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

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.