Effect of Stay Active Advice on Pain and Disability in Patients with Low Back Pain: a randomized controlled trial

Main Article Content

Noha Khaled Shoukry
Salam Mohamed Elhafez
Raymond Lee
Abeer Farag Hanafy

Keywords

Back pain, Advice of Staying Active, Pain, Disability

Abstract

Background: Stay active advice is considered the ‘first line’ for treating patients with low back pain (LBP) and is recommended in all international guidelines. However, the current evidence in favor of the advice of staying active for patients with LBP is limited. Purpose: The purpose of the study was to study the effect of the advice of staying active on the Visual Analogue Scale (VAS) pain score and Oswestry disability index (ODI) in patients with low-risk non-specific low back pain (NSLBP).
Methods: Thirty-five patients with low-risk NSLBP for less than three months participated in this study. They were randomly assigned into two groups; Group 1: Stay active advice and Group 2: the control group; patients in this group were not given any advice at all and were asked to come after six weeks for re-assessment as the advice group. Data were collected using VAS and ODI at the baseline and after six weeks.
Results: Mixed design MANOVA revealed that the VAS pain score was significantly decreased at the six-week assessment compared to the baseline measurements in both groups (p<0.05) and was significantly lower in the Stay active group at the 6-week assessment compared to the Control group (p =0.001). Also, the ODI decreased significantly at the six-week assessment compared to the baseline measurements in both groups (p<0.05) but with no significant difference between the two groups for the VAS and ODI scores at the six-week assessment (P>0.05).
Conclusion: The advice of staying active is beneficial in reducing perceived pain intensity without deleterious effects on disability in patients with low-risk NSLBP.

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References

1. Hoy D, Brooks P, Blyth F, & Buchbinder R. The Epidemiology of low back pain. Best Pract Res Clin Rheumatol, 2010; 24(6): 769–81.
2. Koes B W, van Tulder M W, Ostelo R, Burton A K, & Waddell G. Clinical guidelines for the management of low back pain in primary care: an international comparison, Spine, 2001; 26:2504–13.
3. Hoy D, March L, Brooks P, Blyth F, Woolf A, Bain C, Williams G, Smith E, Vos T, Barendregt J. The global burden of low back pain: estimates from the global burden of disease 2010 study. Ann Rheum Dis, 2014; 73(6): 968–74.
4. Koes BW, van Tulder M, Lin CW, Macedo LG, McAuley J, & Maher C. An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. Eur Spine J, 2010; 19(12): 2075–94.
5. Costa-Black KM, Loisel P, Anema JR, Pransky G. Back pain and work. Best Pract Res Clin Rheumatol. 2010; 24: 227–40.
6. Mody GM, & Brooks PM. Improving musculoskeletal health: global issues. Best Pract Res Clin Rheumatol, 2012; 26: 237–49.
7. Van Tulder M, Becker A, Bekkering T, Breen A, Del Real MTG, Hutchinson A, et al. Chapter 3: European guidelines for the management of acute nonspecific low back pain in primary care. Eur Spine J, 2006; 15(2): 169-191.
8. Bach SM, and Holten KB. Guideline update: what's the best approach to acute low back pain? J Fam Pract, 2009; 58(12):1.
9. Dahm KT, Brurberg KG, Jamtvedt G, Hagen KB. Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. In: The Cochrane Library, 2010; 6(9) CD007612.
10. Hill JC, Dunn KM, Lewis M, Mullis R, Main CJ, Foster NE, & Hay EM. A primary care back pain screening tool: identifying patient subgroups for initial treatment. Arthritis Rheum, 2008; 59(5): 632-641.
11. Carlsson A. Assessment of chronic pain. I. Aspects of reliability and validity of the Visual Analogue Scale. Pain, 1983;16(1): 87-101.
12. Ostelo RW, Deyo RA, Stratford P. Interpreting change scores for pain and functional status in low back pain: towards international consensus regarding minimal important change. Spine, 2008; 33(1): 90-94.
13. Olaya-Contreras P, Styf1 J, Arvidsson D, Frennered K, & Hansson T. The effect of the stay active advice on physical activity and on the course of acute severe low back pain. BMC Sports Science, Medicine, and Rehabilitation, 2015; 7(19): 1-9.
14. Shipton E A. Physical Therapy Approaches in the Treatment of Low Back Pain. Pain Ther, 2018; 7: 127-137.
15. Hurwitz EL, & Morgenstern H. Immediate and long term effects of immune stimulation: hypothesis linking the immune response to subsequent physical and psychological wellbeing. Med Hypotheses, 2001; 56: 620–624.
16. Hurwitz EL, Morgenstern H, & Chiao C. Effects of recreational physical activity and back exercises on low back pain and psychological distress: findings from the UCLA Low Back Pain Study. Am J Public Health, 2005; 95: 1817–24.
17. Wand B, Bird C, McAtrhur J, McDowell M, & De Souza L. Early intervention for the Management of acute low back pain. A single-blind randomized trial of biopsychosocial education, manual therapy, and exercise. Spine, 2004; 29(21): 2350–2356.
18. Frost H, Lamb S, Doll H, Carver T, & Stewart-Brown S. Randomized controlled trial physiotherapy compared with advice for low back pain. BMJ, 2004; 239: 708–714.
19. Rozenberg S, Delval C, Rezvani Y, Olovieri-Apicella N, Kuntz JL, Legrand E, et al. Bed rest or normal activity for patients with acute low back pain: a randomized controlled trial. Spine, 2002; 27(14):1487–93.