Pedometer-Based Internet-Mediated Intervention For Adults With Chronic Low Back Pain: Randomized Controlled Trial

Autor: Rob Holleman, Sarah L. Krein, Hyungjin Myra Kim, Reema Kadri, John D. Piette, Maria Hughes, Caroline R. Richardson, Eve A. Kerr
Jazyk: angličtina
Rok vydání: 2013
Předmět:
Adult
Male
medicine.medical_specialty
Health Informatics
Walking
lcsh:Computer applications to medicine. Medical informatics
law.invention
03 medical and health sciences
0302 clinical medicine
Quality of life (healthcare)
Physical medicine and rehabilitation
Randomized controlled trial
law
Surveys and Questionnaires
Health care
Back pain
medicine
Humans
030212 general & internal medicine
Veterans Affairs
Original Paper
Internet
exercise therapy
business.industry
lcsh:Public aspects of medicine
Chronic pain
Social Support
lcsh:RA1-1270
Middle Aged
medicine.disease
Low back pain
3. Good health
Treatment Outcome
Roland Morris Disability Questionnaire
randomized controlled trial
Physical therapy
lcsh:R858-859.7
Female
medicine.symptom
Chronic Pain
business
Low Back Pain
030217 neurology & neurosurgery
Zdroj: Journal of Medical Internet Research
Journal of Medical Internet Research, Vol 15, Iss 8, p e181 (2013)
ISSN: 1438-8871
1439-4456
Popis: BackgroundChronic pain, especially back pain, is a prevalent condition that is associated with disability, poor health status, anxiety and depression, decreased quality of life, and increased health services use and costs. Current evidence suggests that exercise is an effective strategy 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. ObjectiveThe objective of the study was to determine whether a pedometer-based, Internet-mediated intervention can reduce chronic back pain-related disability. MethodsA parallel group randomized controlled trial was conducted with 1:1 allocation to the intervention or usual care group. 229 veterans with nonspecific chronic back pain were recruited from one Department of Veterans Affairs (VA) health care system. Participants randomized to the intervention received an uploading pedometer and had access to a website that provided automated walking goals, feedback, motivational messages, and social support through an e-community (n=111). Usual care participants (n=118) also received the uploading pedometer but did not receive the automated feedback or have access to the website. The primary outcome was measured using the Roland Morris Disability Questionnaire (RDQ) at 6 months (secondary) and 12 months (primary) with a difference in mean scores of at least 2 considered clinically meaningful. Both a complete case and all case analysis, using linear mixed effects models, were conducted to assess differences between study groups at both time points. ResultsBaseline mean RDQ scores were greater than 9 in both groups. Primary outcome data were provided by approximately 90% of intervention and usual care participants at both 6 and 12 months. At 6 months, average RDQ scores were 7.2 for intervention participants compared to 9.2 for usual care, an adjusted difference of 1.6 (95% CI 0.3-2.8, P=.02) for the complete case analysis and 1.2 (95% CI -0.09 to 2.5, P=.07) for the all case analysis. A post hoc analysis of patients with baseline RDQ scores ≥4 revealed even larger adjusted differences between groups at 6 months but at 12 months the differences were no longer statistically significant. ConclusionsIntervention participants, compared with those receiving usual care, reported a greater decrease in back pain-related disability in the 6 months following study enrollment. Between-group differences were especially prominent for patients reporting greater baseline levels of disability but did not persist over 12 months. Primarily, automated interventions may be an efficient way to assist patients with managing chronic back pain; additional support may be needed to ensure continuing improvements. Trial RegistrationClinicalTrials.gov NCT00694018; http://clinicaltrials.gov/ct2/show/NCT00694018 (Archived by WebCite at http://www.webcitation.org/6IsG4Y90E).
Databáze: OpenAIRE
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