Pedometer-driven Walking for Chronic Low Back Pain

Low back pain (LBP) has high lifetime prevalence with nonspecific LBP representing the majority of cases.(1) Relapses in pain (60%) and work absences (33%) are common,(1) making LBP one of the most costly conditions in the United Kingdom (total cost of £STG12,300 million, with the cost of informal care and production losses related to LBP contributing £STG10,668 million of this total figure).(2) Current research evidence supports the use of exercise- based treatment approaches for chronic low back pain (CLBP; pain persisting for at least 12 wk); in the United Kingdom, supervised group-based exercise programs are recommended, along with advice to stay physically active.(3) There is no specific guidance on how to self-direct participants to maintain or increase their physical activity (PA), although Savigny et al(3) refer to the National Institute for Clinical Health and Excellence (NICE) guidance on methods to increase PA.(4) One of the interventions identified in this review (NICE, 2006), was pedometer-driven walking, which can incorporate features considered important for increasing PA, that is, professional guidance, self-direction, and on-going professional support.(5) The evidence to support walking in people with CLBP is promising(6,7); however, it is not yet clear what approach works best. Hartvigsen et al(8) showed that supervised Nordic walking was as effective as unsupervised Nordic walking, and a trial by some of the current research team(9) is currently investigating the effects of a structured walking program according to ACSM guidelines (30 min, 5 times/ wk). Other approaches for promoting PA have advocated the use of step targets driven by a pedometer, for example, 10,000 steps, which can be accumulated throughout the day in bouts of at least 10 minutes, and where 3000 steps approximates to 30 minutes of walking.(10) It is not clear whether such an approach would be suitable for people with LBP, for example, in terms of how many steps they should or could accumulate, and what risks might be associated with this approach for this clinical population. No trial to date has investigated the use of a pedometer driven walking program in people with CLBP.(7) Therefore as a first step, before implementing a main RCT, we designed a preliminary study to test the feasibility of delivering a pedometer-driven walking program as an adjunct to a standard education/advice session in people with CLBP.(11) Our specific objectives were to: Assess recruitment and adherence rates in education/ advice (E) and education/advice plus pedometer-driven walking program (EWP) groups. Determine the incidence of adverse events (AEs), including musculoskeletal injuries, and level of overall satisfaction in both groups. Make between and within group comparisons and estimate effect sizes for changes in functional disability, PA levels, stage of change, fear avoidance, self-efficacy, health-related quality of life, psychosocial beliefs, general health, and participant satisfaction.