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Supervised walking in comparison with fitness training for chronic back pain in physiotherapy: results of the SWIFT single-blinded randomized controlled trial (ISRCTN17592092)

Hurley, Deirdre A.a,b,*; Tully, Mark A.c; Lonsdale, Chrisd; Boreham, Colin A. G.a,b; van Mechelen, Willeme; Daly, Lesliea; Tynan, Aódanf; McDonough, Suzanne M.g

doi: 10.1016/j.pain.0000000000000013
Research Paper

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.

Supplemental Digital Content is Available in the Text.There was no difference in effectiveness of a supervised walking programme, an exercise class and usual physiotherapy for people with chronic low back pain.

aUCD School of Public Health, Physiotherapy & Population Science, University College Dublin, Dublin, Ireland

bInstitute for Sport and Health, UCD School of Public Health, Physiotherapy & Population Science, University College Dublin, Dublin, Ireland

cUKCRC Centre of Excellence for Public Health, Institute of Clinical Science B, Royal Victoria Hospital, Queen's University Belfast, Belfast, Northern Ireland

dFaculty of Health Sciences, Institute for Positive Psychology and Education, Australian Catholic University, Strathfield, Australia

eDepartment of Public Health and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands

fEuropean Access to Medicines Centre of Excellence, GlaxoSmithKline, Brentford, Middlesex, United Kingdom

gHealth and Rehabilitation Sciences Research Institute, University of Ulster, Antrim, Northern Ireland

Corresponding author. Address: UCD School of Public Health, Physiotherapy and Population Science, Health Sciences Centre, University College Dublin, Room A302, Belfield, Dublin 4, Ireland. Tel: +353 1 7166524; fax: +353 1 7166501. E-mail address: (D. A. Hurley).

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

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Received July 11, 2014

Received in revised form October 9, 2014

Accepted October 28, 2014

© 2015 International Association for the Study of Pain
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