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Effectiveness of a healthy lifestyle intervention for chronic low back pain

a randomised controlled trial

Williams, Amandaa,b,c,*; Wiggers, Johna,b; O'Brien, Kate M.a,b,c; Wolfenden, Lukea,b; Yoong, Sze Lina,b; Hodder, Rebecca K.a,b,c; Lee, Hopinb,c,d,e; Robson, Emma K.a,c; McAuley, James H.d,f; Haskins, Robing; Kamper, Steven J.c,h; Rissel, Chrisi; Williams, Christopher M.a,b,c

doi: 10.1097/j.pain.0000000000001198
Research Paper

We assessed the effectiveness of a 6-month healthy lifestyle intervention, on pain intensity in patients with chronic low back pain who were overweight or obese. We conducted a pragmatic randomised controlled trial, embedded within a cohort multiple randomised controlled trial of patients on a waiting list for outpatient orthopaedic consultation at a tertiary hospital in NSW, Australia. Eligible patients with chronic low back pain (>3 months in duration) and body mass index ≥27 kg/m2 and <40 kg/m2 were randomly allocated, using a central concealed random allocation process, to receive advice and education and referral to a 6-month telephone-based healthy lifestyle coaching service, or usual care. The primary outcome was pain intensity measured using an 11-point numerical rating scale, at baseline, 2 weeks, and monthly for 6 months. Data analysis was by intention-to-treat according to a prepublished analysis plan. Between May 13, 2015, and October 27, 2015, 160 patients were randomly assigned in a 1:1 ratio to the intervention or usual care. We found no difference between groups for pain intensity over 6 months (area under the curve, mean difference = 6.5, 95% confidence interval −8.0 to 21.0; P = 0.38) or any secondary outcome. In the intervention group, 41% (n = 32) of participants reported an adverse event compared with 56% (n = 45) in the control group. Our findings show that providing education and advice and telephone-based healthy lifestyle coaching did not benefit patients with low back pain who were overweight or obese, compared with usual care. The intervention did not influence the targeted healthy lifestyle behaviours proposed to improve pain in this patient group.

Lifestyle management involving education and advice, and health coaching was not effective in improving pain intensity nor weight for patients with chronic low back pain.

aHunter New England Population Health, Wallsend, New South Wales, Australia

bSchool of Medicine and Public Health, Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia

cCentre for Pain, Health and Lifestyle, New South Wales, Australia

dNeuroscience Research Australia (NeuRA), Randwick, New South Wales, Australia

eCentre for Statistics in Medicine, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom

fSchool of Medical Sciences, Faculty of Medicine, University of NSW, Sydney, New South Wales, Australia

gOutpatient Services, John Hunter Hospital, Hunter New England Local Health District, New Lambton, New South Wales, Australia

hSchool of Public Health, University of Sydney, Camperdown, New South Wales, Australia

iNSW Office of Preventive Health, Liverpool Hospital, South West Sydney Local Health District, Liverpool BC, New South Wales, Australia

Corresponding author. Address: Hunter New England Local Health District, Locked Bag 10, Wallsend, New South Wales 2287, Australia. Tel.: +61 2 4924 6206; fax: +61 2 4924 6490. E-mail address: (A. Williams).

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Received October 03, 2017

Received in revised form February 07, 2018

Accepted February 28, 2018

© 2018 International Association for the Study of Pain
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