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Open Access Highly Accessed Study protocol

A walking programme and a supervised exercise class versus usual physiotherapy for chronic low back pain: a single-blinded randomised controlled trial. (The Supervised Walking In comparison to Fitness Training for Back Pain (SWIFT) Trial)

Deirdre A Hurley1*, Grainne O'Donoghue1, Mark A Tully2, Jennifer Klaber Moffett3, Willem van Mechelen4, Leslie Daly5, Colin AG Boreham6 and Suzanne M McDonough7

Author Affiliations

1 School of Physiotherapy & Performance Science, University College Dublin, Dublin 4, Ireland

2 Centre of Excellence for Public Health (Northern Ireland), Queens University Belfast, Mulhouse, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BJ, Northern Ireland

3 Institute of Rehabilitation, University of Hull, 215 Analaby Road, Hull, HU3 2PG, UK

4 EMGO Institute and Department of Public Health and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands

5 School of Public Health and Population Science, University College Dublin, Dublin 4, Ireland

6 Institute for Sport and Health, Phillips Building, University College Dublin, Dublin 4, Ireland

7 Health and Rehabilitation Sciences Research Institute, University of Ulster, Jordanstown Campus, Antrim, BT37 0QB, Northern Ireland

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BMC Musculoskeletal Disorders 2009, 10:79  doi:10.1186/1471-2474-10-79

Published: 2 July 2009

Abstract

Background

Chronic low back pain (CLBP) is a persistent disabling condition with rising significant healthcare, social and economic costs. Current research supports the use of exercise-based treatment approaches that encourage people with CLBP to assume a physically active role in their recovery. While international clinical guidelines and systematic reviews for CLBP support supervised group exercise as an attractive first-line option for treating large numbers of CLBP patients at low cost, barriers to their delivery include space and time restrictions in healthcare settings and poor patient attendance. The European Clinical Guidelines have identified the need for research in the use of brief/minimal contact self-activation interventions that encourage participation in physical activity for CLBP. Walking may be an ideally suited form of individualized exercise prescription as it is easy to do, requires no special skills or facilities, and is achievable by virtually all ages with little risk of injury, but its effectiveness for LBP is unproven.

Methods and design

This study will be an assessor-blinded randomized controlled trial that will investigate the difference in clinical effectiveness and costs of an individualized walking programme and a supervised general exercise programme compared to usual physiotherapy, which will act as the control group, in people with chronic low back pain. A sample of 246 patients will be recruited in Dublin, Ireland through acute general hospital outpatient physiotherapy departments that provide treatment for people with CLBP. Patients will be randomly allocated to one of the three groups in a concealed manner. The main outcomes will be functional disability, pain, quality of life, fear avoidance, back beliefs, physical activity, satisfaction and costs, which will be evaluated at baseline, and 3, 6 and 12 months [follow-up by pre-paid postage]. Qualitative telephone interviews and focus groups will be embedded in the research design to obtain feedback about participants' experiences of the interventions and trial participation, and to inform interpretation of the quantitative data. Planned analysis will be by intention to treat (quantitative data) and thematic analysis (qualitative data)

Discussion

The trial will evaluate the effectiveness of a walking programme and a supervised general exercise programme compared to usual physiotherapy in people with CLBP.

Trial registration

Current controlled trial ISRCTN17592092