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Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_10 | Pages 5 - 5
1 May 2017
Marley J McDonough S Tully M Bunting B O'Hanlon J Porter-Armstrong A
Full Access

Background

Chronic musculoskeletal pain increases an individual's risk of developing many chronic diseases and the risk of all-cause early mortality. There is irrefutable evidence supporting the role of physical activity (PA) in reducing these risks. Sustaining changes to PA behaviours is challenging and efforts are needed to understand the barriers and facilitators of change. Understanding these factors is a vital step in developing behaviour change interventions.

Objectives

Explore barriers and facilitators to engaging in PA in adults accessing pain services.

Explore barriers and facilitators to promoting PA by healthcare professionals, exercise professionals and charity staff/expert patients.


Orthopaedic Proceedings
Vol. 97-B, Issue SUPP_2 | Pages 16 - 16
1 Feb 2015
Campbell C Kerr D McDonough S Murphy M Tully M
Full Access

Background and purpose

To identify methods used to measure free living sedentary behaviour in people with back pain and review the validity and reliability of identified measures.

Methods

Databases including CINAHL, EMBASE, MEDLINE, AMED, PsycINFO, SPORTDiscus and the Sedentary Behaviour and Research Network website (www.sedentarybehaviour.org) were searched for relevant published articles up to June 2014. Studies which measured sedentary behaviour in people with back pain were included. Quality of the included studies was assessed using the Newcastle Ottawa Scale. The Consensus-based Standards for the Selection of Measurement Instruments (COSMIN) Checklist was used to assess psychometric properties.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_I | Pages 6 - 6
1 Jan 2012
O'Connor S Tully M Ryan B Baxter G Bradley J McDonough S
Full Access

Aims/background

Current treatment recommendations advocate various exercise modalities for people with chronic Low Back Pain (cLBP)1. Walking appears to represent an inexpensive and readily accessible activity for a range of individuals, including those who were previously sedentary. However, the effectiveness of such interventions are uncertain in cLBP.

Methods

A systematic review was undertaken to examine the effectiveness of walking interventions across a range of chronic musculoskeletal pain conditions, including LBP. Six electronic databases were searched for relevant studies. Data for pain and self reported function were extracted and where appropriate, results were pooled and analysed using RevMan (v.5).


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_I | Pages 47 - 47
1 Jan 2012
Lonsdale C Murray A Humphreys MT McDonough S Williams G Hurley D
Full Access

Purpose

This pilot study tested the feasibility of a self-determination theory-based communication skills training programme designed to increase physiotherapists' psychological needs supportive behaviour when treating patients with chronic low back pain (CLBP>12 weeks).

Methods

Both control (n = 4) and intervention (n = 3) physiotherapists received one hour of evidence-based CLBP management education. Intervention group physiotherapists also received six hours of autonomy-support training, utilizing the ‘5A’ health behaviour change model. Consenting participants [intervention n=16, mean (SD) age = 49.00 years (14.91); control n=12, mean (SD) age = 43.42 (11.70yrs)] completed the primary [self-reported PA, adherence to prescribed exercises, pain, disability, satisfaction] and secondary outcomes [psychological needs support, autonomous motivation, competence] at Week 1 and at Week 4.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_I | Pages 8 - 8
1 Jan 2012
Hurley D Eadie J Tully M van Mechelen W Boreham C McDonough S Lonsdale C Daly L
Full Access

Background and purpose

Sleep disturbance is a prevalent symptom in people with chronic low back pain (CLBP >12 weeks), but there is currently no knowledge of the effectiveness of physiotherapy for this problem. This study evaluated the feasibility of a randomised controlled trial (RCT) exploring the effects of physiotherapy on sleep disturbance in CLBP [Current controlled trial ISRCTN 54009836].

Methods

A sample of 60 consenting patients with CLBP [23 M, 37 F; mean (SD) age = 44.93 (13.41) years] were recruited in Beaumont Hospital, Dublin and randomly allocated to one of three groups [supervised exercise class (SEC), walking programme (WP) and usual physiotherapy (UP)] in a concealed manner. The main outcomes were sleep quality, functional disability, pain, and quality of life at baseline, 3 and 6 months.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_IV | Pages 489 - 490
1 Nov 2011
Hendrick P Hale L Bell M Milosavljevic S Hurley-Osing D McDonough S Baxter D
Full Access

Background: Activity advice and prescription are commonly used in the management of low back pain (LBP). However, no research has assessed whether objective measurements of physical activity predict outcome, recovery and course of LBP.

Methods: One hundred and one patients with acute LBP were recruited into a longitudinal cohort study. Each participant completed the Roland Morris Disability Questionnaire (RMDQ), Visual Analogue Scale and a “simple” activity question, detailing whether they had resumed full “normal” activities (Y/N), at baseline (T0) and 3 months (T1); Baecke Physical Activity Questionnaire, Fear-Avoidance Beliefs Questionnaire and the 12-item General Health Questionnaire at T0. Physical activity was measured for 7 days at T0 and T1 with an RT3 accelerometer and the seven day physical activity recall questionnaire (7d-PAR).

Results: The only significant predictor of RMDQ change was RMDQ score at T0 (p < .0001). Physical activity change did not predict RMDQ change in both univariate (p = 0.82) and multivariate analysis (p = 0.84). Paired t-tests found a significant change in RMDQ (p < .0001) and return to full “normal” activities (p < .0001) from T0 to T1, but no significant change in activity levels measured with the RT3 (p = 0.56) or the 7d-PAR (p = 0.43). RMDQ change (OR 1.72, p = 0.01) and RMDQ at T1 (OR 0.65, p = 0.04) predicted return to full “normal” activities at T1.

Conclusions: These results question the role of physical activity in LBP recovery and the assumption that activity levels change as LBP symptoms resolve.

Conflicts of Interest: None

Sources of Funding: This research was supported by a University of Otago Establishment Grant


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_IV | Pages 489 - 489
1 Nov 2011
McDonough S Hunter R Tully M Walsh D Dhamija S McCann S Liddle S Glasgow P Paterson C Gormley G Hurley D Delitto A Park J Bradbury I Baxter G
Full Access

Background and Purpose: Current clinical guidelines recommend supervised exercise as a first-line treatment in the management of low back pain (LBP). To date studies have not used objective forms of measuring changes in free-living physical activity (FLPA). The aim of this study was to compare FLPA between two groups who received either supervised exercise and auricular acupuncture (EAA) or exercise alone (E).

Methods: 51 patients with non-specific LBP [mean±SD=42.8±12.4 years] wore an accelerometer for 7 days at baseline, end of the intervention (week 8) and follow up (week 25). FLPA variables were extracted: % time (hours) spent in postures; daily step count and cadence. Data were analysed using SPSS (v15). Repeated measures ANCOVA were performed using a mixed linear model.

Results: There was no difference in daily step count between the two groups at any time point (E, mean±SD, week 1, 8197±2187; week 8, 8563±2438, week 25, 8149±2800; EAA, mean±SD, week 1, 8103±1942; week 8, 8010±2845, week 25, 8139±1480, p=0.9) or cadence. No differences in postures were noted, apart from time sitting/lying which was shorter at week 25 in the E group (p=0.006).

Conclusions & Implications: Supervised exercise classes, with or without acupuncture, do not produce changes in FLPA in the short term or longer term in people with LBP. This suggests more effective ways should be sought to encourage the patient to incorporate activity into their daily lives. These findings have informed the design of two walking intervention trials for LBP patients.

Conflict of Interest: None

Sources of Funding: Research and Development Office, Northern Ireland, Strategic Priority Fund, Department of Employment and Learning, Northern Ireland.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_I | Pages 235 - 235
1 Mar 2010
O’Donoghue G van Mechelen W Tully M Moffett JK Daly L Boreham C McDonough S Hurley D
Full Access

Background & Purpose: Clinical guidelines support physical activity for people with chronic low back pain (CLBP); walking is an ideal form of physical activity as it is easy to do, requires no special skills and is achievable by virtually all ages with little risk of injury but there are no current evidence-based structured walking programmes (WP) for this population. The purpose of this study was to develop a WP for CLBP patients in preparation for a proposed randomized controlled trial.

Methods: An 8-week structured WP was developed using Intervention Mapping (IM) principles:

literature review,

4 focus groups (n=18 CLBP patients),

Physiotherapist Interviews (n=4), and then pilot-tested in a consenting sample of 10 CLBP patients [n=5 male, 5 female; mean (SD)= 50.5 (12.6) years], who completed the 10-metre Shuttle Walk Test, Oswestry Disability Index, NRS, Euro-Qol, Fear Avoidance, Back Beliefs, International Physical Activity and Self-Efficacy Questionnaires, at baseline and 8-week follow-up, and wore the activPAL™ accelerometer for 7 days pre and post intervention.

Results: Both the CLBP patients and physiotherapists interviewed endorsed walking as a suitable form of physical activity, and identified possible barriers as fear avoidance, exacerbation of pain, behavioural change, motivation, time, personal safety and adverse weather. The pilot study found 90% compliance with the WP. Descriptive analysis of change scores showed improvements at 8-weeks in all self reported outcomes and objectively measured physical activity and functional capacity.

Conclusion: Intervention Mapping was successfully used to develop a WP intervention for chronic LBP, the efficacy of which is being evaluated in a randomized controlled trial.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_I | Pages 234 - 234
1 Mar 2010
Hurley D Brady L O’Brien E McDonough S Baxter G Heneghan C
Full Access

Background & Purpose: Current clinical guidelines support physical activity programmes for people with low back pain (LBP), but a major factor limiting their efficacy is the patient’s level of adherence, difficult to assess using self-report, and the lack of objective data on activity levels in this population. This study investigated differences in the self-report and objective activity levels of LBP patients and age-matched controls.

Methods: 20 patients with non-specific LBP [5 male, 15 female; mean (SD) age = 43.2 (12.1) years] and 20 healthy controls [10 male, 10 female; mean (SD) age = 39.6 (10.9) years] wore the activPAL™ uniaxial accelerometer on the anterior thigh during waking hours for 7 days, and completed the 7-Day Physical Activity Recall Questionnaire (7DRQ). Data were analysed using SPSS (v12).

Results: There was no difference between groups in energy expenditure as measured by the 7DRQ (p> 0.05), but the activPAL™ data showed LBP subjects expended significantly less energy than controls (p=0.004) over the 7-day period, and failed to reach the recommended 10,000 steps per day [mean (SD) = 8067.9 steps (2581.7)] compared to controls [mean (SD)= 10,864 (3,570.3); t = 2.84, p=0.007)]. The LBP subjects also had a significantly lower mean cadence (p=0.004), a lower walking index (p=0.001), and took significantly more short walks (0–100 steps) and less long walks (> 100 steps) than controls (p< 0.05).

Conclusions & Implications: People with LBP are less physically active than age-matched controls, and this is more evident with objective than subjective evaluation. These findings have informed the design of a targeted walking programme for LBP patients.