Early physiotherapy for chronic low back pain patients

ISRCTN ISRCTN14405580
DOI https://doi.org/10.1186/ISRCTN14405580
Submission date
02/08/2020
Registration date
04/08/2020
Last edited
06/09/2023
Recruitment status
No longer recruiting
Overall study status
Completed
Condition category
Musculoskeletal Diseases
Prospectively registered
Protocol
Statistical analysis plan
Results
Individual participant data

Plain English summary of protocol

Background and study aims
Low Back Pain (LBP) is a very common symptom experienced by a high number of the population. Mostly, LBP symptoms resolve with time or conservative treatment. It has been proposed that imaging, MRI mainly, can negatively impact patient's recovery in terms of high consumption of pain killers, frequent visits to the doctors and elevating the anxiety and fear of the patients. This study is set to examine whether providing physiotherapy in secondary care level hospitals instead of MRI imaging is feasible and acceptable.

Who can participate?
Patients with non-specific LBP, no underlying serious pathology, who are referred to spine clinics in a secondary care center in Riyadh, Saudi Arabia aged from 18-65. There should be no recorded of MRI or physiotherapy in the past 6 months.

What does the study involve?
The patients will be randomized into two groups. the first group will be referred to have physiotherapy immediately. the second group (routine practice) will have MRI for their spine then discuss the result with the doctor before being referred to physiotherapy.

What are the possible benefits and risks of participating?
There are no expected benefits or associated risks from participating in this study.

Where is the study run from?
King Fahad Medical City (Saudi Arabia)

When is the study starting and how long is it expected to run for?
October 2015 to July 2018

Who is funding the study?
Saudi Spine Society (Saudi Arabia)

Who is the main contact?
Dr Ahmed Alhowimel, a.alhowimel@psau.edu.sa

Contact information

Dr Ahmed Alhowimel
Scientific

3948 Alhabtah Street
unit 3
Riyadh
12989-6769
Saudi Arabia

ORCiD logoORCID ID 0000-0002-2936-7581
Phone +966 0553470558
Email a.alhowimel@psau.edu.sa

Study information

Study designSingle-center two-arm non-inferiority feasibility randomized controlled trial
Primary study designInterventional
Secondary study designRandomised controlled trial
Study setting(s)Hospital
Study typeTreatment
Participant information sheet Not available in web format, please use the contact details to request a patient information sheet
Scientific titleFeasibility study and process evaluation of MRI plus physiotherapy vs. physiotherapy alone in non-specific chronic low back pain among patients in Saudi Arabia
Study objectivesIt is not known whether altering the practice of routine MRI use in Saudi Arabia would be acceptable to healthcare practitioners and patients and lead to improved psychosocial and disability outcomes. Therefore, this study will seek to examine the feasibility and acceptability of conducting an RCT to answer the following question: Does MRI diagnosis negatively influence psychosocial and disability outcomes in patients with CLBP who are undergoing physiotherapy?
Ethics approval(s)1. Approved 21/12/2016, Research Ethics Committee of the Faculty of Medicine and Health Science at the University of Nottingham (Medical School, Queen's Medical Centre Campus, Nottingham, NG7 2UH; louise.sabir@nottingham.ac.uk; +44(0)115 8232561), ref: OVS 18082016
2. Approved 21/11/2016, King Fahad Medical City (Riyadh, Saudi Arabia; +966 12889999; okasule@kfmc.med.sa), ref: H-01-R-R-012
Health condition(s) or problem(s) studiedChronic low back pain
InterventionMRI+ Physiotherapy
Participants allocated to the MRI group were sent for an MRI scan of the lumbar spine, and a follow-up visit was planned to discuss the results. The time interval to undergo MRI ranged from 3 to 6 weeks. After discussing the results with their doctor, the patients were referred to physiotherapy. Next, another copy of the questionnaire booklet was completed by the participants after finishing the physiotherapy treatment, which lasted for a period of 2 weeks to 4 weeks.

Early Physiotherapy
Following allocation participants in the control arm (namely, the non-MRI group) were immediately asked to complete the booklet of questions and standard questionnaires. Participants were then referred to a physiotherapist for treatment, and the time required to initiate physiotherapy ranged from 1 week to 2 weeks. After completing the physiotherapy treatment programme, which lasted for 2 weeks to 4 weeks, the second assessment was taken
Intervention typeBehavioural
Primary outcome measureThe feasibility and acceptability of a large scale RCT:
1. Recruitment: Recruit at least 24 participants
2. Follow-up: If there is no more than 20% of loss to follow-up
3. Acceptability: If most participants interviewed stated that randomisation is acceptable and if at least 65% of eligible patients consent to participate in the trial
Secondary outcome measuresThere are no secondary outcome measures
Overall study start date01/10/2015
Completion date29/07/2018

Eligibility

Participant type(s)Patient
Age groupAdult
Lower age limit18 Years
Upper age limit65 Years
SexBoth
Target number of participantsThe sample size (n=36) was calculated from the number of patients matching the inclusion criteria who visited spine clinics in the 3 months prior to conducting the study. The estimated non-consent rate of 50%, suggested 6 new patients to be randomized per month.
Total final enrolment16
Key inclusion criteria1. Aged 18 – 65 years
2. Complaint of CLBP with no clear medical diagnosis (malignancy, fracture, infection, spinal stenosis, spondylolisthesis, or inflammatory disease)
3. Pain persisting for more than 3 months
Key exclusion criteria1. Pregnancy
2. New mother <6 months postpartum
3. Those who had undergone pain-relieving procedures (injection or denervation) in the previous 3 months
4. Those who showed evidence of neurological impairment specific to LBP and received physiotherapy treatment for their LBP and/or MRI scan in the last 6 months prior to recruitment
Date of first enrolment01/03/2018
Date of final enrolment24/07/2018

Locations

Countries of recruitment

  • Saudi Arabia

Study participating centre

King Fahad Medical City
Kurais Street
Riyadh
12231
Saudi Arabia

Sponsor information

Saudi Spine Society
Other

7432 Ath Thumamah Road
As Sahafah
Riyadh
-
Saudi Arabia

Phone +966 0114348837
Email info@saudispine.org
Website http://saudispine.org/

Funders

Funder type

Research organisation

Saudi Spine Society

No information available

Results and Publications

Intention to publish date01/09/2020
Individual participant data (IPD) Intention to shareYes
IPD sharing plan summaryOther
Publication and dissemination planPlanned publication in high-impact peer-reviewed journal.
IPD sharing planAll data generated or analysed during this study will be included in the subsequent results publication.

Study outputs

Output type Details Date created Date added Peer reviewed? Patient-facing?
Preprint results 09/03/2020 No No
Protocol file 07/08/2020 No No
Results article 30/11/2020 06/09/2023 Yes No

Additional files

ISRCTN14405580_PROTOCOL.pdf
uploaded 07/08/2020

Editorial Notes

06/09/2023: Publication reference added.
07/08/2020: Uploaded protocol (not peer reviewed) Version n/a.
04/08/2020: Trial’s existence confirmed by The University of Nottingham