Low Back PainNCT04320654
Advice of Staying Active for Sub Acute Low Back Pain
A study testing exercise in people with Low Back Pain, run by Cairo University.
Trial summary
The variabilities in the management approaches for patients with LBP reflect uncertainty about the optimal approach. Therefore, there is a need for the implementation of early treatment strategies relying on an evidence-based knowledge to treat the problems and reduce the risk for recurrence and chronicity of LBP. Read more about this study
- Who is it for?
- Ages 18 to 60 years
- Conditions the study is for
- Low Back Pain
- What is being tested?
- exercise
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 120 participants
- Where
- No sites listed yet
- Study dates
- Apr 2020to Jan 2022
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 60 years
- All sexes
- No healthy volunteers
- Adult
Who may be able to join
- Patients will be included if they are between 18 - 65 years of age
- able to stand and walk without assistance.
- Patients will also be included if they have a history of non specific low back pain classified as low risk of poor outcome with a total score of three or less based on the STarT Back Tool score (Hill et al., 2008).
- The back-pain episode is subacute
Who cannot join
- Patients will be excluded if they have any neurological disease or balance deficits due to vestibular disorders, such as vertebrobasilar insufficiency and visual disorders,
- systemic infection,
- current pregnancy,
- severe musculoskeletal deformity (scoliosis or kyphosis),
- injury to the lower extremity that would interfere with testing or a history of any surgery in the three months prior to testing.
- Patients will also be excluded if they have pain below the knee consistent with a disc herniation, presence of neurological signs, serious spinal complications (e.g., vertebral fracture, tumor or infection),
- spinal stenosis,
- confounding conditions such as extreme obesity, severe scoliosis, significant anatomical leg length inequality, previous spinal surgery.
About this study
Official title: Will Patients With Low Back Pain Benefit From the Advice of Staying Active
The variabilities in the management approaches for patients with LBP reflect uncertainty about the optimal approach. Therefore, there is a need for the implementation of early treatment strategies relying on an evidence-based knowledge to treat the problems and reduce the risk for recurrence and chronicity of LBP.
Advice is considered as the 'first in line' for the treatment of patients with LBP and is recommended in all international guidelines, yet it is under-utilized by the general practitioners. The current evidence in favor for the advice of staying active for patients with LBP is limited, with small or no benefits in pain relief, functional improvement or sick leave compared to rest in bed. Consequently, there is a huge gap between the evidence and practice.
So, the current study aimed at filling this gap and expanding the previous findings by investigating the effect of the advice of staying active on the level of perceived pain, physical activity level, postural control and functional disability in patients with low risk LBP (with a total score of three or less based on the STarT Back Tool score).
Read the detailed description
In spite of the great effort, LBP remains a significant burden on the society and can cause a disturbing impact on the functional ability during the productive years of the individuals. It is important to find pragmatic treatments that not only reduce the pain, but also decrease the disability. Activity monitoring in real life has the potential to change our concept of outcomes, and as a result, expand our ideas about the appropriateness of the interventions in rehabilitation.
The international guidelines vary but agree on advising patients with LBP to remain physically active. The National Institute for Clinical Excellence (NICE)'s updated guideline on the LBP recommends encouraging people to continue with their normal activities as far as possible. NICE found that there were no randomized controlled trials (RCTs) (which are the best way of investigating the efficacy of a treatment) that compared the effect of the advice of staying active with no advice or the advice to rest.
Despite the guidelines, it was reported that many health care providers are still too restrictive and believe that LBP requires some avoidance of activities and to remain off- work. Many general practitioners do not give advice on daily activities to patients with back pain and there is confusion about what constitutes an effective advice. Only 12% of the physiotherapists identify correctly the guidelines, and most of them do not agree with these guidelines regarding the return to work or activity. Investigating the benefit of the advice of staying active and different active intervention programs in patients with low risk NSLBP may help in developing recommendations for the physiotherapists responsible for reviewing exercise protocols for patients with LBP.
Therefore, the improvement of the primary care management of patients with LBP has the potential to reduce the long-term effects of back pain, including persistent disabling symptoms, low quality of life, and reduced capacity to work. The advice of staying active may not only be a treatment to improve the recovery from LBP, but also an opportunity to promote physical activity for other health benefits, such as improved cardio-metabolic function, blood pressure, and reduced body fatness.
- Conditions
- Low Back Pain
- Being tested
- exercise
- Medical subject headings
- Low Back Pain
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
exerciseOther
The aim of this intervention is to increase patients average daily step count. The walking program is a behavior change intervention in which the pedometer will be used as a tool to help the patients monitor their activity levels.
| Study group | Role | What they receive |
|---|---|---|
| advice of staying active | Experimental | The patients will be advised to stay as physically active as possible and continue their everyday activities as normally as possible. Receives: Other: exercise |
| walking program | Experimental | Patients will be encouraged to go about their normal daily activities. At week one, patients will be asked to familiarize themselves with wearing the pedometer and recording their daily steps in a walking diary for the subsequent 7 days. The patients will return to see the physiotherapist at the end of week one to discuss any issues with the program, pedometer or recording of desired information. A step target for week two will be agreed between the physiotherapist and the patient by referring to the mean daily step count recorded at baseline, and the average step count calculated from the walking diary Receives: Other: exercise |
| Backward walking | Experimental | All patients will be instructed to walk at their desired pace 3 days per week with a steady rhythm. The duration of each training session will initially be 15 minutes and will gradually increase, and finally reach 25 minutes, for every session (Hao Chen, 2011). There will be no constraint or indication about head and trunk position during backward training Receives: Other: exercise |
| Targeted home-based hip exercise | Experimental | Patients who will be assigned in this group will perform a hip exercise program for six weeks, three times / week to ensure an adequate recovery between exercise sessions (appendix V). The strengthening exercises will focus on strengthening the gluteus maximus (GMax), gluteus medius (GMed), gluteus minimus (GMin) and short hip external rotator muscles (Distefano et al., 2009). Receives: Other: exercise |
| control group | No intervention | The patients will not be given any intervention and will be asked to come after 6 weeks for re-assessment |
What is being measured
The primary outcome is the main question the study is designed to answer.
level of perceived pain by Visual analogue scale
The Visual analogue scale will be used for measuring the pain intensity the scale ranges from 0 to 10 where 0 means no pain and 10 means severe intolerable pain.
Measured: six weeks
Secondary outcomes (1)
number of steps
A spring-leverd pedometer (Yamax Digiwalker CW-701, Yamax, Japan) will be used to assess the number of steps. The number of steps will be used as an indicator for the level of physical activity
Measured: six weeks
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted25 Mar 2020
- Study startApr 2020 (estimated)
- Primary completionSep 2020 (estimated)
- Study completionJan 2022 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Low Back PainStudies of the same condition, open and under way.
- More trials run by Cairo UniversityThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- different groups each will receive specific intervention at the same time
- Masking
- Single blind
- Who is masked
- Participant
- Enrolment
- 120 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Cairo University
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Noha Khaled Shoukry, Cairo University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT04320654
- Sponsor's protocol ID
- 5402
- Status last verified
- Mar 2020
- First submitted
- 23 Mar 2020
- Last updated
- 26 Mar 2020
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Study at a glance
From the registry record, last updated by the sponsor on 26 Mar 2020. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Will Patients With Low Back Pain Benefit From the Advice of Staying Active
- ClinicalTrials.gov ID
- NCT04320654
- Acronym / sponsor ID
- 5402
- Conditions
- Low Back Pain
- Study type
- Interventional
- Recruitment status
- Unknown status
- Enrolment
- 120 participants (estimated)
- Lead sponsor
- Cairo UniversityUniversity, hospital or other
- Study start
- Apr 2020 (estimated)
- Primary completion
- Sep 2020 (estimated)
- Study completion
- Jan 2022 (estimated)
- First posted
- 25 Mar 2020 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The variabilities in the management approaches for patients with LBP reflect uncertainty about the optimal approach. Therefore, there is a need for the implementation of early treatment strategies relying on an evidence-based knowledge to treat the problems and reduce the risk for recurrence and chronicity of LBP.
Advice is considered as the 'first in line' for the treatment of patients with LBP and is recommended in all international guidelines, yet it is under-utilized by the general practitioners. The current evidence in favor for the advice of staying active for patients with LBP is limited, with small or no benefits in pain relief, functional improvement or sick leave compared to rest in bed. Consequently, there is a huge gap between the evidence and practice.
So, the current study aimed at filling this gap and expanding the previous findings by investigating the effect of the advice of staying active on the level of perceived pain, physical activity level, postural control and functional disability in patients with low risk LBP (with a total score of three or less based on the STarT Back Tool score).
Detailed description
In spite of the great effort, LBP remains a significant burden on the society and can cause a disturbing impact on the functional ability during the productive years of the individuals. It is important to find pragmatic treatments that not only reduce the pain, but also decrease the disability. Activity monitoring in real life has the potential to change our concept of outcomes, and as a result, expand our ideas about the appropriateness of the interventions in rehabilitation.
The international guidelines vary but agree on advising patients with LBP to remain physically active. The National Institute for Clinical Excellence (NICE)'s updated guideline on the LBP recommends encouraging people to continue with their normal activities as far as possible. NICE found that there were no randomized controlled trials (RCTs) (which are the best way of investigating the efficacy of a treatment) that compared the effect of the advice of staying active with no advice or the advice to rest.
Despite the guidelines, it was reported that many health care providers are still too restrictive and believe that LBP requires some avoidance of activities and to remain off- work. Many general practitioners do not give advice on daily activities to patients with back pain and there is confusion about what constitutes an effective advice. Only 12% of the physiotherapists identify correctly the guidelines, and most of them do not agree with these guidelines regarding the return to work or activity. Investigating the benefit of the advice of staying active and different active intervention programs in patients with low risk NSLBP may help in developing recommendations for the physiotherapists responsible for reviewing exercise protocols for patients with LBP.
Therefore, the improvement of the primary care management of patients with LBP has the potential to reduce the long-term effects of back pain, including persistent disabling symptoms, low quality of life, and reduced capacity to work. The advice of staying active may not only be a treatment to improve the recovery from LBP, but also an opportunity to promote physical activity for other health benefits, such as improved cardio-metabolic function, blood pressure, and reduced body fatness.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (participant)
- Number of arms
- 5
- Model description
- different groups each will receive specific intervention at the same time
| Arm | Type | Receives |
|---|---|---|
| advice of staying active | Experimental | Other: exerciseThe patients will be advised to stay as physically active as possible and continue their everyday activities as normally as possible. |
| walking program | Experimental | Other: exercisePatients will be encouraged to go about their normal daily activities. At week one, patients will be asked to familiarize themselves with wearing the pedometer and recording their daily steps in a walking diary for the subsequent 7 days. The patients will return to see the physiotherapist at the end of week one to discuss any issues with the program, pedometer or recording of desired information. A step target for week two will be agreed between the physiotherapist and the patient by referring to the mean daily step count recorded at baseline, and the average step count calculated from the walking diary |
| Backward walking | Experimental | Other: exerciseAll patients will be instructed to walk at their desired pace 3 days per week with a steady rhythm. The duration of each training session will initially be 15 minutes and will gradually increase, and finally reach 25 minutes, for every session (Hao Chen, 2011). There will be no constraint or indication about head and trunk position during backward training |
| Targeted home-based hip exercise | Experimental | Other: exercisePatients who will be assigned in this group will perform a hip exercise program for six weeks, three times / week to ensure an adequate recovery between exercise sessions (appendix V). The strengthening exercises will focus on strengthening the gluteus maximus (GMax), gluteus medius (GMed), gluteus minimus (GMin) and short hip external rotator muscles (Distefano et al., 2009). |
| control group | No intervention | –The patients will not be given any intervention and will be asked to come after 6 weeks for re-assessment |
Who may qualify
- Ages
- 18 to 60 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult
Key inclusion criteria (4 listed)
- Patients will be included if they are between 18 - 65 years of age
- able to stand and walk without assistance.
- Patients will also be included if they have a history of non specific low back pain classified as low risk of poor outcome with a total score of three or less based on the STarT Back Tool score (Hill et al., 2008).
- The back-pain episode is subacute
Key exclusion criteria (8 listed)
- Patients will be excluded if they have any neurological disease or balance deficits due to vestibular disorders, such as vertebrobasilar insufficiency and visual disorders,
- systemic infection,
- current pregnancy,
- severe musculoskeletal deformity (scoliosis or kyphosis),
- injury to the lower extremity that would interfere with testing or a history of any surgery in the three months prior to testing.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| exerciseThe aim of this intervention is to increase patients average daily step count. The walking program is a behavior change intervention in which the pedometer will be used as a tool to help the patients monitor their activity levels. | Other | Backward walking, Targeted home-based hip exercise, advice of staying active, walking program |
Primary outcome
level of perceived pain by Visual analogue scale
Time frame: six weeks
The Visual analogue scale will be used for measuring the pain intensity the scale ranges from 0 to 10 where 0 means no pain and 10 means severe intolerable pain.
1 secondary outcome
number of steps
Time frame: six weeks
Results and safety
Results are not available in the source record.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 26 Mar 2020.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
The record lists no contact. Use the official record to reach the sponsor.
Questions about this trial
What is this clinical trial studying?
A study testing exercise in people with Low Back Pain, run by Cairo University.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 4 inclusion and 8 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: status not confirmed, as of the sponsor's last update on 26 Mar 2020. Status can change between updates, so confirm with the study contact before making plans.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
Results are not available in the source record.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
level of perceived pain by Visual analogue scale (time frame: six weeks). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 26 Mar 2020; AzTrials last refreshed its copy on 6 Nov 2026.