A comparison of usual care physiotherapy, a pedometer-based walking intervention and a combination of both to treat patients suffering from nociceptive or neuropathic chronic lower back pain: A Randomised Controlled Trial

Nikki Coghill, Richard Feher

Research output: Contribution to journalArticlepeer-review

Abstract

Chronic lower back pain (CLBP) remains a physiotherapy treatment challenge with evidence lacking in which treatments best improve outcomes. Furthermore, the role of CLBP phenotypes, including nociceptive and neuropathic phenotypes, on CLBP outcomes has been unexplored.

The primary objective of this randomised controlled trial was to assess changes in pain intensity between baseline and 12-week follow-up between and within the following three treatment groups: usual care physiotherapy (P), a partly supervised pedometer-based walking intervention (W), and a combination of both (PW) in patients with nociceptive or neuropathic CLBP. Secondary objectives assessed changes in disability, kinesiophobia and pain catastrophizing between baseline and 12-week follow-up between and within the three groups A third objective determined whether pain phenotype affects primary and secondary outcomes.

A sample of 147 participants, 62.6% (92/147) female and 37.4% (55/147) males; mean age (SD) 46.2 (10.9) years with nociceptive (52.4%, 77/147) or neuropathic (47.6%, 70/147) CLBP were recruited from three private practice physiotherapy clinics in Johannesburg, South Africa. Consenting participants completed self-reported measures of pain intensity, disability, kinesiophobia, pain catastrophizing. Physical activity was measured using pedometers to record daily steps. Participants were randomly allocated to P (n=46), W (n=52), or PW (n=49) groups, and followed up at 12-weeks (completion 72.8%, 107/147).

An intention-to-treat analysis using a linear mixed model showed significant improvement in pain intensity (p<0.01), disability (p<0.01), kinesiophobia (p<0.01) and pain catastrophizing (p<0.01) in all groups but there was no significant difference between groups at 12-week follow-up. Neuropathic pain phenotype at baseline predicted greater pain intensity (p=0.04) and disability (p=0.01) at 12-weeks. The group with neuropathic pain phenotype exhibited fewer steps overall when compared to the group with nociceptive pain phenotype (p=0.02). Moreover, greater than two physiotherapy visits showed a significant improvement in pain intensity (p=0.01), kinesiophobia (p=0.01) and on pain catastrophizing (p=0.01). Further exploration of the ideal number of physiotherapy visits may be necessary to improve outcomes optimally.

In conclusion, the three treatments investigated were equally effective for the management of CLBP
Original languageEnglish
JournalPain
Publication statusAcceptance date - 2021

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