Effectiveness of an individualised swimming and education programme for chronic low back pain (EduSwim): a randomised controlled trial.

Abstract

OBJECTIVE To assess the effectiveness of a swimming and education programme compared with education alone for patients with chronic low back pain. METHOD Adults with chronic, non-specific low back pain were randomised to a swimming and education (intervention) group or an education alone (control) group (1:1). The intervention group received an individualised swimming and education programme facilitated by four physiotherapy telehealth sessions delivered over 8 weeks. The control group received up to two telehealth sessions with a physiotherapist covering the same educational content as the intervention group. The primary outcome was disability (Roland Morris Disability Questionnaire, (RMDQ)) at 8 weeks. Secondary outcomes included pain intensity, patient-specific functional limitation, pain self-efficacy, fear of movement, patient-perceived global improvement and adverse events. Linear mixed models were used to assess intervention effects. RESULTS 76 participants were randomised (39 to intervention and 37 to control). Swimming and education together was more effective than education alone for disability at 8 weeks (RMDQ mean difference (MD) -2.5, 95% CI -4.5 to -0.5), but this between-group difference was not sustained at 52 weeks. For pain intensity, the intervention showed a small benefit at 8 weeks that may not be clinically significant (MD -0.7, 95% CI -1.5 to 0.0). All other secondary outcomes showed a pattern of better outcomes in the intervention group early, which typically reduced over time. The intervention group had more adverse events, although almost all were non-serious. CONCLUSION A swimming and education programme was more effective than education alone for short-term improvement of chronic low back pain. TRIAL REGISTRATION NUMBER ACTRN12624000263594.