Reducing sedentary behaviour to decrease chronic low back pain: the stand back randomised trial

Abstract

Objective: The Stand Back study evaluated the feasibility and effects of a multicomponent intervention targeting reduced prolonged sitting and pain self-management in desk workers with chronic low back pain (LBP).

Methods: This randomised controlled trial recruited 27 individuals with chronic LBP, Oswestry Disability Index (ODI) >10% and desk jobs (sitting ≥20 hours/week). Participants were randomised within strata of ODI (>10%-<20%, ≥20%) to receive bimonthly behavioural counselling (in-person and telephone), a sit-stand desk attachment, a wrist-worn activity-prompting device and cognitive behavioural therapy for LBP self-management or control. Self-reported work sitting time, visual analogue scales (VAS) for LBP and the ODI were assessed by monthly, online questionnaires and compared across intervention groups using linear mixed models.

Results: Baseline mean (SD) age was 52 (11) years, 78% were women, and ODI was 24.1 (10.5)%. Across the 6-month follow-up in models adjusted for baseline value, work sitting time was 1.5 hour/day (P<0.001) lower comparing intervention to controls. Also across follow-up, ODI was on average 8 points lower in intervention versus control (P=0.001). At 6 months, the relative decrease in ODI from baseline was 50% in intervention and 14% in control (P=0.042). LBP from VAS was not significantly reduced in intervention versus control, though small-to-moderate effect sizes favouring the intervention were observed (Cohen's d ranged from 0.22 to 0.42).

Conclusion: An intervention coupling behavioural counselling targeting reduced sedentary behaviour and pain self-management is a translatable treatment strategy that shows promise for treating chronic LBP in desk-bound employees.

Trial registration number: NCT0224687; Pre-results.

Trial registration: ClinicalTrials.gov NCT02624687.

Keywords: disability; low back pain; physical function; sedentary behavior; sit-stand desk.

Conflict of interest statement

Competing interests: BBG reports being a Principal Investigator on studies funded by the National Institutes of Health, and the American Heart Association, and the Tomayko Foundation, and a Co-Investigator on studies funded by the Agency for Healthcare and Quality Research and the National Institutes of Health. BBG was also the Principal Investigator of a separate, investigator-initiated study funded by the Humanscale company; Humanscale had no role and provided no funding or supplies to this research. JMJ reports being one the Scientific Advisory Board for Weight Watchers International, a Co-Investigator on a study funded by Weight Watchers International awarded to the University of Pittsburgh, a Co-Investigator on a study funded by Humanscale awarded to the University of Pittsburgh, and a Principal and Co-Investigator on studies funded by the National Institutes of Health awarded to the University of Pittsburgh. JMJ was also a Co-Investigator of a separate, investigator-initiated study funded by the Humanscale company; Humanscale had no role and provided no funding or supplies to this research.

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Figures

Figure 1.

Participant Flow Diagram

Figure 2.. Sitting Time by Intervention Group.

Plotted values are mean ± SEM. Numerical data reported in Appendix Table 1. Group effect calculated from a linear mixed model adjusting for baseline value, time, and education. * indicates difference between groups with p

Figure 3.. Oswestry Disability Index by Intervention Group.

Plotted values are mean ± SEM. Numerical data reported in Appendix Table 1. Group effect calculated from a linear mixed model adjusting for baseline value, time, and education. * indicates difference between groups with p