Trunk Muscle Training+NMES: Improving Function in Elders With Chronic Back Pain

描述（由申请人提供）：腰痛（LBP）是最常见的肌肉骨骼问题，也是75岁以上人群中第三常见的症状。事实上，17.3%的LBP医生访问涉及65岁以上的人。在老年人中，LBP与许多负面后果有关，包括身体功能下降，跌倒风险增加，情绪障碍增加和医疗保健利用增加。令人惊讶的是，很少有研究关注65岁以上人群的LBP。但是，最近的证据表明，LBP与腹部和脊柱旁肌肉中肌内脂肪浸润增加有关，这种改变的肌肉组成增加了老年人活动相关功能下降的风险。虽然躯干肌肉训练（TMT）已被用于年轻的LBP群体，但它在老年人中未经证实，并且考虑到老年肌肉的受损状态，单独使用可能不足以大幅改善功能和症状。TMT增强神经肌肉电刺激（NMES），已知提高力量和功能超出单独意志锻炼的能力，可能会提供更大的改善。使用运动干预治疗老年人慢性LBP被假设为预防功能下降和虚弱进展的一种方法;然而，这一假设尚未得到实验证实。在这项探索性研究中，我们将测试的假设，TMT加NMES将导致减少残疾和疼痛的严重程度相比，通常的护理老年人慢性下腰痛。使用随机对照实验设计，62名年龄65-85岁的社区居住老年人患有慢性LBP，从未接受过脊柱手术，并且除背部外没有明显疼痛，将接受（1）NMES增强的TMT或（2）每周两次的被动对照干预，持续12周。随机化前、末次治疗后即刻和3个月后，将由设盲的评价者评估以下参数：通过奥斯韦斯特里残疾问卷测量的自报残疾、通过疼痛温度计测量的疼痛严重程度、通过基于表现的测量的身体功能和心理社会功能（情绪、自我效能、自评健康和疼痛相关恐惧）。将在基线和最后一次治疗后立即进行磁共振成像，以评估肌肉成分及其在维持疼痛-残疾周期中的潜在作用。如果这项探索性研究表明TMT+NMES有效，未来将设计更长随访期的研究，以研究其预防功能下降的疗效，并确定对医疗费用的影响。如果没有令人信服的证据表明，对患有慢性LBP的老年人进行运动干预可以减少残疾，并且具有成本效益，则不会发生实践指南的变化。 公共卫生相关性：鉴于社区居住老年人慢性腰痛（LBP）的患病率及其相关的负面功能后果，这项研究将对公共卫生产生广泛影响，因为旨在减少LBP老年人群疼痛和残疾的研究有限。这项研究的潜在益处包括：（a）通过改善疼痛管理以及身体和心理社会功能，改善社区居住的慢性LBP老年人的生活质量;（B）为慢性LBP老年人开发非药物治疗，从而保护未来的个体免受潜在有毒药物的影响;以及（c）集中于降低卫生保健使用成本的研究的未来发展。

DESCRIPTION (provided by applicant): Low back pain (LBP) is the most frequently reported musculoskeletal problem and third most frequently reported symptom of any kind in people over the age of 75. In fact, 17.3% of all visits to physicians for LBP involve individuals over 65. In older adults, LBP has been associated with a host of negative consequences, including decreased physical function, increased fall risk, increased mood disturbance and increased healthcare utilization. Surprisingly, little research has focused on LBP in people over 65. But, recent evidence demonstrates that LBP is associated with increased intramuscular fat infiltration in the abdominal and paraspinal muscles and that this altered muscle composition increases the risk of mobility-related functional decline in older adults. While trunk muscle training (TMT) has been used in younger LBP groups, it is unproven in elders and, alone, may not be sufficient to substantially improve function and symptoms, given the compromised state of aged muscle. TMT augmented with neuromuscular electrical stimulation (NMES), known to improve strength and function beyond the capacity of volitional exercise alone, may provide greater improvements. Treatment of chronic LBP in older adults using an exercise intervention has been hypothesized as a way to prevent functional decline and frailty progression; however, this hypothesis has yet to be experimentally confirmed. In this exploratory study, we will test the hypothesis that TMT plus NMES will result in reduced disability and pain severity compared to usual care in elders with chronic LBP. Using a randomized controlled experimental design, 62 community dwelling older adults age 65-85 with chronic LBP who never had spinal surgery, and have no prominent pain in sites other than the back, will receive either (1) TMT augmented with NMES or (2) a passive, control intervention twice a week for 12 weeks. Prior to randomization, immediately after the last treatment session and 3 months later, the following parameters will be assessed by a masked evaluator: self-reported disability as measured by the Oswestry Disability Questionnaire, pain severity as measured by the Pain Thermometer, physical function as measured by performance-based measures, and psychosocial function (mood, self-efficacy, self-rated health, and pain-related fear). Magnetic resonance imaging will be done at baseline and immediately after last treatment session to evaluate muscle composition and its underlying role in perpetuating the pain-disability cycle. If this exploratory study suggests that TMT+NMES is effective, future studies with longer follow-up periods will be designed to investigate its efficacy for preventing functional decline and determine the impact on healthcare costs. Practice guideline changes will not occur without compelling evidence that exercise interventions for elders with chronic LBP result in reduced disability and are cost-effective. PUBLIC HEALTH RELEVANCE: Given the prevalence of chronic low back pain (LBP) in community dwelling older adults and the associated negative functional consequences, this research will have a broad impact on public health as there has been limited research aimed at reducing pain and disability in the geriatric population with LBP. The potential benefits of this research include: (a) improving quality of life for community-dwelling older adults with chronic LBP by improving pain management, as well as physical and psychosocial function; (b) developing a non-pharmacologic treatment for elders with chronic LBP, and thus protecting future individuals from exposure to potentially toxic medications; and (c) future development of studies focused on decreasing health care utilization costs.