A pilot study to determine the effect of one physical therapy session on physical activity levels for individuals with chronic low back pain

Wayne Brewer, Brian T Swanson, Toni S Roddey, Habeeblai Adewale, Caleb Ashmore, Jennifer Frerich, Cory Perrin, Alexis Ortiz, Wayne Brewer, Brian T Swanson, Toni S Roddey, Habeeblai Adewale, Caleb Ashmore, Jennifer Frerich, Cory Perrin, Alexis Ortiz

Abstract

Background: A pilot study was conducted to quantify the effect size of changes in physical activity after of one session of physical therapy for individuals with chronic low back pain and to determine factors that predict daily sedentary activity time.

Methods: Fourteen subjects with at least 3 days of physical activity accelerometer data were analyzed before and after one session of physical therapy. Data was analyzed using 1-tailed, paired t-tests with level of significance set at 0.05. Effect sizes were computed using the baseline and post intervention mean differences divided by the baseline and post-intervention differences in the standard deviation.

Results: A nonsignificant reduction in steps-per-day and time spent performing sedentary activities, with increases in light and moderate-vigorous physical activity were found (effect size: 0.15-0.33). A nonsignificant decrease in daily sitting and standing time 1 week immediately following the physical therapy session and an increase in daily lying time (p = 0.03) (effect size: 0.23-0.69) were found.

Conclusion: One physical therapy session resulted in a small physical activity change for individuals with chronic low back pain. Baseline and post intervention levels of pain catastrophisation and perceptions of disability need to be explored in future studies to determine if these are factors that influence levels of physical activity change for these individuals Results are limited by the small sample size, however the ability to increase physical activity in this population may be of clinical relevance. Trial Registration NCT02823756; June 30, 2016: Retrospectively Registered.

Keywords: Chronic low back pain; Physical activity; Physical therapy.

Figures

Fig. 1
Fig. 1
Consort diagram of flow of subjects in the study

References

    1. Freburger JK, Holmes GM, Agans RP, Jackman AM, Darter JD, Wallace AS, Castel LD, Kalsbeek WD, Carey TS. The rising prevalence of chronic low back pain. Arch Intern Med. 2009;169(3):251–258. doi: 10.1001/archinternmed.2008.543.
    1. Hoy D, Brooks P, Blyth F, Buchbinder R. The Epidemiology of low back pain. Best Pract Res Clin Rheumatol. 2010;24(6):769–781. doi: 10.1016/j.berh.2010.10.002.
    1. Wertli MM, Rasmussen-Barr E, Weiser S, Bachmann LM, Brunner F. The role of fear avoidance beliefs as a prognostic factor for outcome in patients with nonspecific low back pain: a systematic review. Spine J. 2014;14(5):816–836. doi: 10.1016/j.spinee.2013.09.036.
    1. Guclu DG, Guclu O, Ozaner A, Senormanci O, Konkan R. The relationship between disability, quality of life and fear-avoidance beliefs in patients with chronic low back pain. Turk Neurosurg. 2012;22(6):724–731.
    1. Koes BW, van Tulder MW, Thomas S. Diagnosis and treatment of low back pain. BMJ. 2006;332(7555):1430–1434. doi: 10.1136/bmj.332.7555.1430.
    1. Vlaeyen JW, Linton SJ. Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain. 2000;85(3):317–332. doi: 10.1016/S0304-3959(99)00242-0.
    1. Vlaeyen JW, Kole-Snijders AM, Boeren RG, van Eek H. Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance. Pain. 1995;62(3):363–372. doi: 10.1016/0304-3959(94)00279-N.
    1. Delitto A, George SZ, Van Dillen LR, Whitman JM, Sowa G, Shekelle P, Denninger TR, Godges JJ. Orthopaedic section of the American Physical Therapy Association: low back pain. J Orthop Sports Phys Ther. 2012;42(4):A1–A57. doi: 10.2519/jospt.2012.42.4.A1.
    1. Delitto A, Erhard RE, Bowling RW. A treatment-based classification approach to low back syndrome: identifying and staging patients for conservative treatment. Phys Ther. 1995;75(6):470–485. doi: 10.1093/ptj/75.6.470.
    1. Stanton TR, Fritz JM, Hancock MJ, Latimer J, Maher CG, Wand BM, Parent EC. Evaluation of a treatment-based classification algorithm for low back pain: a cross-sectional study. Phys Ther. 2011;91(4):496–509. doi: 10.2522/ptj.20100272.
    1. Stanton TR, Hancock MJ, Apeldoorn AT, Wand BM, Fritz JM. What characterizes people who have an unclear classification using a treatment-based classification algorithm for low back pain? A cross-sectional study. Phys Ther. 2013;93(3):345–355. doi: 10.2522/ptj.20120263.
    1. George SZ, Wittmer VT, Fillingim RB, Robinson ME. Comparison of graded exercise and graded exposure clinical outcomes for patients with chronic low back pain. J Orthop Sports Phys Ther. 2010;40(11):694–704. doi: 10.2519/jospt.2010.3396.
    1. George SZ, Zeppieri G. Physical therapy utilization of graded exposure for patients with low back pain. J Orthop Sports Phys Ther. 2009;39(7):496–505. doi: 10.2519/jospt.2009.2983.
    1. Rubinstein SM, van Middelkoop M, Assendelft WJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for chronic low-back pain. Cochrane Database Syst Rev. 2011;2:CD008112.
    1. Swenson R, Haldeman S. Spinal manipulative therapy for low back pain. J Am Acad Orthop Surg. 2003;11(4):228–237. doi: 10.5435/00124635-200307000-00002.
    1. Bronfort G, Haas M, Evans RL, Bouter LM. Efficacy of spinal manipulation and mobilization for low back pain and neck pain: a systematic review and best evidence synthesis. Spine J. 2004;4(3):335–356. doi: 10.1016/j.spinee.2003.06.002.
    1. Borys C, Lutz J, Strauss B, Altmann U. Effectiveness of a multimodal therapy for patients with chronic low back pain regarding pre-admission healthcare utilization. PLoS ONE. 2015;10(11):e0143139. doi: 10.1371/journal.pone.0143139.
    1. Campbell J, Colvin LA. Management of low back pain. BMJ. 2013;347:f3148. doi: 10.1136/bmj.f3148.
    1. Chou R, Qaseem A, Owens DK, Shekelle P. Clinical Guidelines Committee of the American College of Physicians: diagnostic imaging for low back pain: advice for high-value health care from the American College of Physicians. Ann Intern Med. 2011;154(3):181–189. doi: 10.7326/0003-4819-154-3-201102010-00008.
    1. Last AR, Hulbert K. Chronic low back pain: evaluation and management. Am Fam Physician. 2009;79(12):1067–1074.
    1. Louw A, Diener I, Butler DS, Puentedura EJ. The effect of neuroscience education on pain, disability, anxiety, and stress in chronic musculoskeletal pain. Arch Phys Med Rehabil. 2011;92(12):2041–2056. doi: 10.1016/j.apmr.2011.07.198.
    1. Leeuw M, Goossens ME, Linton SJ, Crombez G, Boersma K, Vlaeyen JW. The fear-avoidance model of musculoskeletal pain: current state of scientific evidence. J Behav Med. 2007;30(1):77–94. doi: 10.1007/s10865-006-9085-0.
    1. Kovacs F, Abraira V, Santos S, Diaz E, Gestoso M, Muriel A, Gil del Real MT, Mufraggi N, Noguera J, Zamora J. Spanish Back Pain Research Network: a comparison of two short education programs for improving low back pain-related disability in the elderly: a cluster randomized controlled trial. Spine (Phila Pa 1976). 2007;32(10):1053–1059. doi: 10.1097/01.brs.0000261556.84266.0f.
    1. Albaladejo C, Kovacs FM, Royuela A, del Pino R, Zamora J. Spanish Back Pain Research Network: the efficacy of a short education program and a short physiotherapy program for treating low back pain in primary care: a cluster randomized trial. Spine (Phila Pa 1976). 2010;35(5):483–496. doi: 10.1097/BRS.0b013e3181b9c9a7.
    1. Smeets RJ, Vlaeyen JW, Hidding A, Kester AD, van der Heijden GJ, van Geel AC, Knottnerus JA. Active rehabilitation for chronic low back pain: cognitive-behavioral, physical, or both? First direct post-treatment results from a randomized controlled trial [ISRCTN22714229. BMC Musculoskelet Disord. 2006;7:5. doi: 10.1186/1471-2474-7-5.
    1. Rutledge T, Atkinson JH, Chircop-Rollick T, D’Andrea J, Garfin S, Patel S, Penzien DB, Wallace M, Weickgenant AL, Slater M. Randomized controlled trial of telephone-delivered cognitive behavioral therapy versus supportive care for chronic back pain. Clin J Pain. 2017
    1. Luk KD, Wan TW, Wong YW, Cheung KM, Chan KY, Cheng AC, Kwan MW, Law KK, Lee PW, Cheing GL. A multidisciplinary rehabilitation programme for patients with chronic low back pain: a prospective study. J Orthop Surg (Hong Kong) 2010;18(2):131–138. doi: 10.1177/230949901001800201.
    1. George SZ, Valencia C, Beneciuk JM. A psychometric investigation of fear-avoidance model measures in patients with chronic low back pain. J Orthop Sports Phys Ther. 2010;40(4):197–205. doi: 10.2519/jospt.2010.3298.
    1. Maughan EF, Lewis JS. Outcome measures in chronic low back pain. Eur Spine J. 2010;19(9):1484–1494. doi: 10.1007/s00586-010-1353-6.
    1. Huijnen I, Verbunt J, Wittink H, Smeets J. Physical performance measurement in chronic low back pain: measuring physical capacity or pain-related behaviour? Eur J Physiother. 2013;15(3):103–110. doi: 10.3109/21679169.2013.830643.
    1. Plaas H, Sudhaus S, Willburger R, Hasenbring MI. Physical activity and low back pain: the role of subgroups based on the avoidance-endurance model. Disabil Rehabil. 2014;36(9):749–755. doi: 10.3109/09638288.2013.814723.
    1. Alschuler KN, Hoodin F, Murphy SL, Rice J, Geisser ME. Factors contributing to physical activity in a chronic low back pain clinical sample: a comprehensive analysis using continuous ambulatory monitoring. Pain. 2011;152(11):2521–2527. doi: 10.1016/j.pain.2011.07.017.
    1. van Weering MG, Vollenbroek-Hutten MM, Hermens HJ. The relationship between objectively and subjectively measured activity levels in people with chronic low back pain. Clin Rehabil. 2011;25(3):256–263. doi: 10.1177/0269215510380828.
    1. Hendrick P, Milosavljevic S, Bell ML, Hale L, Hurley DA, McDonough SM, Melloh M, Baxter DG. Does physical activity change predict functional recovery in low back pain? Protocol for a prospective cohort study. BMC Musculoskelet Disord. 2009;10:136. doi: 10.1186/1471-2474-10-136.
    1. van Weering MG, Vollenbroek-Hutten MM, Tonis TM, Hermens HJ. Daily physical activities in chronic lower back pain patients assessed with accelerometry. Eur J Pain. 2009;13(6):649–654. doi: 10.1016/j.ejpain.2008.07.005.
    1. Hasenbring MI, Plaas H, Fischbein B, Willburger R. The relationship between activity and pain in patients 6 months after lumbar disc surgery: do pain-related coping modes act as moderator variables? Eur J Pain. 2006;10(8):701–709. doi: 10.1016/j.ejpain.2005.11.004.
    1. Liszka-Hackzell JJ, Martin DP. An analysis of the relationship between activity and pain in chronic and acute low back pain. Anesth Analg. 2004;99(2):477–481. doi: 10.1213/01.ANE.0000132696.15310.DD.
    1. Verbunt JA, Westerterp KR, van der Heijden GJ, Seelen HA, Vlaeyen JW, Knottnerus JA. Physical activity in daily life in patients with chronic low back pain. Arch Phys Med Rehabil. 2001;82(6):726–730. doi: 10.1053/apmr.2001.23182.
    1. Gomersall SR, Ng N, Burton NW, Pavey TG, Gilson ND, Brown WJ. Estimating physical activity and sedentary behavior in a free-living context: a pragmatic comparison of consumer-based activity trackers and ActiGraph accelerometry. J Med Internet Res. 2016;18(9):e239. doi: 10.2196/jmir.5531.
    1. Troiano RP. Large-scale applications of accelerometers: new frontiers and new questions. Med Sci Sports Exerc. 2007;39(9):1501. doi: 10.1097/mss.0b013e318150d42e.
    1. Crouter SE, Churilla JR, Bassett DR., Jr Estimating energy expenditure using accelerometers. Eur J Appl Physiol. 2006;98(6):601–612. doi: 10.1007/s00421-006-0307-5.
    1. Vanhees L, Lefevre J, Philippaerts R, Martens M, Huygens W, Troosters T, Beunen G. How to assess physical activity? How to assess physical fitness? Eur J Cardiovasc Prev Rehabil. 2005;12(2):102–114. doi: 10.1097/00149831-200504000-00004.
    1. Prince SA, Adamo KB, Hamel ME, Hardt J, Connor Gorber S, Tremblay M. A comparison of direct versus self-report measures for assessing physical activity in adults: a systematic review. Int J Behav Nutr Phys Act. 2008;5:56. doi: 10.1186/1479-5868-5-56.
    1. Downs A, Van Hoomissen J, Lafrenz A, Julka DL. Accelerometer-measured versus self-reported physical activity in college students: implications for research and practice. J Am Coll Health. 2014;62(3):204–212. doi: 10.1080/07448481.2013.877018.
    1. Dyrstad SM, Hansen BH, Holme IM, Anderssen SA. Comparison of self-reported versus accelerometer-measured physical activity. Med Sci Sports Exerc. 2014;46(1):99–106. doi: 10.1249/MSS.0b013e3182a0595f.
    1. Moy ML, Matthess K, Stolzmann K, Reilly J, Garshick E. Free-living physical activity in COPD: assessment with accelerometer and activity checklist. J Rehabil Res Dev. 2009;46(2):277–286. doi: 10.1682/JRRD.2008.07.0083.
    1. Aadland E, Ylvisaker E. Reliability of the actigraph GT3X+ accelerometer in adults under free-living conditions. PLoS ONE. 2015;10(8):e0134606. doi: 10.1371/journal.pone.0134606.
    1. Hart TL, Swartz AM, Cashin SE, Strath SJ. How many days of monitoring predict physical activity and sedentary behaviour in older adults? Int J Behav Nutr Phys Act. 2011;8:62. doi: 10.1186/1479-5868-8-62.
    1. Schuelter-Trevisol F, Wolff FH, Alencastro PR, Grigoletti S, Ikeda ML, Brandao AB, Barcellos NT, Fuchs SC. Physical activity: do patients infected with HIV practice? How much? A systematic review. Curr HIV Res. 2012;10(6):487–497. doi: 10.2174/157016212802429794.
    1. Qi Q, Strizich G, Merchant G, Sotres-Alvarez D, Buelna C, Castaneda SF, Gallo LC, Cai J, Gellman MD, Isasi CR, Moncrieft AE, Sanchez-Johnsen L, Schneiderman N, Kaplan RC. Objectively measured sedentary time and cardiometabolic biomarkers in US hispanic/latino adults: the hispanic community health study/study of latinos (HCHS/SOL) Circulation. 2015;132(16):1560–1569. doi: 10.1161/CIRCULATIONAHA.115.016938.
    1. Freedson PS, Lyden K, Kozey-Keadle S, Staudenmayer J. Evaluation of artificial neural network algorithms for predicting METs and activity type from accelerometer data: validation on an independent sample. J Appl Physiol. 2011;111(6):1804–1812. doi: 10.1152/japplphysiol.00309.2011.
    1. Keller A, Hayden J, Bombardier C, van Tulder M. Effect sizes of non-surgical treatments of non-specific low-back pain. Eur Spine J. 2007;16(11):1776–1788. doi: 10.1007/s00586-007-0379-x.
    1. Saffer H, Dave D, Grossman M, Leung LA. Racial, ethnic, and gender differences in physical activity. J Hum Cap. 2013;7(4):378–410. doi: 10.1086/671200.
    1. Marshall SJ, Jones DA, Ainsworth BE, Reis JP, Levy SS, Macera CA. Race/ethnicity, social class, and leisure-time physical inactivity. Med Sci Sports Exerc. 2007;39(1):44–51. doi: 10.1249/01.mss.0000239401.16381.37.

Source: PubMed

3
S'abonner