Health Services Research & Development

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2017 HSR&D/QUERI National Conference Abstract

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4043 — Incorporating Walking into Cognitive Behavioral Therapy for Chronic Pain: Safety and Efficacy of a Progressive Walking Intervention

Lead/Presenter: Alicia Heapy, COIN - West Haven
All Authors: Heapy AA (VA Connecticut) Buta E (Yale University) Driscoll MA (VA Connecticut) Goulet JL (VA Connecticut) LaChappelle KM (VA Connecticut) Piette JD (VA Ann Arbor) Skein SL (VA Ann Arbor)

Objectives:
To examine the safety and efficacy of a pedometer-measured walking program to increase physical activity offered as part of cognitive behavioral therapy for chronic pain (CBT-CP).

Methods:
Veterans with chronic back pain engaged in 10 weeks of CBT-CP, delivered either in person or by interactive voice response (IVR). Participants reported pedometer-measured step counts via daily automated calls beginning one week before treatment and continuing through treatment termination. Beginning in week three, Veterans in both conditions were asked to increase their daily steps by 10% each week over the prior week's average. We proactively assessed for walking-related adverse events (AE) using weekly automated queries of participants and staff review of participants' medical charts. We used longitudinal linear mixed models to examine predictors of daily steps and the rate of change in steps including day in the trial, day of the week, treatment group, baseline body mass index (BMI), pain site, age, depressive symptom severity, and pain intensity as fixed effects.

Results:
Participants were 118 Veterans (mean (SD) age: 57.9 (11.6)) with longstanding pain (median: 12.5 years) of moderate intensity (mean 5.5/10), primarily Caucasian (64%) and male (78%). At baseline, participants were sedentary (mean steps/day = 4079, SD: 2643). There was no significant difference between groups in rate of change in steps per day, but there was a significant increase from baseline to the end of treatment in both groups (2071.7 steps (95% CI 1343.1 to 2800.3)). Older participants took fewer steps on average (p = .001) and day of the week was associated with steps (p < .0001) with the fewest steps occurring on Sundays (-823 fewer than Mondays). There were 92 AEs. Only two were serious and neither was related to study participation.

Implications:
A progressive walking program resulted in an average of one mile of additional daily steps among Veterans with chronic pain. Walking was safe for this sample of sedentary Veterans with longstanding chronic pain.

Impacts:
Walking has been shown to reduce pain and disability associated with chronic pain. A daily walking program incorporated into CBT-CP resulted in an increase in walking equivalent to, if not slightly better than, standalone walking programs for people with chronic pain.