Does a patient’s physical activity predict recovery from an episode of acute low back pain? A prospective cohort study

BMC Musculoskeletal Disorders

G David Baxter³  Peter Herbison²  Suzanne M McDonough⁴  Deirdre A Hurley⁵  Leigh Hale³  Stephan Milosavljevic³  Paul Hendrick¹ 

[1] Division of Physiotherapy Education, University of Nottingham, Hucknall Road, Nottingham NG5 1PB, UK;Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand;Centre for Physiotherapy Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand;Faculty of Life and Health Sciences, University of Ulster, Newtownabbey, Northern Ireland;School of Public Health, Physiotherapy and Population Science, College of Life Sciences, University College Dublin, Belfield, Ireland

关键词: Cohort;    Predictor;    Recovery;    Acute low back pain;    Physical activity;   

Others  :  1132992
DOI  :  10.1186/1471-2474-14-126

 received in 2012-08-29, accepted in 2013-04-02,  发布年份 2013

【 摘 要 】

Background

Advice to remain active and normalisation of activity are commonly prescribed in the management of low back pain (LBP). However, no research has assessed whether objective measurements of physical activity predict outcome and recovery in acute low back pain.

Method

The aims of this study were to assess the predictive relationship between activity and disability at 3 months in a sub-acute LBP population. This prospective cohort study recruited 101 consenting patients with sub-acute LBP (< 6 weeks) who completed the Roland Morris Disability Questionnaire (RMDQ), the Visual Analogue Scale, and resumption of full ‘normal’ activity question (Y/N), at baseline and 3 months. Physical activity was measured for 7 days at both baseline and at 3 months with an RT3 accelerometer and a recall questionnaire.

Results

Observed and self-reported measures of physical activity at baseline and change in activity from baseline to 3 months were not independent predictors of RMDQ (p > 0.05) or RMDQ change (p > 0.05) over 3 months. A self-report of a return to full ‘normal’ activities was significantly associated with greater RMDQ change score at 3 months (p < 0.001). Paired t-tests found no significant change in activity levels measured with the RT3 (p = 0.57) or the recall questionnaire (p = 0.38) from baseline to 3 months.

Conclusions

These results question the predictive role of physical activity in LBP recovery, and the assumption that activity levels change as LBP symptoms resolve. The importance of a patient’s perception of activity limitation in recovery from acute LBP was also highlighted.

Trial registration

Clinical Trial Registration Number, ACTRN12609000282280

【 授权许可】

   
2013 Hendrick et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Van Tulder M, Becker A, Bekkering T, Breen A, Del Real MTG, Hutchinson A, Koes B, Laerum E, Malmivaara A: Chapter 3: European guidelines for the management of acute nonspecific low back pain in primary care. Eur Spine J 2006, 15:S169-S191.
• [2]Staal JB, Hlobil H, van Tulder MW, Waddell G, Burton AK, Koes BW, van Mechelen W: Occupational health guidelines for the management of low back pain: an international comparison. Occup Environ Med 2003, 60:618-626.
• [3]Verbunt JA, Seelen HA, Vlaeyen JW, Van de Heijden GJ, Heuts PH, Pons K, Knottnerus JA: Disuse and deconditioning in chronic low back pain: Concepts and hypotheses on contributing mechanisms. Eur J Pain 2003, 7:9-21.
• [4]Goubert L, Crombez G, Hermans D, Vanderstraeten G: Implicit attitude towards pictures of back-stressing activities in pain-free subjects and patients with low back pain: An affective priming study. Eur J Pain 2003, 7:33-42.
• [5]Hasenbring M, Marienfeld G, Kuhlendahl D, Soyka D: Risk factors of chronicity in lumbar disc patients: A prospective investigation of biologic, psychologic, and social predictors of therapy outcome. Spine 1994, 19:2759-2765.
• [6]Basler HD, Luckmann J, Wolf U, Quint S: Fear-avoidance beliefs, physical activity, and disability in elderly individuals with chronic low back pain and healthy controls. Clin J Pain 2008, 24:604-610.
• [7]Smeets RJEM, Wittink H: The deconditioning paradigm for chronic low back pain unmasked? Pain 2007, 130:201-202.
• [8]Di Iorio A, Abate M, Guralnik JM, Bandinelli S, Cecchi F, Cherubini A, Corsonello A, Foschini N, Guglielmi M, Lauretani F: From chronic low back pain to disability, a multifactorial mediated pathway: The InCHIANTI study. Spine 2007, 32:E809-E815.
• [9]Smeets RJEM, Maher CG, Nicholas MK, Refshauge KM, Herbert RD: Do psychological characteristics predict response to exercise and advice for subacute low back pain? Arthrit Rheum-Arthr 2009, 61:1202-1209.
• [10]Bousema EJ, Verbunt JA, Seelen HAM, Vlaeyen JWS, Andre Knottnerus J: Disuse and physical deconditioning in the first year after the onset of back pain. Pain 2007, 130:279-286.
• [11]Hurwitz EL, Morgenstern H, Chiao C: Effects of recreational physical activity and back exercises on low back pain and psychological distress: findings from the UCLA Low Back Pain Study. Am J Public Health 2005, 95:1817-1824.
• [12]Mortimer M, Pernold G, Wiktorin C: Low back pain in a general population. Natural course and influence of physical exercise - A 5-year follow-up of the Musculoskeletal Intervention Center-Norrtalje Study. Spine 2006, 31:3045-3051.
• [13]Jacob T, Baras M, Zeev A, Epstein L: A longitudinal, community-based study of low back pain outcomes. Spine 2004, 29:1810-1817.
• [14]Oleske DM, Lavender SA, Andersson GBJ, Morrissey MJ, Zold-Kilbourn P, Allen C, Taylor E: Risk factors for recurrent episodes of work-related low back disorders in an industrial population. Spine 2006, 31:789-798.
• [15]Young Casey C, Greenberg MA, Nicassio PM, Harpin RE, Hubbard D: Transition from acute to chronic pain and disability: A model including cognitive, affective, and trauma factors. Pain 2008, 134:69-79.
• [16]Arnau JM, Vallano A, Lopez A, Pellise F, Delgado MJ, Prat N: A critical review of guidelines for low back pain treatment. Eur Spine J 2006, 15:543-553.
• [17]Grotle M, Brox JI, Vollestad NK: Concurrent comparison of responsiveness in pain and functional status measurements used for patients with low back pain. Spine 2004, 29:E492-501.
• [18]Powell SM, Jones DI, Rowlands AV: Technical variability of the RT3 accelerometer. Med Sci Sport Exer 2003, 35:1773-1778.
• [19]Powell SM, Rowlands AV: Intermonitor variability of the RT3 accelerometer during typical physical activities. Med Sci Sport Exer 2004, 36:324-330.
• [20]Krasnoff JB, Kohn MA, Choy FKK, Doyle J, Johansen K, Painter PL: Interunit and intraunit reliability of the RT3 triaxial accelerometer. J Phys Act Health 2008, 5:527-538.
• [21]Hale LA, Pal J, Becker I: Measuring free-living physical activity in adults with and without neurologic dysfunction with a triaxial accelerometer. Arch Phys Med Rehab 2008, 89:1765-1771.
• [22]Bonnefoy M, Normand S, Pachiaudi C, Lacour JR, Laville M, Kostka T: Simultaneous validation of ten physical activity questionnaires in older men: a doubly labeled water study. J Am Geriatr Soc 2001, 49:28-35.
• [23]Washburn RA, Jacobsen DJ, Sonko BJ, Hill JO, Donnelly JE: The validity of the stanford seven-day physical activity recall in young adults. Med Sci Sport Exer 2003, 35:1374-1380.
• [24]Johansen KL, Painter P, Kent-Braun JA, Ng AV, Carey S, Da Silva M, Chertow GM: Validation of questionnaires to estimate physical activity and functioning in end-stage renal disease. Kidney Int 2001, 59:1121-1127.
• [25]Pols MA, Peeters PHM, Bueno De-Mesquita HB, Ocke MC, Wentink CA, Kemper HCG, Collette HJA: Validity and repeatability of a modified Baecke questionnaire on physical activity. Int J Epidemiol 1995, 24:381-388.
• [26]Jacob T, Baras M, Epstein L: Low back pain: Reliability of a set of pain measurement tools. Arch Phys Med Rehab 2001, 82:735-742.
• [27]Baecke J, Burema J, Frijters J: A short questionnaire for the measurement of habitual physical activity in epidemiological studies. Am J Clin Nutr 1982, 36:936-942.
• [28]Turner JA, Fulton-Kehoe D, Franklin G, Wickizer TM, Wu R: Comparison of the roland-morris disability questionnaire and generic health status measures: a population-based study of workers’ compensation back injury claimants. Spine 2003, 28:1061-1067.
• [29]Williamson A, Hoggart B: Pain: A review of three commonly used pain rating scales. J Clin Nurs 2005, 14:798-804.
• [30]Ostelo RWJG, de Vet HCW: Clinically important outcomes in low back pain. Best Pract Res Cl Rh 2005, 19:593-607.
• [31]Swinkels-Meewisse EJ, Swinkels RA, Verbeek AL, Vlaeyen JW, Oostendorp RA: Psychometric properties of the Tampa Scale for kinesiophobia and the fear-avoidance beliefs questionnaire in acute low back pain. Manual Ther 2003, 8:29-36.
• [32]Grotle M, Vollestad NK, Veierod MB, Brox JI: Fear-avoidance beliefs and distress in relation to disability in acute and chronic low back pain. Pain 2004, 112:343-352.
• [33]Woby SR, Watson PJ, Roach NK, Urmston M: Adjustment to chronic low back pain - The relative influence of fear-avoidance beliefs, catastrophizing, and appraisals of control. Behav Res Ther 2004, 42:761-774.
• [34]Bashir K, Blizard R, Jenkins R, Mann A: Validation of the 12-item general health questionnaire in british general practice. Primary Care Psychia 1996, 2:245-247.
• [35]Croft PR, Papageorgiou AC, Ferry S, Thomas E, Jayson MIV, Silman AJ: Psychologic distress and low back pain: Evidence from a prospective study in the general population. Spine 1995, 20:2731-2737.
• [36]Feyer AM, Herbison P, Williamson AM, De Silva I, Mandryk J, Hendrie L, Hely MCG: The role of physical and psychological factors in occupational low back pain: A prospective cohort study. Occup Environ Med 2000, 57:116-120.
• [37]Hendrick P, Milosavljevic S, Bell ML, Hale L, Hurley DA, McDonough SM, Melloh M, Baxter DG: Does physical activity change predict functional recovery in low back pain? Protocol for a prospective cohort study. BMC Musculoskelet Disord 2009, 10:136. BioMed Central Full Text
• [38]Gretebeck RJ, Montoye HJ: Variability of some objective measures of physical activity. Med Sci Sport Exer 1992, 24:1167-1172.
• [39]Chen C, Jerome GJ, LaFerriere D, Young DR, Vollmer WM: Procedures used to standardize data collected by RT3 triaxial accelerometers in a large-scale weight-loss trial. J Phys Act Health 2009, 6:354-359.
• [40]Huijnen IPJ, Verbunt JA, Roelofs J, Goossens M, Peters M: The disabling role of fluctuations in physical activity in patients with chronic low back pain. Eur J Pain 2009, 13:1076-1079.
• [41]Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, Swartz AM, Strath SJ, O’Brien WL, Bassett DR Jr, Schmitz KH, Emplaincourt PO: Compendium of physical activities: An update of activity codes and MET intensities. Med Sci Sports Exerc 2000, 32:S498-504.
• [42]Ostelo RWJG, Deyo RA, Stratford P, Waddell G, Croft P, Von Korff M, Bouter LM, De Vet HC: Interpreting change scores for pain and functional status in low back pain: Towards international consensus regarding minimal important change. Spine 2008, 33:90-94.
• [43]Ghoname EA, Craig WF, White PF, Ahmed HE, Hamza MA, Henderson BN, Gajraj NM, Huber PJ, Gatchel RJ: Percutaneous electrical nerve stimulation for low back pain: a randomized crossover study. JAMA 1999, 281:818-823.
• [44]McCracken LM, Gross RT, Eccleston C, McCracken LM, Gross RT, Eccleston C: Multimethod assessment of treatment process in chronic low back pain: comparison of reported pain-related anxiety with directly measured physical capacity. Behav Res Ther 2002, 40:585-594.
• [45]Bennett JA, Winters-Stone K, Nail LM, Scherer J: Definitions of Sedentary in physical-activity-intervention trials: A summary of the literature. J Aging Phy Activ 2006, 14:456-477.
• [46]Mark A, Merom D, Bauman A: How active at work? Differing physical activity demands by occupation. Journal of Occupational Health and Safety - Australia and New Zealand 2008, 24:63-72.
• [47]Davidson M: Rasch analysis of 24-, 18- and 11-item versions of the Roland-Morris Disability Questionnaire. Qual Life Res 2009, 18:473-481.
• [48]Lee CE, Simmonds MJ, Novy DM, Jones S: Self-reports and clinician-measured physical function among patients with low back pain: a comparison. Arch Phys Med Rehab 2001, 82:227-231.
• [49]Verbrugge LM, Jette AM: The disablement process. Soc Sci Med 1994, 38:1-14.
• [50]Crombez G, Vervaet L, Lysens R, Baeyens F, Eelen P: Avoidance and confrontation of painful, back-straining movements in chronic back pain patients. Behav Modif 1998, 22:62-77.
• [51]Motl RW, McAuley E, Snook EM, Gliottoni RC: Physical activity and quality of life in multiple sclerosis: Intermediary roles of disability, fatigue, mood, pain, self-efficacy and social support. Psychol Health Med 2009, 14:111-124.
• [52]Burke V, Beilin LJ, Cutt HE, Mansour J, Mori TA: Moderators and mediators of behaviour change in a lifestyle program for treated hypertensives: A randomized controlled trial (ADAPT). Health Educ Res 2008, 23:583-591.
• [53]Verbunt JA, Sieben JM, Seelen HA, Vlaeyen JW, Bousema EJ, van der Heijden GJ, Knottnerus JA, Verbunt JA, Sieben JM, Seelen HAM: Decline in physical activity, disability and pain-related fear in sub-acute low back pain. Eur J Pain 2005, 9:417-425.
• [54]Damush TM, Weinberger M, Perkins SM, Rao JK, Tierney WM, Qi R, Clark DO: The long-term effects of a self-management program for inner-city primary care patients with acute low back pain. Arch Intern Med 2003, 163:2632-2638.
• [55]Vlaeyen JW, de Jong J, Geilen M, Heuts PH, van Breukelen G: The treatment of fear of movement/(re)injury in chronic low back pain: further evidence on the effectiveness of exposure in vivo. Clin J Pain 2002, 18:251-261.
• [56]Smeets RJ, van Geel KD, Verbunt JA: Is the fear avoidance model associated with the reduced level of aerobic fitness in patients with chronic Low back pain? Arch Phys Med Rehab 2009, 90:109-117.
• [57]Williamson E: Fear Avoidance Beliefs Questionnaire (FABQ). Aust J Physiother 2006, 52:149.
• [58]Kovacs FM, Abraira V, Royuela A, Corcoll J, Alegre L, Cano A, Muriel A, Zamora J, Gil Del Real MT, Gestoso M, Mufraggi N: Minimal clinically important change for pain intensity and disability in patients with nonspecific low back pain. Spine 2007, 32:2915-2920.
• [59]Warren JM, Ekelund U, Besson H, Mezzani A, Geladas N, Vanhees L: Assessment of physical activity - A review of methodologies with reference to epidemiological research: A report of the exercise physiology section of the European Association of Cardiovascular Prevention and Rehabilitation. Eur J Cardiov Prev R 2010, 17:127-139.
• [60]Cervantes CM, Porretta DL: Physical activity measurement among individuals with disabilities: A literature review. Adapt Phys Act Q 2010, 27:173-190.
• [61]Ferguson FC, Brownlee M, Webster V: A Delphi study investigating consensus among expert physiotherapists in relation to the management of low back pain. Musculoskeletal Care 2008, 6:197-210.
• [62]Fullen BM, Baxter GD, O’Donovan BGG, Doody C, Daly LE, Hurley DA: Factors impacting on doctors’ management of acute low back pain: A systematic review. Eur J Pain 2009, 13:908-914.
• [63]Clemes SA, Matchett N, Wane SL: Reactivity: An issue for short-term pedometer studies? Brit J Sport Med 2008, 42:68-70.
• [64]Behrens TK, Dinger MK: Motion sensor reactivity in physically active young adults. Res Q Exercise Sport 2007, 78:1-8.