Individually tailored treatment targeting activity, motor behavior, and cognition reduces pain-related disability: a randomized controlled trial in patients with musculoskeletal pain. A randomized trial of walking versus physical methods for chronic pain management 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 One-year followup of patients with osteoarthritis of the knee who participated in a program of supervised fitness walking and supportive patient education. Supervised fitness walking in patients with osteoarthritis of the knee. A randomized, controlled trial. The effect of a task-oriented walking intervention on improving balance self-efficacy poststroke: a randomized, controlled trial. Exercise, self-efficacy, and mobility performance in overweight and obese older adults with knee osteoarthritis. A multidisciplinary rehabilitation programme improves disability, kinesiophobia and walking ability in subjects with chronic low back pain: results of a randomised controlled pilot study Treating disability in knee osteoarthritis with exercise therapy: a central role for self-efficacy and pain. Long-term efficacy and effectiveness of a behavioural and community-based exercise intervention (Urban Training) to increase physical activity in patients with COPD: a randomised controlled trial Self-efficacy and the progression of functional limitations and self-reported disability in older adults with knee pain. Performance Problems of Patients With Chronic Low-Back Pain and the Measurement of Patient-Centered Outcome Effectiveness of workplace interventions in rehabilitating musculoskeletal disorders and preventing its consequences among workers with physical and sedentary employment: systematic review protocol A randomized trial of functional electrical stimulation for walking in incomplete spinal cord injury: Effects on walking competency The Effectiveness of Exercise on Recovery and Clinical Outcomes in Patients With Soft Tissue Injuries of the Hip, Thigh, or Knee: A Systematic Review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. An evidence-based walking program among older people with knee osteoarthritis: the PEP (participant exercise preference) pilot randomized controlled trial The Back 2 Activity Trial: education and advice versus education and advice plus a structured walking programme for chronic low back pain
UNLABELLED This study compares the outcomes of an individually tailored behavioral medicine intervention ( experimental ) with physical exercise therapy ( control ) . The experimental intervention was systematic ally individualized according to each participant 's behavioral treatment goals and functional behavioral analyses . One hundred twenty-two patients seeking care at 3 primary health care clinics because of musculoskeletal pain were r and omized . Ninety-seven completed the trial . Data were collected at baseline , immediately after treatment , and at a 3-month follow-up . Analyses of data from completers , as well as intention-to-treat analyses , showed that the experimental group experienced lower levels of disability ( P = .01 ) , lower maximum pain intensity ( P = .02 ) , higher levels of pain control ( P = .001 ) , and lower fear of movement ( P = .022 ) as a result of treatment condition . Self-efficacy ( P = .0001 ) and physical performance ( P = .0001 ) increased over time for both groups . Participants in the experimental group generally reported more positive effects after treatment . Treatment fidelity was maintained during the course of the study . Activity can be resumed and pain might be managed by the patients themselves if treatment incorporates the biopsychosocial explanatory model of pain and strategies are tailored according to individual 's priorities of everyday life activities and empirically derived determinants of pain-related disability . PERSPECTIVE This study shows that the biomedical and the psychosocial perspectives of the experiences and consequences of pain complement rather than contradict each other . Primary health care patients with persistent musculoskeletal pain benefit more from a systematic tailoring of treatments according to biopsychosocial factors than from a physically based exercise intervention We conducted a pilot study to evaluate a practical exercise program for elderly people with chronic musculo-skeletal pain . Thirty-three subjects ( mean age , 73 years ; 69 % back pain ; 24 % knee pain ; 9 % hip pain ) were r and omly assigned to one of three groups . Group 1 received a 6-week supervised program of walking . Group 2 received a pain education program that included instruction and demonstration of use of heat , cold , massage , relaxation and distraction . Group 3 received usual care . Outcomes including pain , self-reported health and functional status , and performance-based measures of functional status were evaluated at baseline , at two weeks and at eight weeks ( end of study ) . Attendance was 100 % for the education sessions and 93 % for walking sessions . No injuries were sustained . Both intervention groups demonstrated significant improvements in pain ( p<0.05 ) and performance-based measures of functional status ( p<0.05 ) , while the control group had no changes . These data suggest that patient education and fitness walking can improve overall pain management and related functional limitations among elderly people with chronic musculo-skeletal pain Background 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 . Methods / Design We describe the design and rationale of a r and omized 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 r and omized to the intervention . Discussion 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 design ed 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 OBJECTIVE To determine whether gains in functioning observed immediately following participation in an 8-week program of supervised fitness walking for patients with knee osteoarthritis were sustained at 1-year followup . METHODS Twenty-nine ( 61.1 % ) of 47 original intervention program patients and 23 ( 51.1 % ) of 45 original control patients were interviewed by telephone at 1-year followup . Patients completed the Arthritis Impact Measurement Scales physical activity , arthritis impact , pain , medication use , and general health perceptions subscales , as well as a separate visual analog pain scale and measures of perceived self-efficacy to cope with arthritis pain and other symptoms . RESULTS Adherence to walking was low , and there were no statistically significant differences between intervention and control patients at one year . CONCLUSIONS The failure of intervention patients to maintain regular walking result ed in loss of functional benefits that were observed at 8 weeks in the original study . Long-term adherence to walking is critical to maintenance of initial gains in functional outcomes OBJECTIVE To assess the effect of a program of supervised fitness walking and patient education on functional status , pain , and use of medication in patients with osteoarthritis of the knee . DESIGN An 8-week r and omized , controlled trial . SETTING Inpatient and outpatient services of an orthopedic hospital in an academic medical center . PATIENTS A total of 102 patients with a documented diagnosis of primary osteoarthritis of one or both knees participated in the study . Data were obtained on 47 of 51 intervention patients and 45 of 51 control patients . INTERVENTIONS An 8-week program of supervised fitness walking and patient education or st and ard routine medical care . MEASUREMENTS Patients were evaluated and outcomes assessed before and after the intervention using a 6-minute test of walking distance and scores on the physical activity , arthritis impact , pain , and medication subscales of the Arthritis Impact Measurement Scale ( AIMS ) . RESULTS Patients r and omly assigned to the walking program had a 70-meter increase in walking distance relative to their baseline assessment , which represents an improvement of 18.4 % ( 95 % Cl , 9.8 % to 27.0 % ) . In contrast , controls showed a 17-meter decrease in walking distance relative to their baseline assessment ( P less than 0.001 ) . Improvements in functional status as measured by the AIMS physical activity subscale were also observed in the walking group but not in the control group ( P less than 0.001 ) ; patients assigned to the walking program improved 39 % ( Cl , 15.6 % to 60.4 % ) . Although changes in scores on the arthritis impact subscale were similar in the two groups ( P = 0.093 ) , the walking group experienced a decrease in arthritis pain of 27 % ( Cl , 9.6 % to 41.4 % ) ( P = 0.003 ) . Medication use was less frequent in the walking group than in the control group at the post-test ( P = 0.08 ) . CONCLUSIONS A program of supervised fitness walking and patient education can improve functional status without worsening pain or exacerbating arthritis-related symptoms in patients with osteoarthritis of the knee OBJECTIVES To evaluate the efficacy of a task-oriented walking intervention in improving balance self-efficacy in persons with stroke and to determine whether effects were task-specific , influenced by baseline level of self-efficacy and associated with changes in walking and balance capacity . DESIGN Secondary analysis of a two-center , observer-blinded , r and omized , controlled trial . SETTING General community . PARTICIPANTS Ninety-one individuals with a residual walking deficit within 1 year of a first or recurrent stroke . INTERVENTION Task-oriented interventions targeting walking or upper extremity ( UE ) function were provided three times a week for 6 weeks . MEASUREMENTS Activities-specific Balance Confidence Scale , Six-Minute Walk Test , 5-m walk , Berg Balance Scale , and Timed " Up and Go " administered at baseline and postintervention . RESULTS The walking intervention was associated with a significantly greater average proportional change in balance self-efficacy than the UE intervention . Treatment effects were largest in persons with low self-efficacy at baseline and for activities relating to tasks practice d. In the walking group , change in balance self-efficacy correlated with change in functional walking capacity ( correlation coefficient=0.45 , 95 % confidence interval=0.16 - 0.68 ) . Results of multivariable modeling suggested effect modification by the baseline level of depressive symptoms and a prognostic influence of age , sex , comorbidity , time poststroke , and functional mobility on change in self-efficacy . CONCLUSION Task-oriented walking retraining enhances balance self-efficacy in community-dwelling individuals with chronic stroke . Benefits may be partially the result of improvement in walking capacity . The influence of baseline level of self-efficacy , depressive symptoms , and prognostic variables on treatment effects are of clinical importance and must be verified in future studies OBJECTIVE To examine changes in mobility-related self efficacy following exercise and dietary weight loss interventions in overweight and obese older adults with knee osteoarthritis ( OA ) , and to determine if self efficacy and pain mediate the effects of the interventions on mobility task performance . METHODS The Arthritis , Diet , and Activity Promotion Trial was an 18-month , single-blind , r and omized , controlled trial comparing the effects of exercise alone , dietary weight loss alone , a combination of exercise plus dietary weight loss , and a healthy lifestyle control intervention in the treatment of 316 overweight or obese older adults with symptomatic knee OA . Participants completed measures of stair-climb time and 6-minute walk distance , self efficacy for completing each mobility task , and self-reported pain at baseline , 6 months , and 18 months during the trial . RESULTS Mixed model analyses of covariance of baseline adjusted change in the outcomes demonstrated that the exercise + dietary weight loss intervention produced greater improvements in mobility-related self efficacy ( P = 0.0035 ) , stair climb ( P = 0.0249 ) and 6-minute walk performance ( P = 0.00031 ) , and pain ( P = 0.09 ) when compared with the healthy lifestyle control intervention . Mediation analyses revealed that self efficacy and pain served as partial mediators of the beneficial effect of exercise + dietary weight loss on stair-climb time . CONCLUSION Exercise + dietary weight loss results in improved mobility-related self efficacy ; changes in these task-specific control beliefs and self-reported pain serve as independent partial mediators of the beneficial effect of exercise + dietary weight loss on stair-climb performance Abstract Purpose To evaluate the effect of a multidisciplinary rehabilitation programme on disability , kinesiophobia , catastrophizing , pain , quality of life and gait disturbances in patients with chronic low back pain ( CLBP ) . Methods This was a parallel-group , r and omised , superiority-controlled pilot study in which 20 patients were r and omly assigned to a programme consisting of motor training ( spinal stabilising exercises plus usual-care ) and cognitive – behavioural therapy ( experimental group , 10 subjects ) or usual-care alone ( control group , 10 subjects ) . Before treatment , 8 weeks later ( post-treatment ) , and 3 months after the end of treatment , the Oswestry Disability Index , the Tampa Scale for Kinesiophobia , the Pain Catastrophizing Scale , a pain numerical rating scale , and the Short-Form Health Survey were assessed . Spatio-temporal gait parameters were also measured by means of an electronic walking mat . A linear mixed model for repeated measures was used for each outcome measure . Results The programme had significant group ( p = 0.027 ) , time ( p < 0.001 ) , and time-by-group interaction ( p < 0.001 ) effects on disability , with the experimental group showing an improvement after training of about 61 % ( 25 % in the control group ) . The analyses of kinesiophobia , catastrophizing , and the quality of life also revealed significant time , group , and time-by-group interaction effects in favour of the experimental group , and there was a significant effect of time on pain . Both groups showed a general improvement in gait parameters , with the experimental group increasing cadence significantly more . Conclusion The multidisciplinary rehabilitation programme including cognitive – behavioural therapy was superior to the exercise programme in reducing disability , kinesiophobia , catastrophizing , and enhancing the quality of life and gait cadence of patients with CLBP OBJECTIVE To examine the effects of aerobic and resistance exercise on self-efficacy beliefs in older adults with knee osteoarthritis ( OA ) and to determine whether self-efficacy and knee pain mediated the effects of the treatments on stair time performance and health perceptions . METHODS Measures of self-efficacy , knee pain , stair climbing performance , and health perceptions were collected prior to r and omization and again at an 18-month followup in older adults with knee OA who were assigned to 1 of 3 treatment conditions : aerobic exercise , resistance training , or health education control .  All analyses were conducted on the intention-to-treat principle . RESULTS Both exercise treatments increased self-efficacy for stair climbing in comparison to the health education control group . Both knee pain and self-efficacy mediated the effect of the treatments on stair climb time , whereas only knee pain mediated health perceptions . CONCLUSIONS The findings suggest that control beliefs and changes in physical symptoms such as knee pain are important outcomes in physical activity programs with patients who have OA of the knee . Moreover , these variables mediate the effects that such programs have on disability and health perceptions There is a need to increase and maintain physical activity in patients with chronic obstructive pulmonary disease ( COPD ) . We assessed 12-month efficacy and effectiveness of the Urban Training intervention on  physical activity  in COPD patients . This r and omised controlled trial ( NCT01897298 ) allocated 407 COPD patients from primary and hospital setting s 1:1 to usual care  ( n=205 ) or Urban Training  ( n=202 ) . Urban Training consisted of a baseline motivational interview , advice to walk on urban trails design ed for COPD patients in outdoor public spaces and other optional components for feedback , motivation , information and support ( pedometer , calendar , physical activity brochure , website , phone text messages , walking groups and a phone number ) . The primary outcome was 12-month change in steps·day−1 measured by accelerometer . Efficacy analysis ( with per- protocol analysis set , n=233 classified as adherent to the assigned intervention ) showed adjusted ( 95 % CI ) 12-month difference + 957 ( 184–1731 ) steps·day−1 between Urban Training and usual care . Effectiveness analysis ( with intention-to-treat analysis set , n=280 patients completing the study at 12 months including unwilling and self-reported non-adherent patients ) showed no differences between groups . Leg muscle pain during walks was more frequently reported in Urban Training than usual care , without differences in any of the other adverse events . Urban Training , combining behavioural strategies with unsupervised outdoor walking , was efficacious in increasing physical activity after 12 months in COPD patients , with few safety concerns . However , it was ineffective in the full population including unwilling and self-reported non-adherent patients . Urban Training in COPD increased physical activity after 12 months but not in self-reported non-adherent patients OBJECTIVES The prospect i ve relationships between self-efficacy beliefs , in conjunction with measures of knee pain and knee strength , and subsequent decline in both physical performance and self-reported disability among older adults with knee pain were examined . METHODS In this prospect i ve epidemiological trial , 480 men and women aged 65 years and older who had knee pain on most days of the week and difficulty with daily activity were followed for 30 months . RESULTS There was a significant interaction of baseline self-efficacy with baseline knee strength in predicting both self-reported disability and stair climb performance . Participants who had low self-efficacy and low strength at baseline had the largest 30-month decline in these outcomes . DISCUSSION These data underscore the important role that self-efficacy beliefs play in underst and ing functional decline with chronic disease and aging . Self-efficacy beliefs appear to be most important to functional decline in older adults when they are challenged by muscular weakness in the lower extremities Study Design . In a prospect i ve interventional study , problems with performance were evaluated in 101 consecutive patients with chronic low-back pain for more than 12 months , before and after participation in an outpatient-based multidisciplinary pain management program in Mansfield , United Kingdom . Objectives . To describe problems identified as most important by patients with chronic low-back pain and to evaluate the Canadian Occupational Performance Measure ( COPM ) as a tool for measuring problem-specific outcomes . Summary of Background Data . Patients with chronic low-back pain report difficulties with a variety of activities . The COPM permits the identification and measurement of problems of particular concern to the patient . Material s and Methods .  COPM , likert-modified Rol and and Morris Disability Question naire , Pain Self-Efficacy Question naire , and 5-minute walk test  were administered at baseline , immediately after , and 9 months after intervention . Differences and statistical interactions were determined by nonparametric tests . Results . Participants identified 60 different types of problem activity , 45 of which were identified by nine or fewer participants . Decreased walking tolerance was the most frequently identified problem ( 56 % of participants ) . Improvements were observed in all outcomes following intervention . Approximately one third of participants reported improvements two or more COPM units in overall performance and satisfaction with their performance at 9 months . Higher reported performance and satisfaction were associated with greater self-efficacy . Increased reported walking performance was associated with increased observed 5-minute walk distance ( R = 0.35 , P = 0.02 ) . Conclusions . Patients with chronic low-back pain report problems with diverse activities . The COPM provides a patient-centered outcome measure that displays good external validity and responsiveness to change when addressing the individual ’s goals Background Musculoskeletal disorders ( MSDs ) are the leading cause of work disability and sickness absence worldwide . The prevalence of MSDs increases with age , consequently challenging sustainable employability among the growing ageing workforce . Knowledge of feasible and efficient workplace-based interventions to rehabilitate MSD or prevent its consequences is therefore warranted . This systematic review will evaluate the effectiveness of workplace-based interventions on MSDs and its consequences among adult workers with physical and sedentary work tasks , respectively . Methods We will search the following bibliographic data bases : PubMed ( including the data base ‘ MEDLINE ’ ) and Web of Science Core Collection ( including the data bases ‘ Science Citation Index Exp and ed ’ , ‘ Social Sciences Citation Index ’ and ‘ Arts & Humanities Citation Index ’ ) . Manual search es will also be performed . We will include r and omised controlled trials ( RCTs ) and non- RCTs reported in English in which ( 1 ) participants are adult workers with MSD , ( 2 ) interventions are aim ing at rehabilitating pain symptoms of MSD or preventing the consequences of MSD and ( 3 ) interventions are initiated and /or carried out at the workplace . The review will adhere to the ‘ Preferred Reporting Items for Systematic review s and Meta-Analyses ’ ( PRISMA ) guidelines for reporting systematic review s and the Institute for Work and Health ( IWH ) guidelines for workplace-based interventions . For the primary evaluation of the review , the quality assessment and evidence synthesis will conform to the IWH guidelines . Secondary evaluation will include a meta- analysis ( unless the included studies do not allow this due to heterogeneity ) and employ the risk of bias domains recommended by Cochrane along with the Grading of Recommendations , Assessment , Development and Evaluations ( GRADE ) approach on the studies with pain intensity as an outcome . Discussion This systematic review will provide knowledge on effective workplace-based interventions among physical and sedentary workers with MSD . RCTs are considered the most powerful experimental design in clinical trials , but solely including these may be too restrictive to underst and effective workplace-based interventions where r and omised and carefully controlled trials ( RCTs ) are not always possible . In order to maximize practical relevance , the selection process will , therefore , include both RCTs and non- RCTs and the quality assessment and evidence synthesis will conform to IWH guidelines focusing on developing practical guidelines for stakeholders . The result of this work will form the basis for industry-specific evidence -based recommendations on effective workplace-based interventions for rehabilitation of MSDs and its consequences that will later be operationalised into concrete and user-friendly practical tools for workplaces . Systematic review registration International Prospect i ve Register of Systematic Review s ( PROSPERO ) number CRD42018116752 Abstract Background Multi-channel surface functional electrical stimulation ( FES ) for walking has been used to improve voluntary walking and balance in individuals with spinal cord injury ( SCI ) . Objective To investigate short- and long-term benefits of 16 weeks of thrice-weekly FES-assisted walking program , while ambulating on a body weight support treadmill and harness system , versus a non-FES exercise program , on improvements in gait and balance in individuals with chronic incomplete traumatic SCI , in a r and omized controlled trial design . Methods Individuals with traumatic and chronic ( ≥18 months ) motor incomplete SCI ( level C2 to T12 , American Spinal Cord Injury Association Impairment Scale C or D ) were recruited from an outpatient SCI rehabilitation hospital , and r and omized to FES-assisted walking therapy ( intervention group ) or aerobic and resistance training program ( control group ) . Outcomes were assessed at baseline , and after 4 , 6 , and 12 months . Gait , balance , spasticity , and functional measures were collected . Results Spinal cord independence measure ( SCIM ) mobility sub-score improved over time in the intervention group compared with the control group ( baseline/12 months : 17.27/21.33 vs. 19.09/17.36 , respectively ) . On all other outcome measures the intervention and control groups had similar improvements . Irrespective of group allocation walking speed , endurance , and balance during ambulation all improved upon completion of therapy , and majority of participants retained these gains at long-term follow-ups . Conclusions Task-oriented training improves walking ability in individuals with incomplete SCI , even in the chronic stage . Further r and omized controlled trials , involving a large number of participants are needed , to verify if FES-assisted treadmill training is superior to aerobic and strength training OBJECTIVE The purpose of this systematic review was to determine the effectiveness of exercise for the management of soft tissue injuries of the hip , thigh , and knee . METHODS We conducted a systematic review and search ed MEDLINE , EMBASE , PsycINFO , the Cochrane Central Register of Controlled Trials , and CINAHL Plus with Full Text from January 1 , 1990 , to April 8 , 2015 , for r and omized controlled trials ( RCTs ) , cohort studies , and case-control studies evaluating the effect of exercise on pain intensity , self-rated recovery , functional recovery , health-related quality of life , psychological outcomes , and adverse events . R and om pairs of independent review ers screened titles and abstract s and assessed risk of bias using the Scottish Intercollegiate Guidelines Network criteria . Best evidence synthesis methodology was used . RESULTS We screened 9494 citations . Eight RCTs were critically appraised , and 3 had low risk of bias and were included in our synthesis . One RCT found statistically significant improvements in pain and function favoring clinic-based progressive combined exercises over a " wait and see " approach for patellofemoral pain syndrome . A second RCT suggests that supervised closed kinetic chain exercises may lead to greater symptom improvement than open chain exercises for patellofemoral pain syndrome . One RCT suggests that clinic-based group exercises may be more effective than multimodal physiotherapy in male athletes with persistent groin pain . CONCLUSION We found limited high- quality evidence to support the use of exercise for the management of soft tissue injuries of the lower extremity . The evidence suggests that clinic-based exercise programs may benefit patients with patellofemoral pain syndrome and persistent groin pain . Further high- quality research is needed Knee osteoarthritis is a common joint problem leading to an increase of pain and a loss of function in older individuals . The main objective of this study was to evaluate if a participant who was r and omly assigned to his preferred group improved his adherence to an effective walking program  compared to a participant who did not receive his preferred group . This was a 9-month pilot r and omized clinical trial , based on a patient treatment preferences design . The 69 eligible participants had a diagnosis of knee osteoarthritis . Participants were r and omized to one of two groups : a supervised community-based or unsupervised walking program , based on the Ottawa Panel guidelines . At 6 months , participants who expressed a preference , either for the supervised or unsupervised program , and who were assigned to their preferred choice of program showed significantly higher adherence to walking sessions ( supervised 60.7 ± 12.3 % , P < 0.0001 ; unsupervised 43.1 ± 12.1 % , P = 0.03 ) , compared to the participants who did not obtain their preferred choice of program . After 9 months , significant improvements were shown according to the level of stiffness evaluated with the WOMAC ( P = 0.01 ) and the functional status assessed with the Timed Up and GO Test ( P = 0.04 ) , among the adherent participants who obtained their preference , as compared to those who did not receive their preference . We show this approach promotes long-term adherence to a community-based walking program , while ensuring the maintenance of clinical benefits of walking , among older adults susceptible to avoid or not properly engage in physical activity Background Current evidence supports the use of exercise-based treatment for chronic low back pain that encourages the patient to assume an active role in their recovery . Walking has been shown it to be an acceptable type of exercise with a low risk of injury . However , it is not known whether structured physical activity programmes are any more effective than giving advice to remain active . Methods / Design The proposed study will test the feasibility of using a pedometer-driven walking programme , as an adjunct to a st and ard education and advice session in participants with chronic low back pain . Fifty adult participants will be recruited via a number of different sources . Baseline outcome measures including self reported function ; objective physical activity levels ; fear-avoidance beliefs and health-related quality of life will be recorded . Eligible participants will be r and omly allocated under strict , double blind conditions to one of two treatments groups . Participants in group A will receive a single education and advice session with a physiotherapist based on the content of the ' Back Book ' . Participants in group B will receive the same education and advice session . In addition , they will also receive a grade d pedometer-driven walking programme prescribed by the physiotherapist . Follow up outcomes will be recorded by the same research er , who will remain blinded to group allocation , at eight weeks and six months post r and omisation . A qualitative exploration of participants ' perception of walking will also be examined by use of focus groups at the end of the intervention . As a feasibility study , treatment effects will be represented by point estimates and confidence intervals . The assessment of participant satisfaction will be tabulated , as will adherence levels and any recorded difficulties or adverse events experienced by the participants or therapists . This information will be used to modify the planned interventions to be used in a larger r and omised controlled trial . Discussion This paper describes the rationale and design of a study which will test the feasibility of using a structured , pedometer-driven walking programme in participants with chronic low back pain . Trial Registration [ IS RCT N67030896
Evidence of fair method ological quality suggests that walking is associated with significant improvements in outcome compared with control interventions but longer-term effectiveness is uncertain .
With the use of the U.S. Preventive Services Task Force system , walking can be recommended as an effective form of exercise or activity for individuals with chronic musculoskeletal pain but should be supplemented with strategies aim ed at maintaining participation .
OBJECTIVE To systematic ally review the evidence examining effects of walking interventions on  pain and self-reported function in individuals with chronic musculoskeletal pain .