Background/Purpose: The majority of older adults with chronic low back pain (cLBP) are inactive and have significant functional limitations, highlighting the need for continued efforts to promote regular engagement in exercise and physical activity. Few studies have directly compared different strategies, including behavioral interventions (i.e., cognitive behavioral therapy) for improving physical function-related outcomes among older adults with cLBP. The objective of this trial was to collect preliminary data on the efficacy of physical activity (PA) only and PA + cognitive behavioral therapy for pain (CBT-P) programs for improving functional outcomes among older adult Veterans with cLBP. We hypothesized that home-based telephone-supported PA only and PA + CBT-P program would produce a significant increase in older adults’ physical function.

Methods: Older adult Veterans with cLBP at the Durham VA HealthCare System were randomized to 12-week telephone-supported PA only or PA + CBT-P interventions or a wait list (WL) control group. A physical therapist conducted the initial evaluation and established the PA and exercise program in person with the participant. Follow up telephone calls were delivered by a physical therapist (n=3) and an exercise counselor (n=10) . The PA intervention included stretching, strengthening, and aerobic activities; CBT-P was tailored for older adults with cLBP. Outcomes measured at baseline and 12-weeks were: physical performance (timed up-and-go; TUG), self-report physical function (PROMIS Health Assessment Questionnaire ((HAQ)), self-reported LBP-specific disability (Roland-Morris Low Back Pain and Disability Questionnaire (RMDQ)), the Satisfaction with Physical Function Scale, and pain catastrophizing (from the Coping Strategies Questionnaire). General linear mixed models were used to compare outcomes over 12-weeks of follow-up among groups. Effect sizes were calculated using Cohen’s d.

Results: Mean age of participants was 70.3 years; 53% were Non-white, 93% Male, and 83% had back pain symptoms lasting longer than 5 years. No significant differences were found for the PA or PA + CBT-P group, compared with the WL group, for primary outcomes of TUG or PROMIS HAQ; however, effect sizes were moderate to large (d= -0.64) for improving physical function on the PROMIS HAQ in the PA only group and small for improvements in the TUG for both the PA only (d= -0.28) and PA+CBT-P (d=-0.31) groups. A significant difference was found for the RMDQ at 12 week follow-up for the PA only group (-4.10 ((95% CI -6.85, -1.34; p<0.01)) compared to WL, with a moderate to large effect size (d=-0.78). Small effect sizes were found for Satisfaction with Physical Function Scale and Coping Strategies Questionnaire Catastrophizing scores in both the PA and PA+CBT-P.

Conclusion: Results from this pilot trial suggest that a home-based telephone-supported PA program may be effective for improving some aspects of physical functioning among inactive older adults with cLBP. The addition of CBT-P did not result in a significant additive affect for increasing physical function or changes in behavioral outcomes. Results provide support for a larger trial investigating telephone-supported PA for older adults with cLBP.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/effects-of-a-home-based-telephone-supported-physical-activity-program-on-physical-function-among-older-adults-with-chronic-low-back-pain/