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Pedometer-Based Internet Mediated Intervention for Chronic Back Pain: Randomized Trial 6 Month Results.

Krein SL, Kadri R, Hughes M, Kerr EA, Piette JD, Holleman R, Kim M, Richardson CR. Pedometer-Based Internet Mediated Intervention for Chronic Back Pain: Randomized Trial 6 Month Results. Paper presented at: AcademyHealth Annual Research Meeting; 2012 Jun 25; Orlando, FL.

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Research Objective: Chronic back pain is a significant problem worldwide, affecting both younger and older adults including at least half of Veterans Health Administration (VHA) 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. Study Design: 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 patients with chronic back pain with initiating and maintaining 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. Population Studied: Veterans with chronic back pain ( > 3 months) receiving care at one VHA medical center. Principal Findings: 229 Veterans with chronic back pain were randomly assigned to the intervention or a control group. Among those completing 6 month assessments, intervention patients (n = 101/110) reported significantly less back pain-related disability compared to controls (n = 104/118) (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). Intent to treat analysis also showed significant differences in disability and pain scores between the intervention and control groups for patients with baseline RMD scores > 4. While average step counts increased in the intervention group by approximately 700 steps, step counts for the control group decreased slightly. There was no between-group difference in fear avoidance scores (13.2 vs. 14.0, p = 0.34). Conclusions: Patients in the Internet mediated intervention, compared with those in the control group, reported a greater decrease in pain related disability and increased their physical activity (walking) in the 6- months following study enrollment. Intervention patients also reported less pain and improvements in general pain-related function. We are currently following enrolled patients to assess the extent to which these improvements are sustained over the subsequent six months. Implications for Policy, Delivery or Practice: 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 patients with chronic back pain. Such intensive but primarily automated interventions can be used to deliver care with broad reach and could be an efficient way of delivering or supplementing care provided through traditional facility based programs.

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