The assessment of lower back mechanical behavior and spinal loads in veterans with non-specific low back pain: a feasibility study

患有非特异性腰痛的退伍军人的下背部机械行为和脊柱负荷的评估：可行性研究

• 批准号: 10183358
• 负责人: Babak Bazrgari
• 金额: --
• 依托单位: VA MEDICAL CENTER - LEXINGTON, KY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-06-01 至 2022-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10183358
• 关键词: Activities of Daily Living; Acute; Address; Affect; Applications Grants; Back; Behavior; Biomechanics; Characteristics; Chronic; Chronic low back pain; Clinic; Clinical; Clinical Management; Control Groups; Development; Elements; Etiology; Evaluation; Failure; Feasibility Studies; Financial compensation; Future; Gender; Goals; Health Status; Individual; Investigation; Life; Low Back Pain; Manuals; Measurement; Measures; Mechanics; Medical center; Methods; Muscle; Nature; Opioid; Outcome; Pain; Participant; Patient Self-Report; Patients; Pelvis; Physical Function; Plant Roots; Population; Preventive treatment; Questionnaires; Recording of previous events; Recurrence; Reflex action; Relapse; Relaxation; Reporting; Research; Research Personnel; Risk; Role; Screening procedure; Source; Spinal; Stress; Surveys; Symptoms; Testing; Tissues; Treatment outcome; Vertebral column; Veterans; Walking; design; disability; effective intervention; effective therapy; experience; high risk; human model; improved; innovation; mechanical behavior; mechanical properties; neuromuscular; neuromusculoskeletal; novel; opioid use; opioid user; pain relief; prescription pain reliever; psychologic; recruit; response; stem; symptom management; tool

Low back pain (LBP) is strongly associated with opioid consumption among veterans, and improved clinical management of LBP is likely to reduce reliance on opioid among veterans. Up to 60% of patients with an acute episode of non-specific LBP experience either symptom persistence or symptom relapse within one year. This is likely an indication of a failure in addressing the underlying mechanisms of pain or initiation of a new etiology; both may stem from a mismatch between patients and treatments. The overall goal of our research is to develop, validate and implement measures that are relevant to known mechanisms of LBP, which can then be used to holistically gauge the health status of patients’ lower backs beyond self-reporting of symptoms. More accurate measurements will help better match of patients with existing treatments or development of more effective new treatments. The specific objective of this study is to generate evidence in support of the feasibility of our methods for 1) the evaluation of relative contribution of lower back tissues to spinal loads, and 2) the investigation of the resultant spinal loads in veterans with non-specific LBP. We have developed a powerful set of tools for the comprehensive assessment of spinal loads and lower back mechanical behavior (MB), that will enable us to examine the existence or development of abnormalities in spinal loads and lower back MB in [five] groups of veterans with different experiences with non-specific LBP. These groups will include [1) veterans with chronic, non-specific LBP and high level of disability (n=10), 2) veterans with chronic, non-specific LBP and low level of disability (n=10),] 3) veterans with non-chronic, non-specific LBP (n=10), 4) asymptomatic veterans with a recent history (i.e., during the past year) of non-specific LBP (n=10), and 5) asymptomatic veterans without a recent history of non-specific LBP (n=10; serving as control group). Successful completion of this feasibility project will pave the way for future studies (merit grant applications) that will verify the role of abnormalities in lower back MB and spinal loads in the clinical presentation of LBP. Such an understanding has the potential to help the affected veterans with disabling non-specific LBP. Specifically, measures of lower back MB and spinal loads can be used not only to identify veterans with mechanical abnormalities in their lower back who are likely to experience LBP in the future, but also to guide novel integrated physical and psychological preventative treatments aimed at improved lower back mechanics. Ultimately, the goal and resultant improvement in clinical outcomes of treatment for non-specific LBP is to diminish reliance on opioids for the symptom management of particularly veterans with chronic LBP.

下背痛（LBP）与退伍军人中的阿片类药物消费密切相关， LBP的管理可能会减少退伍军人对阿片类药物的依赖。高达60%的急性 非特异性LBP发作在一年内经历症状持续或症状复发。这 这可能是一个失败的迹象，在解决疼痛的潜在机制或启动一个新的 病因学;两者都可能源于患者和治疗之间的不匹配。我们研究的总体目标 是制定、验证和实施与LBP已知机制相关的措施，这些措施可以 然后用于整体测量患者下背部的健康状况，而不仅仅是自我报告症状。 更准确的测量将有助于更好地匹配患者现有的治疗或发展， 更有效的新疗法。本研究的具体目标是提供证据支持 我们的方法的可行性：1）评价下背部组织对脊柱负荷的相对贡献，以及 2)非特异性腰痛退伍军人脊柱负荷的调查。我们已经开发出一种 一套强大的工具，用于全面评估脊柱负荷和下背部力学行为 (MB)，这将使我们能够检查脊柱负荷异常的存在或发展， 在[五]组具有不同非特异性LBP经验的退伍军人中支持MB。这些团体将 包括[1）患有慢性、非特异性LBP和高度残疾退伍军人（n=10），2）患有慢性、非特异性LBP和高度残疾的退伍军人（n=10）， 非特异性LBP和低水平残疾（n=10），] 3）非慢性、非特异性LBP退伍军人（n=10），4） 具有近期病史的无症状退伍军人（即，在过去一年中）的非特异性LBP（n=10），和5） 无症状的退伍军人，近期没有非特异性LBP的历史（n=10;作为对照组）。 成功完成这一可行性项目将为未来的研究铺平道路（奖学金申请） 这将验证下背部MB和脊柱负荷异常在LBP临床表现中的作用。 这样的理解有可能帮助受影响的退伍军人与禁用非特异性LBP。 具体而言，下背部MB和脊柱负荷的测量不仅可以用于识别退伍军人， 机械异常，在他们的下背部谁有可能在未来的经验LBP，但也指导 新型综合身体和心理预防治疗旨在改善下背部力学。 最终，非特异性LBP治疗的目标和临床结果的改善 是减少对阿片类药物的依赖，特别是对患有慢性疾病的退伍军人的症状管理， LBP。