Email updates

Keep up to date with the latest news and content from BMC Musculoskeletal Disorders and BioMed Central.

Open Access Study protocol

Veterans walk to beat back pain: study rationale, design and protocol of a randomized trial of a pedometer-based Internet mediated intervention for patients with chronic low back pain

Sarah L Krein12*, Tabitha Metreger1, Reema Kadri1, Maria Hughes1, Eve A Kerr12, John D Piette12, Hyungjin Myra Kim13 and Caroline R Richardson14

Author Affiliations

1 VA Ann Arbor Health Services Research and Development Center of Excellence, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA

2 Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA

3 Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, MI, USA

4 Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI, USA

For all author emails, please log on.

BMC Musculoskeletal Disorders 2010, 11:205  doi:10.1186/1471-2474-11-205

Published: 13 September 2010



Chronic back pain is a significant problem worldwide and may be especially prevalent among patients receiving care in the U.S. Department of Veterans Affairs healthcare system. Back pain affects adults at all ages and is associated with disability, lost workplace productivity, functional limitations and social isolation. Exercise is one of the most effective strategies for managing chronic back pain. Yet, there are few clinical programs that use low cost approaches to help patients with chronic back pain initiate and maintain an exercise program.


We describe the design and rationale of a randomized controlled trial to assess the efficacy of a pedometer-based Internet mediated intervention for patients with chronic back pain. The intervention uses an enhanced pedometer, website and e-community to assist these patients with initiating and maintaining a regular walking program with the primary aim of reducing pain-related disability and functional interference. The study specific aims are: 1) To determine whether a pedometer-based Internet-mediated intervention reduces pain-related functional interference among patients with chronic back pain in the short term and over a 12-month timeframe. 2) To assess the effect of the intervention on walking (measured by step counts), quality of life, pain intensity, pain related fear and self-efficacy for exercise. 3) To identify factors associated with a sustained increase in walking over a 12-month timeframe among patients randomized to the intervention.


Exercise is an integral part of managing chronic back pain but to be effective requires that patients actively participate in the management process. This intervention is designed to increase activity levels, improve functional status and make exercise programs more accessible for a broad range of patients with chronic back pain.

Trial Registration Number