Improving self-management of lower back pain with a core activity detecting belt

下背部疼痛是NHS最常见的疾病之一，也是病假和残疾的主要原因。英国政府建议，首要的治疗方法应该是锻炼，这通常比止痛药或背部手术更有效、更安全、更便宜。然而，运动只有在定期和适当的情况下才有效。这也许可以解释为什么针对背部的锻炼通常不起作用——因为人们厌倦了锻炼，或者做得不正确。虽然物理疗法可以通过一对一的个人训练来帮助背部锻炼，但这是一种有限的资源。NHS通常会提供少量的个性化锻炼课程或培训课程。但除此之外，背部疼痛患者只会得到一张练习表，并希望他们自己“坚持下去”。这个项目将开发一种简单的装置，可以鼓励人们自己进行背部锻炼。该装置是一条腰带，可以检测躯干“核心”肌肉的活动；然后通过智能手机或智能手表将这些活动显示给用户。这使用户能够“看到”他们的肌肉收缩；跟踪他们的锻炼表现，努力达到每天的锻炼目标。这不仅可以激励——就像计步器激励步行一样——而且腰带还可以指示人们是否正确地进行锻炼。核心肌肉是通过背部锻炼来锻炼的。一组肌肉是“腹肌”（或“六块腹肌”），健身爱好者对它再熟悉不过了；但其他的是更深更薄的腹部肌肉，还有一条沿着脊柱两侧延伸。当这些其他肌肉进行定期锻炼时，它们可以减少或预防背痛。然而，人们往往不知道如何使用它们，即使是在物理治疗师向他们展示的时候。因此，这条腰带可以通过让患者看到需要收缩的正确肌肉，向他们展示如何进行合适的锻炼。在我们早期的研究中，我们表明，与金标准方法相比，我们的皮带装置是测量核心肌肉收缩的可靠方法，金标准方法是一种仅在实验室中使用的称为肌电图的复杂仪器。我们还发现，当人们在背部锻炼时使用我们的设备和反馈应用程序时，无论是主动还是非主动，他们都增加了锻炼的精力和时间。我们还发现，使用带有肌肉反馈装置的受试者更恰当地进行背部锻炼，激活了正确的肌肉组。这些影响在有背痛或没有背痛的人身上都有发现。研究参与者在使用我们的发明时感到更投入，更有动力去锻炼；感觉腰带很舒服，App也很容易理解，很多人都想再次使用或购买它。鉴于我们早期研究的令人鼓舞的结果，我们现在希望进一步开发该设备，以确保皮带设计足够舒适，并且易于使用，以便人们想要在家中使用它，重复使用数周，数月甚至数年。我们也希望应用程序易于理解，所以它可以在没有专业帮助的情况下使用。我们将在那些背痛的人身上测试这款腰带和应用程序，这些人已经去看了全科医生或看过治疗师来帮助他们。我们的设备将补充标准治疗。使用2个月后，我们将看到该设备对他们的运动水平和背部疼痛有什么影响。我们希望腰痛患者在配备肌肉反馈带后，能够更有效、更频繁地锻炼，减少疼痛和残疾。考虑到我们的设备的预期成本很低，而且足够简单，任何人都可以戴上并使用它，我们希望我们的发明可以在整个NHS推广，实现有效的自我护理。这将减少残疾、依赖性和降低成本。

Lower back pain is one of the commonest ailments seen by the NHS, and a leading cause of sick leave and disability. The UK Government recommends that first line treatment should be exercise, which is often more effective, safer and cheaper, than painkillers or back surgery. However exercise is only effective if performed regularly and appropriately. This may explain why prescribing exercise for the back often does not work - because people tire of exercises, or perform manoeuvres incorrectly. While physiotherapy can help with back exercises - by offering one-to-one personal training - this is a limited resource. Typically the NHS offers a small number of personalised exercise sessions, or a training class. But beyond this, back pain sufferers are merely provided with an exercise sheet, and expected to "get on with it" themselves.This project will develop a simple device that can encourage people to perform back exercises by themselves. The device is a belt that detects activity of "core" muscles in the trunk; and then displays this activity back to the user via a smartphone or smartwatch. This enables users to "see" their muscles contract; track their exercise performance, and strive to reach daily workout goals. Not only can this incentivize - in the same way that step-counters motivate walking - but the belt will also indicate to people if they are performing exercises correctly or not.The core muscles targeted are those that are worked on with back exercises. One set of muscles are the "Abs" (or "6-pack") that fitness fanatics know only too well; but others are a deeper thinner tummy muscle, and another one that runs down either side of the spine. When these other muscles are engaged with regular exercise, they can reduce or prevent back pain. However often people don't know how to engage them, even when they are shown by a physiotherapist. Hence the belt can show patients how to perform suitable exercises by enabling them to visualise the correct muscles that need to be contracted.In our earlier research we showed that our belt device is a reliable way of measuring core muscles contracting, by comparison with a gold standard method, that is a sophisticated instrument called EMG, used only in laboratories. We also showed that when people used our device, in combination with a feedback App during back exercises, they increased the amount of effort and time they put into exercise, whether prompted or unprompted. We also found that subjects using the device with muscle feedback performed back exercises more appropriately, activating the right set of muscles. These effects were found in people with or without back pain.Research participants felt more engaged and motivated to exercise when they used our invention; felt the belt was comfortable and the App easy to understand, and many wanted to use it again or purchase it.Given encouraging results from our early studies, we now wish to develop the device further to ensure that the belt design is sufficiently comfortable, and simple to apply, for people to want to use it at home, repeatedly for weeks, months or even years. We also want the App to be easily understood, so it can be used without professional assistance. We shall test the belt and App out on people who have back pain, who have attended their GP or seen a therapist to help with this. Our device will supplement standard treatment. After 2 months of use, we shall see what effect the device has had on their level of exercise, and back pain.We expect that patients with lower back pain will exercise more effectively and more often when provided with the muscle feedback belt, which is likely to reduce pain and disability. Given the expected cost of our device is low, and simple enough that anyone could put it on and use it, we expect our invention could be rolled out across the NHS, enabling effective self-care. This will reduce disability, dependency and reduce costs.