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Krein SL, Kadri R, Hughes M, Kerr EA, Piette JD, Holleman R, Richardson C. Veterans walk to beat back pain: randomized trial 6 month results. Paper presented at: VA HSR&D / QUERI National Meeting; 2012 Jul 17; National Harbor, MD.
Objectives: Chronic back pain is a significant problem, affecting at least half of VA primary care patients. Although exercise is one of the most effective management strategies, there are few programs to help people with chronic back pain initiate and maintain a regular exercise program. The objective of this study is to assess the efficacy of a pedometer-based Internet-mediated intervention for reducing pain-related functional interference among Veterans with chronic back pain. Methods: We report pre-specified 6-month results from a randomized controlled trial of an intervention that uses an enhanced pedometer, website, and e-community to assist Veterans with chronic back pain to initiate and maintain a regular walking program. The primary outcome is back pain-related disability as measured using the Roland and Morris Disability (RMD) Questionnaire. Secondary outcomes include walking (objectively measured by pedometer step counts), pain intensity, pain-related functional interference, pain-related fear avoidance, and self-efficacy for exercise. Results: 229 Veterans with chronic back pain were randomly assigned to the intervention (n = 110) or a control group (n = 118). Among those completing at 6 months, intervention patients reported significantly less back pain-related disability compared to controls (RMD: 7.2 vs. 9.2, p = 0.01) as well as lower pain scores (4.7 vs. 5.2, p = 0.05), less general pain-related functional interference (37.6 vs. 43.6, p = 0.02), and greater exercise self-efficacy (6.4 vs. 5.7, p = 0.004). While average step counts increased in the intervention group by approximately 700 steps, step counts for the control group decreased slightly. There was no difference in fear avoidance scores (13.2 vs. 14.0, p = 0.34) between the intervention and control groups. Implications: The intervention increased physical activity (walking) and improved functional status among Veterans with chronic back pain in the 6 months following enrollment. We are currently following enrolled Veterans to assess the extent to which these improvements are sustained over the subsequent six months. Impacts: A facilitated walking intervention that uses an enhanced pedometer and the Internet may be an important strategy for enhancing management and improving access to an effective exercise program for Veterans with chronic back pain.
