Impact of Early Initiation of Exercise on Acute Low Back Pain and Disability

Background: Low back pain (LBP) is the leading cause of chronic pain and disability worldwide and was the third major contributor to health care spending in the United States. Early initiation of exercise is known to be beneficial in chronic LBP but there is limited evidence on the benefits of similar activity prescription in acute LBP. Aim: This evidence-based project was an exploratory study that evaluated the utility of implementing a patient education tool promoting Early Exercise for Acute Low Back Pain (EE) and the use of instruments to measure pain (Numeric Pain Rating Scale [NPRS]) and disability (Roland Morris Disability Questionnaire [RMDQ]) at baseline and again at 4-weeks post-presentation. Methods: This pilot study was a single group, quasi-experimental design conducted at an urgent care clinic in Southern California. The intervention (EE patient education tool) was offered to adult patients aged 30-60 years with acute (<4 weeks), non-specific LBP. Baseline data on participants was collected using the EE Demographic and Baseline Questionnaires, NPRS, and RMDQ. Follow-up data was collected using the online EE Follow-Up Questionnaire, NPRS, and RMDQ 4-weeks post-presentation. Analysis of the data was evaluated with a one-tailed t-test. Results: Due to the concurrent COVID-19 pandemic, only two subjects completed all components of the project. At initial visit, average NPRS was 8.6 (out of 10) and average RMDQ was 15 (out of 24). At 4-week follow-up, participants reported an NPRS of zero. On a one-tailed t-test, there was statistical difference between pre- and post-intervention pain levels (p = 0.04) on these two participants. Follow-up measurement of disability showed one participant with complete resolution (RMDQ score of zero) while the other participant had a follow-up score of 7 for an average follow-up RMDQ score of 3.5. Conclusions: This pilot project, while time and subject limited, demonstrated a large effect size, utility and feasibility of the EE intervention in the urgent care setting. A power analysis indicates that a two-tailed ANCOVA, with 3 covariates, and assuming a large (0.40) effect size, would require at least 111 subjects in a future study