Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2013 Aug 19;15(8):e181.
doi: 10.2196/jmir.2605.

Pedometer-based Internet-Mediated Intervention for Adults With Chronic Low Back Pain: Randomized Controlled Trial

Free PMC article
Randomized Controlled Trial

Pedometer-based Internet-Mediated Intervention for Adults With Chronic Low Back Pain: Randomized Controlled Trial

Sarah L Krein et al. J Med Internet Res. .
Free PMC article


Background: Chronic pain, especially back pain, is a prevalent condition that is associated with disability, poor health status, anxiety and depression, decreased quality of life, and increased health services use and costs. Current evidence suggests that exercise is an effective strategy for managing chronic pain. However, there are few clinical programs that use generally available tools and a relatively low-cost approach to help patients with chronic back pain initiate and maintain an exercise program.

Objective: The objective of the study was to determine whether a pedometer-based, Internet-mediated intervention can reduce chronic back pain-related disability.

Methods: A parallel group randomized controlled trial was conducted with 1:1 allocation to the intervention or usual care group. 229 veterans with nonspecific chronic back pain were recruited from one Department of Veterans Affairs (VA) health care system. Participants randomized to the intervention received an uploading pedometer and had access to a website that provided automated walking goals, feedback, motivational messages, and social support through an e-community (n=111). Usual care participants (n=118) also received the uploading pedometer but did not receive the automated feedback or have access to the website. The primary outcome was measured using the Roland Morris Disability Questionnaire (RDQ) at 6 months (secondary) and 12 months (primary) with a difference in mean scores of at least 2 considered clinically meaningful. Both a complete case and all case analysis, using linear mixed effects models, were conducted to assess differences between study groups at both time points.

Results: Baseline mean RDQ scores were greater than 9 in both groups. Primary outcome data were provided by approximately 90% of intervention and usual care participants at both 6 and 12 months. At 6 months, average RDQ scores were 7.2 for intervention participants compared to 9.2 for usual care, an adjusted difference of 1.6 (95% CI 0.3-2.8, P=.02) for the complete case analysis and 1.2 (95% CI -0.09 to 2.5, P=.07) for the all case analysis. A post hoc analysis of patients with baseline RDQ scores ≥4 revealed even larger adjusted differences between groups at 6 months but at 12 months the differences were no longer statistically significant.

Conclusions: Intervention participants, compared with those receiving usual care, reported a greater decrease in back pain-related disability in the 6 months following study enrollment. Between-group differences were especially prominent for patients reporting greater baseline levels of disability but did not persist over 12 months. Primarily, automated interventions may be an efficient way to assist patients with managing chronic back pain; additional support may be needed to ensure continuing improvements.

Trial registration: NCT00694018; (Archived by WebCite at

Keywords: Internet; chronic pain; exercise therapy; randomized controlled trial.

Conflict of interest statement

Conflicts of Interest: None declared.


Figure 1
Figure 1
Study flow diagram.
Figure 2
Figure 2
Mean RDQ scores (top) and MOS functional interference scores (bottom). A and B: full sample, C and D: patients with baseline RDQ scores ≥ 4.

Similar articles

See all similar articles

Cited by 21 articles

See all "Cited by" articles


    1. Deyo RA, Mirza SK, Martin BI. Back pain prevalence and visit rates: estimates from U.S. national surveys, 2002. Spine (Phila Pa 1976) 2006 Nov 1;31(23):2724–7. doi: 10.1097/ - DOI - PubMed
    1. Brooks PM. The burden of musculoskeletal disease--a global perspective. Clin Rheumatol. 2006 Nov;25(6):778–81. doi: 10.1007/s10067-006-0240-3. - DOI - PubMed
    1. Lawrence RC, Helmick CG, Arnett FC, Deyo RA, Felson DT, Giannini EH, Heyse SP, Hirsch R, Hochberg MC, Hunder GG, Liang MH, Pillemer SR, Steen VD, Wolfe F. Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States. Arthritis Rheum. 1998 May;41(5):778–99. doi: 10.1002/1529-0131(199805)41:5<778::AID-ART4>3.0.CO;2-V. - DOI - PubMed
    1. Koes BW, van Tulder MW, Thomas S. Diagnosis and treatment of low back pain. BMJ. 2006 Jun 17;332(7555):1430–4. doi: 10.1136/bmj.332.7555.1430. - DOI - PMC - PubMed
    1. Andersson GB. Epidemiological features of chronic low-back pain. Lancet. 1999 Aug 14;354(9178):581–5. doi: 10.1016/S0140-6736(99)01312-4. - DOI - PubMed

Publication types

Associated data