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Nordic walking no better than general advice in management of non-specific CLBP
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July 2013
Nordic walking no better than general advice in management of non-specific CLBP
Study Type:Therapy
OE Level Evidence:2
Journal Level of Evidence:N/A
Supervised and non-supervised Nordic walking in the treatment of chronic low back pain: a single blind randomized clinical trial
BMC Musculoskelet Disord. 2010 Feb 10;11:30.Did you know you're eligible to earn 0.5 CME credits for reading this report? Click Here
Synopsis
136 patients with chronic low back pain were randomized into 3 groups that received a supervised nordic training, unsupervised training or a general advice on management of pain and functionality. At 8 weeks, there was no statistically significant effect of supervised Nordic Walking on the Low Back Pain Rating Scale (LBPRS) or the Patient Specific Function Scale (PSFS) when compared to non-supervised Nordic Walking group or group given advice to remain active.
Publication Funding Details
+
Funding:
Non-funded
Conflicts:
None disclosed
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
Yes = 1
Uncertain = 0.5
Not Relevant = 0
No = 0
The Reporting Criteria Assessment evaluates the transparency with which authors report the methodological and trial characteristics of the trial within the publication. The assessment is divided into five categories which are presented below.
3/4
Randomization
3/4
Outcome Measurements
4/4
Inclusion / Exclusion
4/4
Therapy Description
4/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
The Fragility Index is a tool that aids in the interpretation of significant findings, providing a measure of strength for a result. The Fragility Index represents the number of consecutive events that need to be added to a dichotomous outcome to make the finding no longer significant. A small number represents a weaker finding and a large number represents a stronger finding.
Why was this study needed now?
Nordic walking involves walking with ski poles, aiding improvement of cardiovascular metabolism. It is yet unknown whether specific or unspecific exercise provides the most benefit for patients with chronic low back pain. This is the first study to investigate whether Nordic walking has a beneficial effects for patients with chronic low back pain.
What was the principal research question?
Does supervised Nordic walking improve the pain and pain-related disability compared to non-supervised Nordic walking or advice to stay active in patients with chronic low back pain?
Study Characteristics
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Population:
136 patients (mean age 46.7 yr) with chronic (>8 week) low back pain, with or without leg pain, after completion of 4 week of treatment by a family physician, chiropractor or physiotherapist
Intervention:
Supervised Nordic Walking: Participants performed Nordic walking, supervised by a specially trained Nordic walking instructor. It was performed twice a week for 8 weeks, in groups of 6-8. Routes were between 3-4km long, and sessions lasted approximately 45 minutes (Mean age: 49.2; n=45).
Unsupervised Nordic Walking: Participants were given a single, 1-hour instruction session of Nordic walking by the same instructor of the previous group. For the next 8 weeks, participants were allowed to perform Nordic walking at home as much as they preferred (Mean age: 45.4; n=46).
Comparison:
Control group: Participants were given information and advice on exercising and staying active, and maintaining their daily function level (Mean age: 45.5; n=45).
Outcomes:
Primary Outcome Measure: Pain and disability measurements utilizing the Low Back Pain Rating Scale (LBPRS)
Secondary Outcome Measure: Functional limitation assessed by the Patient Specific Function Scale (PSFS), EQ 5D, medication use and time off from work
Methods:
Prospective RCT
Time:
Assessments were made 11, 26 and 52 weeks after randomization.
What were the important findings?
- Within the supervised NW group, the improvement in the pain scale of the LBPRS was significant at 11 weeks, 26 weeks, and 52 weeks (P=0.009, 0.01, and 0.03, respectively), and was consistently the largest average improvement among the three groups. Despite this, the improvements were not significantly different, at any time point, from the unsupervised NW group, who had a significant improvement at 26 weeks, nor the control group, whose improvement was significant at 11 and 26 weeks.
- Similar to the pain scale, while the average improvement on the disability scale of the LBPRS was greatest and significant at all time points in the supervised NW group, the differences compared to the unsupervised group and control group were not significant. Effect in the unsupervised group was borderline significant at 52 weeks (P=0.06), and in the control group at 11 and 26 weeks (P=0.01 and 0.03, respectively).
- On the PSFS, improvement within each group was significant at all time points (Supervised NW group: P= 0.009, 0.001, and 0.02, respectively) (Unsupervised NW group: P < 0.001, 0.004, and 0.001, respectively) (Control group: P=0.01, 0.01, and 0.004, respectively). The differences between groups were not significant at any time point.
- Minimum clinically important difference (MCID) on LBPRS pain subscale was achieved by 10 participants of the supervised NW group, 10 of the unsupervised NW group, and 8 in the control group by the end of 52 weeks. MCID on the disability scale of the LBPRS was attained by 7, 4, and 4, respectively. The difference between groups for either scale was not significant.
- There was no significant difference observed between groups at any point for outcome on the EQ5D.
What should I remember most?
8 weeks of bi-weekly supervised Nordic Walking resulted in small clinical effects but the results were not statistically different when compared to the unsupervised Nordic Walking group or the group only given advice to remain active.
How will this affect the care of my patients?
Nordic Walking, although it offers a safe and cheap rehabilitation modality for various conditions including Lower Back Pain, has not been proven superior to conventional advice when assessed for improvement in pain and pain-related loss of function.
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