Physiotherapy for sleep disturbance in people with chronic low back pain: results of a feasibility randomized controlled trial

Arch Phys Med Rehabil. 2013 Nov;94(11):2083-92. doi: 10.1016/j.apmr.2013.04.017. Epub 2013 May 2.


Objective: To determine the feasibility of a randomized controlled trial investigating the effectiveness of physiotherapy for sleep disturbance in chronic low back pain (CLBP) (≥12wks).

Design: Randomized controlled trial with evaluations at baseline, 3 months, and 6 months.

Setting: Outpatient physiotherapy department in an academic teaching hospital.

Participants: Participants with CLBP were randomly assigned to a walking program (n=20; mean age ± SD, 46.4±13.8y), supervised exercise class (n=20; mean age ± SD, 41.3±11.9y), or usual physiotherapy (n=20; mean age ± SD, 47.1±14.3y). The 3-month evaluation was completed by 44 participants (73%), and 42 (70%) participants completed the 6-month evaluation.

Interventions: Participants received a physiotherapy-delivered 8-week walking program, an 8-week group supervised exercise class (1 class/wk), or 1-to-1 usual physiotherapy (advice, manual therapy, and exercise).

Main outcome measures: Sleep was assessed by the self-reported Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Pittsburgh Sleep Diary, and objective actigraphy.

Results: Groups were comparable at baseline. Most (95%, n=57) of the participants had sleep disturbance. The acceptability of actigraphy was excellent at baseline (58 of 60 participants), but dropped at 3 months (26 of 44 participants). There were improvements on the PSQI and ISI in all groups at 3 and 6 months, with predominantly medium effect sizes (Cohen d=0.2-0.5).

Conclusions: The high prevalence of sleep disturbance indicated the feasibility of good recruitment in future trials. The PSQI would be a suitable screening tool and outcome measure alongside an objective nonobtrusive sleep outcome measure. The effectiveness of physiotherapy for sleep disturbance in CLBP warrants investigation in a fully powered randomized controlled trial.

Keywords: Actigraphy; CLBP; Dyssomnias; ISI; Insomnia Severity Index; LBP; Low back pain; MCID; PSD; PSQI; Physical therapy specialty; Pittsburgh Sleep Diary; Pittsburgh Sleep Quality Index; RCT; Rehabilitation; SE; SEC; TST; UP; WP; chronic low back pain; low back pain; minimal clinically important difference; randomized controlled trial; sleep efficiency; supervised exercise class; total sleep time; usual physiotherapy; walking program.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Chronic Disease
  • Feasibility Studies
  • Female
  • Humans
  • Intention to Treat Analysis
  • Low Back Pain / epidemiology
  • Low Back Pain / rehabilitation*
  • Male
  • Middle Aged
  • Physical Therapy Modalities*
  • Prevalence
  • Sleep Wake Disorders / epidemiology
  • Sleep Wake Disorders / rehabilitation*
  • Walking

Associated data

  • ISRCTN/ISRCTN54009836