Exercise is recommended for people with chronic low back pain (LBP), but compliance with unsupervised home exercise is poor. Despite this, older people with poor physical functioning often prefer home-based exercise because accessing treatment facilities can be difficult and costly. Realising this highlighted the need to investigate low cost and accessible treatment options for older people with chronic LBP.

The research

Part of my research aims to develop and test strategies that could help people with LBP manage their symptoms independently, and ultimately reduce their reliance of a healthcare system with scarce resources. We recently completed a randomised controlled trial that investigated the effectiveness of a home-based video-game exercise program in 60 older people with chronic LBP. To be included, patients had to be over 55 years old, report non-specific LBP that had lasted for at least three months, report a usual pain intensity of 3/10 or greater on a numeric rating scale, and be able to mobilise without a walking aid.

Participants in the video game exercise group performed a range of flexibility, strength, aerobic and balance exercises at home for eight weeks using the Nintendo Wii-Fit-U program. Participants were encouraged to perform the exercises for 60 minutes, three times per week, and the only contact they had with a physiotherapist was during the first session, where they were instructed how to use the program. Participants received fortnightly telephone calls from the physiotherapist to ensure there were no issues with the program and to address any questions or concerns they had. We instructed participants in the control group to maintain their usual physical activities and healthcare- seeking behaviours.

Like many trials, recruitment was not straightforward. We anticipated participants’ understanding of the program would present a challenge. However, most participants learnt how to use the Wii-Fit-U program after only 45–60 minutes of instruction, and were confident with how to increase or decrease the difficulty of the program if necessary.

The results

We found that participants completing home-based video-game exercises experienced a 27 per cent reduction in pain and a 23 per cent increase in function at the end of the eight-week trial. This represents an improvement in pain and function of 1 to 1.5 points over the control group (0–10 scale). Although this effect appears small, it is comparable to trials that have investigated exercise programs with more supervision.

Improvements in participants’ ability to continue their daily activities despite having pain (‘pain self-efficacy’) favoured the exercise group in the intermediate and long-term. However, there was no difference between the exercise and control group for the remaining outcomes: physical activity, care-seeking, disability, kinesiophobia (fear of movement/re-injury), and falls-efficacy.

Our study found high compliance to home-based video-game exercises, with participants completing on average 85 per cent of recommended sessions. However, many of these sessions failed to last for 60 minutes, which suggests older people with chronic LBP might be more suited to shorter exercise sessions.

The future

Given that participants rarely had issues or questions regarding how to use the equipment, future trials should consider removing the fortnightly telephone calls from the physiotherapist. Effectiveness in this context would further support the use of home-based video-game exercises as a self-management strategy that could reduce the reliance older people with chronic LBP have on the healthcare system.

Joshua Zadro, APAM, is a physiotherapist and postdoctoral research fellow at the Institute for Musculoskeletal Health, University of Sydney. He is currently investigating strategies to replace low-value physiotherapy with high-value physiotherapy. The research was published in Physical Therapy.