2017 HSR&D/QUERI National Conference
4040 — Physical Activity for Older Adults with Chronic Low Back Pain, PACe-LBP: A Pilot Trial
Lead/Presenter: Shannon Taylor, COIN - Durham
All Authors: Taylor SS (Durham VA HealthCare System)
Goode AP (Duke University School of Medicine)
Coffman CJ (Durham VA HealthCare System, Duke University School of Medicine)
Allen KD (Durham VA HealthCare System, University of North Carolina)
The objective of this pilot trial was to collect preliminary data on the efficacy of physical activity (PA) only and PA + cognitive behavioral therapy for pain (CBT-P) programs for improving functional outcomes among older Veterans with chronic low back pain (cLBP).
Sixty older Veterans with cLBP at the Durham VA HealthCare System were randomized to 12-week PA only or PA + CBT-P interventions or a waitlist control group. Interventions were home-based, with one face-to-face visit to demonstrate the PA program, followed by telephone check-ins. The PA intervention included stretching, strengthening, and aerobic activities; CBT-P was tailored to specific issues for older adults with cLBP. Outcomes measured at baseline and 12-weeks were: an objective test of general physical function (timed up-and-go; TUG), self-report of LBP-specific disability (Roland-Morris Low Back Pain and Disability Questionnaire; RMD-Q), the Satisfaction with Physical Function Scale, and pain catastrophizing (from the Coping Strategies Questionnaire). We conducted paired t-tests to assess within-group changes in outcomes, focusing on effect sizes (Cohen's d) and clinical relevance of these changes.
Mean age of participants was 70.3 years; 53% were Non-white, 93% Male, and 83% had back pain symptoms lasting longer than 5 years. Participants in both PA and PA + CBT-P groups had small to large effect size improvements between baseline and 12-weeks in objective physical functioning (TUG), LBP-specific disability (RMD-Q), and satisfaction with physical functioning; in contrast, participants in the control group had small to medium effect size declines in these measures. PA group improvement in mean RMD-Q was clinically meaningful. Individuals in all three groups reported small to medium effect size decreases in mean pain catastrophizing.
In this pilot trial, a home-based telephone-supported PA intervention resulted in a large effect size for physical function improvements and clinically-meaningful improvement in disease-specific function in older adults with cLBP. Results provide support for a larger trial.
This project is a key first step in evaluating home-based PA and PA + CBT-P programs that could be widely disseminated in the VA at relatively low cost and reach many functionally vulnerable older Veterans with cLBP to improve PA and physical function.