Back Pain Clinical Trial
Official title:
Veterans Walk to Beat Back Pain
The objective of this study was to assess whether an Internet-mediated pedometer based intervention would increase walking and improve function among individuals with chronic back pain.
Project Background/Rationale: Chronic pain, and especially back pain, is common among VA
patients, affecting approximately 60% of veterans using VA primary care services. Chronic
pain is associated with increased disability, poorer health status, anxiety and depression,
decreased quality of life, decreased employment and increased health services use and costs.
Current evidence suggests that exercise is one of the most effective strategies for managing
chronic pain. However, there are few clinical programs that use generally available tools
and a relatively low cost approach to help patients with chronic back pain initiate and
maintain an exercise program.
Project Objectives: The primary objective of this study was to assess the efficacy of an
Internet-mediated pedometer based intervention that was designed to increase walking and
improve pain-related function among individuals with chronic back pain. The Specific Aims of
this randomized, controlled trial were: 1) To determine whether an internet-mediated
pedometer based intervention will reduce 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 among patients with chronic back
pain; and 3) To identify factors associated with a sustained increase in walking over a
12-month timeframe among patients randomized to the intervention.
Project Methods: We conducted a randomized controlled trial of an Internet-mediated,
pedometer based intervention to promote walking and improve pain-related function among
patients with chronic back pain compared to enhanced usual care. Participants were followed
for 12 months to investigate the efficacy of the intervention in assisting patients with
initiating and maintaining a regular walking program and improving pain-related function. We
recruited patients with chronic back pain (primarily low back pain) receiving care at one VA
health care system. Study patients were randomized to one of two groups: 1) enhanced usual
care or 2) the Internet-mediated, pedometer based intervention. All participants attended an
educational program designed specifically for individuals with chronic back pain. Study
participants randomized to the intervention were given an enhanced pedometer and access to a
study website that provided step goals and feedback, tailored motivational messages and an
e-community. Those in the control group received a pedometer but did not have access to the
website. Both groups completed on-line survey assessments at baseline, 6, and 12 months and
were asked to report adverse events on a regular basis. The primary outcome for this study
was pain-related functional interference. Secondary outcomes included average daily steps at
12 months as measured using the study pedometer, health related quality of life, pain
intensity, pain related fear and self-efficacy for exercise. The analysis was conducted
based on intention to treat principles and used multivariable modeling procedures to
determine the effect of the intervention on our outcomes.
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Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Supportive Care
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