Effectiveness of m-health-based core strengthening exercise and health education for public safety workers with chronic non-specific low back pain: study protocol for a superiority randomized controlled trial (SAFEBACK)

BACKGROUND

Low back pain (LBP) is the leading cause of years lived with disability worldwide. Public safety workers are highly exposed to physically demanding activities and inappropriate postures, increasing the risk of experiencing LBP. Smartphone app-based self-managed interventions may be an alternative for chronic non-specific LBP (CNSLBP) treatment. This study aims to evaluate the effectiveness of a smartphone app-based self-managed exercise program plus health education, compared to a health education program alone, on neuromuscular and perceptual outcomes in police officers and firefighters with CNSLBP.

METHODS

This is a parallel, two-armed, blinded evaluator randomized clinical trial. Police officers and firefighters (from public safety institutions in the Rio Grande do Sul state, Brazil) will be randomly assigned to a m-health self-managed exercise program (twice a week) plus health education or health education alone. Self-management exercise program components are mobility and core resistance exercises, available on the app. Follow-ups will be conducted post-treatment (8 weeks) and 16 weeks after randomization. The co-primary outcomes will be pain intensity and disability post-treatment (8 weeks). Secondary outcomes will be biopsychosocial factors related to CNSLBP.

DISCUSSION

We hypothesize that the effects of a smartphone app-based self-managed exercise program on co-primary and secondary outcomes will be superior, compared to the health education only in public safety workers with CNSLBP.

TRIAL REGISTRATION

The study was prospectively registered at ClinicalTrials.gov (NCT05481996. Registered on August 01, 2022).

Physical Fitness Characteristics That Relate to Work Sample Test Battery Performance in Law Enforcement Recruits

This study determined relationships between an agency-specific fitness test battery (PT500), and a work sample test battery (WSTB) in law enforcement recruits. Retrospective analysis on 219 males and 34 females from one agency was conducted. The PT500 comprised: push-ups, sit-ups, and mountain climbers in 120 s; pull-ups; and 201 m and 2.4 km runs. The WSTB comprised: 99 yard (90.53 m) obstacle course (99OC); body drag (BD) with a 165 pound (75 kg) dummy; 6 foot (1.83 m) chain link fence (CLF) and solid wall (SW) climb; and 500 yard (457.2 m) run (500R). Partial correlations, controlling for sex, calculated PT500 and WSTB relationships (p < 0.05). Stepwise regression determined whether fitness predicted WSTB performance. The 500R related to all PT500 assessments (r range = −0.127–0.574), 99OC related to all bar push-ups and mountain climbers, and BD related to none. The CLF related to sit-ups, pull-ups, and 2.4 km run; SW related to mountain climbers, pull-ups, and 2.4 km run (r range = −0.127–−0.315). Push-ups, pull-ups, and 2.4 km run were involved in predictive relationships for 99OC, CLF, SW, and 500R (r² range = 0.217–0.500). To perform better in the WSTB and job-specific tasks, developing upper-body strength and aerobic fitness may be beneficial.