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

Abstract

Chronic lower back pain (CLBP) remains a physiotherapy treatment challenge with evidence lacking in which treatments best improve outcomes. Furthermore, the presence of CLBP phenotypes, including nociceptive and neuropathic phenotypes, is rarely mentioned in physiotherapy literature. 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. The review of literature demonstrates the complex neurophysiology involved in CLBP pain phenotypes. Physiotherapists currently lack a comprehensive knowledge of pain. Associated psychosocial pain outcomes in literature exploring usual care physiotherapy and walking has been sparse. The limited randomized controlled trials involved up until now have not fully explored walking as exercise independently nor combined with usual care physiotherapy to treat CLBP. 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 weekly 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 statistically significant difference between groups at 12-week follow-up. However, a minimally clinically important difference in pain intensity was only observed in the PW group at the 12-week follow-up. 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, no statistically significant difference was found between the three treatments investigated.

Date of Award	28 Apr 2021
Original language	English
Awarding Institution	University of Bath
Supervisor	Nikki Coghill (Supervisor) & Antonio Wadley (Supervisor)