FRI0712-HPR EFFICACY OF GRADED ACTIVITY WITH AND WITHOUT DAILY-MONITORED-WALKING ON SELECTED CLINICAL ATTRIBUTES OF PATIENTS WITH CONCOMITANT LOW-BACK PAIN AND TYPE-2 DIABETES
Authors: Opeyemi Idowu, Ade Adeniyi
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Graded Activity (GA) is efficacious in managing clinical attributes of patients with Low-Back Pain (LBP) in the general population [1,2]. It is unknown whether GA is efficacious in managing these clinical attributes in patients with concomitant LBP and Type-2 Diabetes (T2D) or additional daily-monitored-walking as a form of physical activity will be required. <h3>Objectives</h3> The objectives of this study were to investigating the effects of GA with and without daily-monitored-walking, and also to compare the efficacy of the two treatment modes on selected clinical attributes of patients with concomitant LBP and T2DM. <h3>Methods</h3> A single-blind controlled trial involving 58 patients (mean age: 48.3±9.4 years, 64.7% females) with concomitant LBP and T2D who received treatment twice weekly for twelve weeks was conducted. Participants were randomized into GA or GA with daily-monitored-walking (GAMW) groups. Pain Intensity (PI), Back Extensors Endurance (BEE), Abdominal Muscular Endurance (AME) and Glycaemic Control (GC) was assessed using Visual Analogue Scale, Biering-Sorensen test, flexor endurance test and HBA1c analyser respectively at baseline, 4th, 8th and 12th week. Data were analysed using repeated measures ANOVA, medians, Mann-Whitney U and Unpaired t-tests at α = 0.05. <h3>Results</h3> At baseline, treatment groups were not significantly different in their physical and clinical characteristics. There were within-group significant differences on PI, AME and BEE in each of GA and GAMW groups across the time points of the study. Within group difference on GC was significant for GAMW (6.3±0.9%, 5.7±0.7%) but not GA (6.3±0.9%, 6.3±0.9%) groups. There were no significant difference between the effects of GA and GAMW on PI at week 4 (Median=-0.78, IQR=0.06; Median=-0.78, IQR=0.08), week 8 (Median=-1.72, IQR=0.06; Median=-1.71, IQR=0.18) and week 12 (Median=-1.46, IQR=0.10; Median=-1.53, IQR=0.18) of the study. Further there was no significant difference between the effects of GA and GAMW on AME at weeks 4 (6.64±0.15; 6.65±0.09), 8 (7.01±0.16; 7.03±0.1) and 12 (5.16±0.05; 5.19±0.09) of the study. Graded activity with daily-monitored-walking had higher improvements than GA alone on BEE (7.34±0.1, 7.25±0.1) at week 8, but not at week 4 (2.37±0.08; 2.36±0.1) or 12 (4.5±0.06; 4.53±0.08) of the study. The GAMW participants also had significant improvement on glycaemic control than GA participants (-0.5±0.2%, -0.6±0.5%) at week 12. Graded activity relieves back symptoms via the development of a sense of control over pain, elimination of pain avoidance as well as by improving overall physical fitness/function [3]. <h3>Conclusion</h3> Graded activity with daily-monitored-walking produced positive effects on GC and yielded better improvement on BEE. <h3>References</h3> [1] Lindstrom, I., Ohlund, C., Eek, C., Wallin, L., Peterson, L., Fordyce, W.E. and Nachemson, A.L. 1992a.The effect of graded activity on patients with subacute low back pain: a randomized prospective clinical study with an operant-conditioning behavioural approach. Phys Ther. 72:279-293. [2] Macedo LG, Latimer J, Maher CG, Hodges PW, McAuley JH, Nicholas MK, Tonin L, Stanton CJ, Stanton TR, Stafford R. Effect of motor control exercises versus graded activity in patients with chronic nonspecific low back pain: a randomized controlled trial. Phys Ther. 2012; 92:363–377. [3] Bello AI, Quartey JNA, Lartey M. Efficacy of Behavioural Graded Activity Compared with Conventional Exercise Therapy in Chronic Nonspecific Low Back Pain: Implication for Direct Health Care Cost. Ghana Med J. 2015; 49:173-180. <h3>Disclosure of Interests</h3> None declared