Nordic walking no better than general advice in management of non-specific CLBP
Supervised and non-supervised Nordic walking in the treatment of chronic low back pain: a single blind randomized clinical trialBMC Musculoskelet Disord. 2010 Feb 10;11:30.
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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.
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.
Inclusion / Exclusion
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?
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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