Development and feasibility of a swimming programme as a rehabilitation modality for people with chronic low back pain: a mixed methods project

Chronic low back pain (CLBP) is a complex multidimensional condition impacting physical activity, function, quality of life and health. It is common practice for health professionals to recommend swimming to people with CLBP for rehabilitation and to improve levels of physical activity. There are several key uncertainties and limited research supporting this recommendation and a lack of specific swimming frameworks this population. The aim of this project was to develop and explore the feasibility of a swimming programme as a rehabilitation modality for people with CLBP.

A mixed methods multi-phase project was designed within the research paradigm of pragmatism, to develop a swimming programme. Collectively the programme objectives enabled swimming to be delivered as a CLBP rehabilitation modality, not simply as instructional swimming sessions. Exploratory research was conducted to understand determinants impacting uptake and engagement and the experience of people swimming with CLBP. The findings were combined with further data in a modified Delphi study involving all stakeholders, leading to the development of the swimming programme. All aspects of the programme were considered, including the setup, pre-programme information, delivery, teaching approaches, session brief, warmup, cooldown, core aquatic skills, swimming strokes and strategies to enable regular swimming. The final study evaluated the feasibility of the swimming programme as a rehabilitation modality and the trial procedures. Meta inferences were drawn from the collective data involving all four studies to enable the swimming programme to be refined for future research.

The findings indicated that a swimming programme, teaching swimming and pain management skills is a feasible and safe rehabilitation modality for people with CLBP, enabling physiotherapists and swimming professionals to collaboratively deliver rehabilitation and education in the community. The programme will undergo further development; well-designed randomised clinical trials are required to measure outcomes, impact, and cost effectiveness, comparing the intervention to usual care.