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Am Fam Physician. 2015;92(3):230

Clinical Question

For adults with chronic low back pain, is a prescribed walking program as effective as physical therapy?

Bottom Line

Giving patients a pedometer, a walking diary, and instructions to walk at least four days per week, then gradually increase the walk's duration and intensity (see synopsis) results in improvement in pain and disability similar to usual physical therapy or a group exercise program. Patient satisfaction scores and days lost from work are similar, and patients are more likely to continue treatment for at least one year. In our office, many clinicians wear a pedometer and we have a box of inexpensive ($1) ones available to give to patients with low back pain and other problems that would benefit from some get-up-and-go. (Level of Evidence = 1b)

Synopsis

Irish researchers enrolled 246 patients referred for physical therapy for the treatment of low back pain that was chronic (at least three months) or recurrent (three or more episodes in the past year). Patients also reported low levels of physical activity, and 76% were overweight or obese. The patients were randomized, using concealed allocation, to receive one of three interventions for up to eight weeks: (1) standard tailored physical therapy; (2) a weekly exercise class specifically aimed at patients with back pain; or (3) a tailored graduated program of walking. The patients in the walking program were given a walking diary and a pedometer and asked to walk at least four days per week. Patients started with at least a 10-minute walk (1,200 steps daily) with the goal of achieving 30 minutes of moderate-intensity physical activity (such as a brisk walk) five days per week. They were supported by weekly telephone calls. All patients also were given a booklet that explains back pain.

Using intention-to-treat analysis, pain and function as measured by the Oswestry Disability Index similarly improved an average of six points in all groups (from an average 35 points of a possible 100). Significantly more walkers, though, achieved a clinically important difference in the score. Scores were higher in all three groups in the patients who adhered to treatment. Patient satisfaction with treatment was similar among the groups. Cost was lowest for the walking program, and sustained adherence with treatment was highest. Time lost from work was similar among the three groups. These were likely highly motivated patients.

Study design: Randomized controlled trial (nonblinded)

Funding source: Foundation

Allocation: Concealed

Setting: Outpatient (specialty)

Reference: HurleyDATullyMALonsdaleCet alSupervised walking in comparison with fitness training for chronic back pain in physiotherapy: results of the SWIFT single-blinded randomized controlled trial (ISRCTN17592092). Pain2015; 156( 1): 131– 147.

POEMs (patient-oriented evidence that matters) are provided by Essential Evidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

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A collection of POEMs published in AFP is available at https://www.aafp.org/afp/poems.

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