Reducing sedentary behaviour to decrease chronic low back pain: the stand back randomised trial

Abstract

Objective: The Stand Back study evaluated the feasibility and effects of a multicomponent intervention targeting reduced prolonged sitting and pain self-management in desk workers with chronic low back pain (LBP).

Methods: This randomised controlled trial recruited 27 individuals with chronic LBP, Oswestry Disability Index (ODI) >10% and desk jobs (sitting ≥20 hours/week). Participants were randomised within strata of ODI (>10%-<20%, ≥20%) to receive bimonthly behavioural counselling (in-person and telephone), a sit-stand desk attachment, a wrist-worn activity-prompting device and cognitive behavioural therapy for LBP self-management or control. Self-reported work sitting time, visual analogue scales (VAS) for LBP and the ODI were assessed by monthly, online questionnaires and compared across intervention groups using linear mixed models.

Results: Baseline mean (SD) age was 52 (11) years, 78% were women, and ODI was 24.1 (10.5)%. Across the 6-month follow-up in models adjusted for baseline value, work sitting time was 1.5 hour/day (P<0.001) lower comparing intervention to controls. Also across follow-up, ODI was on average 8 points lower in intervention versus control (P=0.001). At 6 months, the relative decrease in ODI from baseline was 50% in intervention and 14% in control (P=0.042). LBP from VAS was not significantly reduced in intervention versus control, though small-to-moderate effect sizes favouring the intervention were observed (Cohen's d ranged from 0.22 to 0.42).

Conclusion: An intervention coupling behavioural counselling targeting reduced sedentary behaviour and pain self-management is a translatable treatment strategy that shows promise for treating chronic LBP in desk-bound employees.

Trial registration number: NCT0224687; Pre-results.

Trial registration: ClinicalTrials.gov NCT02624687.

Keywords: disability; low back pain; physical function; sedentary behavior; sit-stand desk.

Figure 1.

Participant Flow Diagram

Figure 2.. Sitting Time by Intervention Group.

Plotted values are mean ± SEM. Numerical data reported in Appendix Table 1. Group effect calculated from a linear mixed model adjusting for baseline value, time, and education. * indicates difference between groups with p<0.05 at specific month

Figure 3.. Oswestry Disability Index by Intervention Group.

Plotted values are mean ± SEM. Numerical data reported in Appendix Table 1. Group effect calculated from a linear mixed model adjusting for baseline value, time, and education. * indicates difference between groups with p<0.05 at specific month