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Objective: To investigate whether adding physical activity coaching and an activity monitor enhanced the effects of a group exercise program on pain intensity and disability for people with chronic nonspecific low back pain., Design: Randomized controlled trial with concealed allocation, intention-to-treat analysis, and blinding of participants and assessors., Methods: One hundred sixty participants with chronic nonspecific low back pain who were aged between 18 and 60 years and seeking care at an outpatient physiotherapy clinic participated. Both groups received supervised group exercise therapy. The intervention group also received physical activity coaching sessions aimed at improving physical activity, and physical activity electronic feedback delivered by an activity monitor. The attention control group received modified approaches of coaching sessions and an activity monitor. Disability was measured using the Roland Morris Disability Questionnaire (0-24), and pain intensity was measured using the 11-point Numerical Rating Scale (0-10). Linear mixed models were performed to test for differences between groups., Results: There were no differences between groups for reductions in disability (mean difference [MD] = -0.5 out of 24 points; 95% confidence interval [CI]: -2.2, 1.1) and pain intensity (MD = -0.4 out of 10 points; 95% CI: -1.3, 0.5) at 3-month follow-up. There were no between-groups differences at 6- and 12-month follow-up assessments., Conclusion: Adding targeted physical activity coaching and an activity monitor did not reduce pain intensity or disability more than an attention control approach in participants with chronic low back pain who were undertaking a group exercise program. J Orthop Sports Phys Ther 2022;52(5):287-299. doi:10.2519/jospt.2022.10874 .

Objective: What model development and external validation studies exist that focus on the prognosis of patients with recent-onset low back pain (LBP)? What is the performance (in terms of discrimination and calibration) of these clinical prediction models?, Methods: Systematic searches on MEDLINE, Embase and CINAHL were conducted. Model development and/or external validation studies of patients with recent-onset LBP were selected. Models predicting outcomes of pain, disability, sick leave, work absence and self-reported recovery, with at least 12 weeks of follow-up, were included. Risk of bias was assessed using the PROBAST instrument., Results: We identified 17 prognostic models developed to predict outcomes in people with recent-onset LBP: six models were in the development phase and 11 were in the validation phase. The most assessed prediction model was the Original Örebro Musculoskeletal Pain Questionnaire. The Da Silva Clinical Prediction Model was the only model, from a study with low risk of bias, that presented acceptable discrimination, demonstrating 'good' performance in predicting recovery from pain (C-statistic 0.71, 95% CI 0.63 to 0.78) and overall acceptable agreement in calibration., Conclusion: Most prediction models for prognosis of patients with recent-onset LBP did not perform well at discrimination, few studies reported calibration and their performance varied across studies. It seems premature to advocate use of the available models, at their current state of development and validation, for low back pain in primary care, considering their generally poor methods and performance., Registration: CRD42020160988., (Copyright © 2022 Australian Physiotherapy Association. Published by Elsevier B.V. All rights reserved.)

Objective: The purpose of this study was to identify factors associated with meeting physical activity guidelines and sedentary recommendations in people with chronic low back pain (LBP)., Methods: This was a cross-sectional study including 171 people with chronic LBP. Trained assessors collected information regarding demographic, anthropometric, and clinical data. Physical activity levels and sedentary time were objectively measured using a tri-axial accelerometer. Participants were classified as being physically active (ie, performing at least 150 minutes of moderate or 75 minutes of vigorous physical activity per week) and sedentary (ie, more than 8 hours of time spent in sedentary activities per day). Multivariable logistic regression analyses were used to determine the association of being physically active or sedentary with the range of demographic, anthropometric and clinical variables., Results: Our results showed that although lower body mass index (odds ratio [OR] = 0.91; 95% CI: 0.85-0.98) and higher self-reported levels of leisure time physical activity (OR = 3.46; 95% CI: 1.94-6.15) were associated with being physically active, lower self-reported levels of physical activity at work (OR = 0.56; 95% CI: 0.39-0.81) was associated with being sedentary., Conclusion: Our findings showed that, in people with LBP, lower body mass index and higher levels of leisure time physical activity may be important factors for identifying those physically active. In contrast, lower levels of physical activity at work may be considered when identifying sedentary people with LBP. Future studies should consider these factors when designing interventions aiming to promote physical activity and decrease sedentary behavior in this population., (Copyright © 2021. Published by Elsevier Inc.)

Background: The Sedentary Behavior Questionnaire (SBQ) is a brief and easy instrument to measure time spent on sedentary activities; however, no study has investigated the reliability and validity of this questionnaire in people with chronic low back pain (LBP)., Objective: To investigate the internal consistency, test-retest reliability, measurement error, construct validity, and interpretability of the SBQ against data derived from an accelerometer in patients with nonspecific chronic LBP., Study Design: Cross-sectional study., Setting: Outpatient physiotherapy clinic., Patients: Seventy-five patients aged between 18 and 60 years (mean age, 42 years old) with nonspecific chronic LBP were recruited for this study., Interventions: Not applicable., Methods: The Cronbach's α was calculated to investigate the internal consistency of the SBQ and the intraclass correlation coefficient (ICC) was calculated to investigate the reliability of the SBQ between two administrations separated by a 1-week interval. Measurement error was assessed calculating the SEM and minimal detectable change (MDC). Spearman correlation (r) was calculated to investigate the construct validity using hypothesis testing. Interpretability was investigated using ceiling and floor effects., Results: The Cronbach's α of the SBQ total score was 0.92, indicating homogeneity among the items of the instrument. The reliability of the SBQ was excellent (ICC > 0.75), without any evidence of ceiling and floor effects. Regarding measurement error, the total score of the SBQ showed an SEM and MDC of 109.8 minutes per day and 304.4 minutes per day, respectively. However, there were no correlations of the SBQ domains or the total score with the accelerometer-measured sedentary time (r < 0.25)., Conclusion: The SBQ is a reliable tool for quantifying time spent in sedentary activities of patients with chronic LBP. The SBQ showed poor construct validity compared to the accelerometer-measured sedentary time, which indicates that patients may underestimate their time spent in sedentary activities., (© 2020 American Academy of Physical Medicine and Rehabilitation.)

Study Design: Cross-sectional study., Objective: To investigate the equivalence of electronic and paper version of self-report questionnaires for the assessment of disability, pain, fear of movement, depression, and physical activity of patients with chronic low back pain (LBP)., Summary of Background Data: Paper and electronic versions of self-report questionnaires are commonly used for assessment of patients with LBP. However, the equivalence of self-report questionnaires commonly used for assessment of patients with chronic LBP remains unclear., Methods: Seventy-nine individuals with chronic LBP seeking physiotherapy care were recruited. Participants attended the clinic twice with an interval of 1 week and completed the self-reported questionnaires in a random order. The following questionnaires were administered: Roland Morris Disability Questionnaire (RMDQ); 11-point numerical rating scale (NRS); Tampa Scale for Kinesiophobia (TSK); Center for Epidemiological Studies-Depression (CES-D), and Baecke Habitual Physical Activity Questionnaire (BPAQ). To investigate the equivalence between the two questionnaire versions, intraclass correlation coefficient with 95% confidence interval and Bland-Altman plotting was used., Results: The paper and electronic versions of the RMDQ, TSK, and CES-D showed good reliability and the showed moderate reliability. In contrast, the NRS showed poor reliability between the electronic and paper versions., Conclusion: Our findings support that the electronic version of the RMDQ, TSK, CES-D, and BPAQ can be administered in clinical and research settings for assessment of patients with chronic LBP. Nevertheless, electronic version of the NRS for assessment of pain intensity should not be used interchangeably in clinical practice in patients with chronic LBP., Level of Evidence: 3.

Background and Objective: Identifying factors that influence the course of low back pain (LBP) is important to help clinicians to identify those patients at higher risk of non-recovery. The objective of this systematic review was to investigate the prognostic role of physical activity in the course of LBP., Databases and Data Treatment: Literature searches were conducted in five electronic databases from their inception to February 2018. Prospective cohort studies investigating the influence of any type of physical activity in people with LBP were considered eligible. The primary outcomes were pain intensity and disability. Two independent reviewers extracted the data and assessed the methodological quality of the included studies. Results were stratified according to participants' symptoms duration at baseline., Results: Twelve studies were considered eligible for this review. Of these, six included patients with chronic LBP, four studies did not specify the patients' duration of symptoms, one study included patients with acute LBP, and one study included patients with subacute LBP. Included studies were heterogeneous in terms of physical activity assessment, outcomes, follow-up duration, and statistical methods, therefore, pooling of results was not performed. We found limited evidence to support the prognostic role of physical activity in the course of LBP., Conclusions: Our review identified limited evidence supporting physical activity as a prognostic factor in LBP. Future cohort studies are needed to clarify the strength and importance of this association., Significance: Despite recent research in the area, this systematic review shows that there is low quality evidence that physical activity may not be a prognostic factor for predicting pain and disability in patients with LBP., (© 2019 European Pain Federation - EFIC®.)

Background: Physical overload at work has been described as a risk factor for the development of low back pain. However, few studies have investigated the prognostic value of perceived physical overload at work in patients with chronic low back pain., Objective: To investigate the association of perceived physical overload at work with pain and disability over a period of 6 months in patients with chronic non-specific low back pain., Methods: Patients with chronic LBP seeking physiotherapy care were considered eligible. Clinical data collected were: pain intensity, disability, fear of movement, depression and perceived physical overload at work. Linear regression analyses were used to investigate the association of perceived physical workload at work at baseline with pain intensity and disability at 6-month follow-up. The total score and the score for each category of the physical overload at work questionnaire were analyzed separately., Results: Ninety-two patients with chronic low back pain were included in the analysis. The subcategories of the physical overload questionnaire were not significantly associated with pain intensity at 6-month follow-up. However, age, disability at baseline and perceived physical overload related to postures of the trunk (B = -0.60 95% CI - 1.18 to - 0.02) and related to positions of the arms (B = 2.72 95% CI 0.07 to 5.37) were significantly associated with disability at 6-month follow-up., Conclusion: Although perceived physical overload at work was not associated with pain intensity in patients with chronic LBP at 6-month follow-up, we identified a significant association between perceived physical overload related to postures of the trunk and positions of the arms with disability at 6-month follow-up. These slides can be retrieved under Electronic Supplementary Material.

Objective: To investigate whether clinical tests used to detect motor control dysfunction can predict improvements in pain and disability in patients with chronic nonspecific low back pain (LBP) who have undergone an 8-week lumbar stabilization exercise program., Study Design: A prospective cohort study., Setting: Outpatient physical therapy university clinic., Participants: Seventy people with chronic nonspecific LBP were recruited, and 64 completed the exercise program (N=64)., Interventions: The lumbar stabilization program was provided twice a week for 8 weeks., Main Outcome Measures: Pain intensity (11-point numerical rating scale) and disability (Roland Morris Disability Questionnaire) and clinical tests, such as the Deep Muscle Contraction (DMC) scale, Clinical Test of Thoracolumbar Dissociation (CTTD), and Passive Lumbar Extension (PLE) test. Univariate and multivariate linear regression models were used in the prediction analysis., Results: Mean changes in pain intensity and disability following the 8-week stabilization program were -3.8 (95% confidence interval [CI], -3.2 to -4.4) and -7.4 (95% CI, -6.3 to -8.5), respectively. Clinical test scores taken at baseline did not predict changes in pain and disability at 8-week follow-up., Conclusion: Our findings revealed that the DMC scale, CTTD, PLE test, clinical tests used to assess motor control dysfunction, do not predict improvements in pain and disability in patients with chronic nonspecific LBP following an 8-week lumbar stabilization exercise program., (Copyright © 2019 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Physical activity plays an important role in the management of chronic low back pain (LBP). Engaging in an active lifestyle is associated with a better prognosis. Nevertheless, there is evidence to suggest that patients with chronic LBP are less likely to meet recommended physical activity levels. Furthermore, while exercise therapy has been endorsed by recent clinical practice guidelines, evidence from systematic reviews suggests that its effect on pain and disability are at best moderate and not sustained over time. A limitation of current exercises programmes for chronic LBP is that these programmes are not designed to change patients' behaviour toward an active lifestyle. Therefore, we will investigate the short- and long-term efficacy of a multimodal intervention, consisting of supervised exercises, health coaching and use of an activity monitor (i.e. Fitbit Flex) compared to supervised exercises plus sham coaching and a sham activity monitor on physical activity levels, pain intensity and disability, in patients with chronic, nonspecific LBP., Methods: This study will be a two-group, single-blind, randomised controlled trial. One hundred and sixty adults with chronic, nonspecific LBP will be recruited. Participants allocated to both groups will receive a group exercise programme. In addition, the intervention group will receive health coaching sessions (i.e. assisting the participants to achieve their physical activity goals) and an activity monitor (i.e. Fitbit Flex). The participants allocated to the control group will receive sham health coaching (i.e. encouraged to talk about their LBP or other problems, but without any therapeutic advice from the physiotherapist) and a sham activity monitor. Outcome measures will be assessed at baseline and at 3, 6 and 12 months post randomisation. The primary outcomes will be physical activity, measured objectively with an accelerometer, as well as pain intensity and disability at 3 months post randomisation. Secondary outcomes will be physical activity, pain intensity and disability at 6 and 12 months post randomisation as well as other self-report measures of physical activity and sedentary behaviour, depression, quality of life, pain self-efficacy and weight-related outcomes at 3, 6, and 12 months post randomisation., Discussion: This study is significant as it will be the first study to investigate whether a multimodal intervention designed to increase physical activity levels reduces pain and disability, and increases physical activity levels compared to a control intervention in patients with chronic LBP., Trial Registration: ClinicalTrials.gov, ID: NCT03200509 . Registered on 28 June 2017.

Objectives: To assess the association of physical activity measures, derived with an accelerometer and a self-reported questionnaire, with fear of movement in patients with chronic nonspecific low back pain (LBP) and to investigate the association between disability and fear of movement in this population., Design: Cross-sectional study., Setting: Outpatient physical therapy university clinics., Participants: Patients (N=119) presenting with nonspecific LBP of >3 months' duration., Interventions: Not applicable., Main Outcome Measures: Physical activity levels measured objectively with an accelerometer (ie, counts per minute, time spent in moderate-to-vigorous and light physical activity per day, number of steps per day, and number of 10-minute bouts of moderate-to-vigorous physical activity per day) and subjectively with a self-reported questionnaire (Baecke Physical Activity Questionnaire); fear of movement (Tampa Scale of Kinesiophobia); pain (11-point numerical rating scale); disability (Roland Morris Disability Questionnaire); and depression (Beck Depression Inventory). The associations were examined with correlational, univariate, and multivariable linear regression analyses., Results: None of the objective physical activity measures were associated with fear of movement. The apparent association of self-reported physical activity levels with fear of movement (correlational analyses: r=-.18; P<.05; univariate regression analyses: β=-.04; 95% confidence interval [CI], -.07 to -.01; P=.04) was not confirmed in multivariable analyses. Fear of movement was consistently associated with disability in both correlational (r=.42; P<.01) and multivariable (β=.21; 95% CI, .11-.31; P<.001) analyses., Conclusions: Our data support one aspect of the fear-avoidance model-that higher fear of movement is associated with more disability-but not the aspect of the model linking fear of movement with inactivity., (Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Study Design: Cross-sectional study.Objective: To investigate the equivalence of electronic and paper version of self-report questionnaires for the assessment of disability, pain, fear of movement, depression, and physical activity of patients with chronic low back pain (LBP).Summary Of Background Data: Paper and electronic versions of self-report questionnaires are commonly used for assessment of patients with LBP. However, the equivalence of self-report questionnaires commonly used for assessment of patients with chronic LBP remains unclear.Methods: Seventy-nine individuals with chronic LBP seeking physiotherapy care were recruited. Participants attended the clinic twice with an interval of 1 week and completed the self-reported questionnaires in a random order. The following questionnaires were administered: Roland Morris Disability Questionnaire (RMDQ); 11-point numerical rating scale (NRS); Tampa Scale for Kinesiophobia (TSK); Center for Epidemiological Studies-Depression (CES-D), and Baecke Habitual Physical Activity Questionnaire (BPAQ). To investigate the equivalence between the two questionnaire versions, intraclass correlation coefficient with 95% confidence interval and Bland-Altman plotting was used.Results: The paper and electronic versions of the RMDQ, TSK, and CES-D showed good reliability and the showed moderate reliability. In contrast, the NRS showed poor reliability between the electronic and paper versions.Conclusion: Our findings support that the electronic version of the RMDQ, TSK, CES-D, and BPAQ can be administered in clinical and research settings for assessment of patients with chronic LBP. Nevertheless, electronic version of the NRS for assessment of pain intensity should not be used interchangeably in clinical practice in patients with chronic LBP.Level Of Evidence: 3. [ABSTRACT FROM AUTHOR]