175:diagnosis / Q000628:therapy*; D059350:Chronic Pain / Q000175:diagnosis / Q000628:therapy*; D026241:Exercise Movement Techniques / Q000379:methods / Q000592:standards*; D005081:Exercise Therapy / Q000379:methods / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods; D026741:Physical Therapy Modalities / Q000592:standards; D011446:Prospective Studies; D016037:Single-Blind Method; D016896:Treatment Outcome; D016138:Walking / Q000592:standards*