Two RCTs hot off the press!
Our team has been working hard over the last couple of years assessing the impact of lifestyle programs for patients with chronic low back pain and knee osteoarthritis. With our papers now published and in press, we are excited to share with you the trial outcomes and importantly, what we learned.
Firstly, what did we do?
We randomly allocated 160 patients with chronic low back pain (trial 1) and 120 patients with knee osteoarthritis (trial 2) to receive a lifestyle intervention or usual care. In both trials, patients received some initial advice on the telephone about the benefits of improving physical activity and reducing weight for their pain and were offered a referral to the NSW Get Healthy Service (GHS). The GHS is a 6-month telephone-based healthy lifestyle coaching service that supports people to modify eating behaviours, increase physical activity and achieve or maintain a healthy weight. The back pain patients were also offered a physiotherapy appointment. The appointment included detailed education about back pain to dispel some pesky myths and lifestyle.
What were the outcomes?
Based on previous research, we had thought that losing a bit of weight and moving towards a healthy body mass index, might help patients with these musculoskeletal conditions to have less pain and improve their function. However, patients in the program didn’t lose more weight, improve their diet or increase physical activity, relative to those not in the program, and we didn’t see any improvement in pain or disability.
What could all of this mean?
We have learned a lot from these trials!
The first thing to point out is that there is some good evidence that weight loss improves symptoms of osteoarthritis of the knee, and this is why clinical practice recommend anyone who is overweight and has osteoarthritis should be supported to lose weight. An issue is that many people can’t access the intensive face-to-face clinical treatments previously studied. This is certainly the case for many people who live in the Hunter New England Health District which provides services to around one million people over an area twice the size of Ireland. This means that we needed to test a scalable option to support patients.
The GHS service was designed for the general population where there is generally a high engagement and positive participant outcomes, maybe because people opt into the service themselves – that is they seem to be motivated to make lifestyle changes. Unfortunately though, most of our patients dropped out of the program early. It could be that patients with musculoskeletal conditions face condition specific barriers to making lifestyle changes that are hard to overcome. For example, pain could well be a barrier to engaging in physical activity. Pain can also lead to compensatory behaviours like so called ‘eating for analgesia’, alcohol use and other drugs. Our process data about patient experiences, indicates these patients believed the general nature of the lifestyle program didn’t provide adequate support for their condition.
The bottom line
General lifestyle support approaches might not benefit patients with chronic musculoskeletal pain, which at any given time could be up to 25% of the population. Patients in pain appear to need extra support to change lifestyle habits compared to the general population. We need to continue to explore ways to support patients with musculoskeletal conditions to improve their lifestyle. This is important not only to potentially help their painful conditions, but also to improve general health and decrease risk of developing other chronic diseases.