Abstract：
BACKGROUND: Moderately vigorous physical activity (PA) may be beneficial for people with sub-acute low back pain (LBP), but may initially be painful for patients and challenging for physical therapists to facilitate.
OBJECTIVE: This study investigated motivational interviewing (MI) delivered by physical therapists and a smartphone app for increasing PA in people with LBP.
METHODS: A mixed methods cluster randomised controlled trial involving 46 adults with LBP in Melbourne, Australia. Participants attended weekly 30-min physical therapy consultations for 6 weeks. Experimental group physical therapists were taught to embed MI into consultations and patients were provided with a self-directed app. The primary outcome was accelerometer-derived moderately vigorous PA. Secondary outcomes were LBP disability (Oswestry Disability Index), functional capacity (Patient Specific Functional Scale), and self-efficacy (Pain Self-Efficacy Questionnaire). Between-group differences were analysed by ANCOVA post-intervention.
RESULTS: There was no statistically significant difference between the experimental group and control group for PA. Between-group differences in LBP disability (MD= 19.4 units, 95% CI: 8.5, 30.3), functional capacity (primary MD= -4.1 units, 95% CI: -6.9, -1.3; average MD= -3.1, 95% CI: -4.9, -1.2) and self-efficacy (MD -11.3 units, 95%CI -20.2, -2.5) favoured the control group with small to moderate effect sizes. There were low levels of overall engagement with the app.
CONCLUSIONS: The embedded MI intervention was no more beneficial than physical therapy alone for PA and was associated with poorer LBP disability, function, and self-efficacy. The effectiveness of embedding MI and a smartphone app into usual care for LBP was not supported.
OBJECTIVE: This study investigated motivational interviewing (MI) delivered by physical therapists and a smartphone app for increasing PA in people with LBP.
METHODS: A mixed methods cluster randomised controlled trial involving 46 adults with LBP in Melbourne, Australia. Participants attended weekly 30-min physical therapy consultations for 6 weeks. Experimental group physical therapists were taught to embed MI into consultations and patients were provided with a self-directed app. The primary outcome was accelerometer-derived moderately vigorous PA. Secondary outcomes were LBP disability (Oswestry Disability Index), functional capacity (Patient Specific Functional Scale), and self-efficacy (Pain Self-Efficacy Questionnaire). Between-group differences were analysed by ANCOVA post-intervention.
RESULTS: There was no statistically significant difference between the experimental group and control group for PA. Between-group differences in LBP disability (MD= 19.4 units, 95% CI: 8.5, 30.3), functional capacity (primary MD= -4.1 units, 95% CI: -6.9, -1.3; average MD= -3.1, 95% CI: -4.9, -1.2) and self-efficacy (MD -11.3 units, 95%CI -20.2, -2.5) favoured the control group with small to moderate effect sizes. There were low levels of overall engagement with the app.
CONCLUSIONS: The embedded MI intervention was no more beneficial than physical therapy alone for PA and was associated with poorer LBP disability, function, and self-efficacy. The effectiveness of embedding MI and a smartphone app into usual care for LBP was not supported.
摘要：
背景：适度的体力活动（PA）可能对亚急性下腰痛（LBP）患者有益，但最初可能对患者来说是痛苦的，对物理治疗师来说是有挑战性的。
目的：这项研究调查了由理疗师和智能手机应用程序提供的动机性访谈（MI），以增加LBP患者的PA。
方法：一项混合方法的集群随机对照试验，包括墨尔本46名患有LBP的成年人，澳大利亚。参与者每周参加30分钟的物理治疗咨询，持续6周。实验组物理治疗师被教导将MI嵌入到咨询中，并为患者提供了一个自我指导的应用程序。主要结果是加速度计衍生的中等强度PA。次要结局是LBP残疾（Oswestry残疾指数），功能能力(患者特定功能量表)，和自我效能感(疼痛自我效能感问卷)。干预后通过ANCOVA分析组间差异。
结果：实验组与对照组PA比较差异无统计学意义。LBP残疾的组间差异(MD=19.4单位，95%CI：8.5，30.3），功能容量(主要MD=-4.1单位，95％CI：-6.9，-1.3；平均MD=-3.1，95％CI：-4.9，-1.2）和自我效能感（MD-11.3单位，95CI-20.2，-2.5）以小到中等的效应大小有利于对照组。该应用程序的整体参与度较低。
结论：对于PA，嵌入式MI干预没有比单独的物理治疗更有益，并且与较差的LBP残疾相关。函数,和自我效能感。不支持将MI和智能手机应用程序嵌入到LBP常规护理中的有效性。
目的：这项研究调查了由理疗师和智能手机应用程序提供的动机性访谈（MI），以增加LBP患者的PA。
方法：一项混合方法的集群随机对照试验，包括墨尔本46名患有LBP的成年人，澳大利亚。参与者每周参加30分钟的物理治疗咨询，持续6周。实验组物理治疗师被教导将MI嵌入到咨询中，并为患者提供了一个自我指导的应用程序。主要结果是加速度计衍生的中等强度PA。次要结局是LBP残疾（Oswestry残疾指数），功能能力(患者特定功能量表)，和自我效能感(疼痛自我效能感问卷)。干预后通过ANCOVA分析组间差异。
结果：实验组与对照组PA比较差异无统计学意义。LBP残疾的组间差异(MD=19.4单位，95%CI：8.5，30.3），功能容量(主要MD=-4.1单位，95％CI：-6.9，-1.3；平均MD=-3.1，95％CI：-4.9，-1.2）和自我效能感（MD-11.3单位，95CI-20.2，-2.5）以小到中等的效应大小有利于对照组。该应用程序的整体参与度较低。
结论：对于PA，嵌入式MI干预没有比单独的物理治疗更有益，并且与较差的LBP残疾相关。函数,和自我效能感。不支持将MI和智能手机应用程序嵌入到LBP常规护理中的有效性。
