Spinal Control during Functional Activities to Improve Low Back Pain Outcomes

功能活动期间的脊柱控制可改善腰痛结果

• 批准号: 8503877
• 负责人: LINDA R VANDILLEN
• 金额: $ 45.51万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-06-10 至 2018-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8503877
• 关键词: Address; Adherence; Aftercare; Analgesics; Attenuated; Chronic low back pain; Classification; Clinical Trials; Exercise; Grant; Healthcare; Hour; Laboratories; Low Back Pain; Measurement; Measures; Mechanical Low Back Pain; Medical; Mental Health; Motor Skills; Movement; Musculoskeletal Pain; Outcome; Pain; Pain Measurement; Pain intensity; Pattern; Performance; Phase; Productivity; Randomized; Randomized Controlled Clinical Trials; Recommendation; Recurrence; Rehabilitation Research; Reporting; Role; Services; Spinal; Sum; Testing; Time; Training; Training Programs; Vertebral column; Work; base; disability; economic outcome; evidence base; flexibility; improved; innovation; instrument; physical conditioning; programs; prospective; public health relevance; skills training; time use; treatment adherence

DESCRIPTION (provided by applicant): Our overall objective is to improve the costly long-term course of mechanical low back pain (LBP). In recent work we found that people in both classification-specific and non-specific treatment groups displayed clinically meaningful improvements in pain and function, but differences between groups were smaller than expected. A possible reason for the attenuated group differences can be found in 3 related facts: 1) in addition to specific or non-specific exercise, both groups received training aimed at modifying the pattern of movement and alignment used in the lumbar spine during functional activities, 2) adherence levels were higher and more prolonged for training in functional activities than for exercise, and 3) outcomes continued to improve for about 6 months after the treatment phase but then gradually reversed along with declines in adherence to training in functional activities. In the current project we will capitalize on the effect of training people to modify their movement and alignment patterns during daily functional activities. This will be done by using a motor skill training program which emphasizes challenging practice in performance of functional activities painlessly with appropriate patterns of movement and alignment. We will also attempt to prolong the beneficial effects of the motor skill training by including a booster treatment 6 months after the initial treatment. To accomplish this we will conduct a prospective, randomized, controlled clinical trial in which people with chronic LBP will be randomized to a treatment of either motor skill training or commonly prescribed, evidence-based, strength and flexibility exercises. Treatment will be provided in 2 phases: 1) initial phase: 6 - 1 hour sessions, once/week for 6 weeks, and 2) booster phase: 1-3 sessions beginning 6 months after the initial phase. We will collect 1) pain, functional limitation, disability, and economic outcomes, 2) reports of adherence, and 3) instrumented measurements of movement and alignment patterns during functional activities. People will be followed for 12 months after the initial treatment phase. We will test 1 if motor skill training results in better outcomes and better adherence than strength and flexibility exercise in the 12 months after treatment, and 2) the effect of a booster treatment provided 6 months after the treatment phase on functional limitations and adherence to treatment. Finally we will examine the relationship between functional limitations and 1) treatment adherence, and 2) movement and alignment patterns displayed during functional activities. Expected outcomes from this project are specific recommendations for the use and timing of motor skill training during functional activities for people with LBP. Successful completion of this project will have an immediate, high impact on rehabilitation research and treatment of people with LBP. In addition, the approach described could be used to study other similarly long-term, costly, and function-limiting musculoskeletal pain conditions.

描述(由申请者提供)：我们的总体目标是改善代价高昂的机械性下腰痛(LBP)的长期疗程。在最近的工作中，我们发现分类特定和非特定治疗组的患者在疼痛和功能方面都显示出临床上有意义的改善，但组之间的差异小于预期。导致两组差异减弱的可能原因有3个相关事实：1)除了特定或非特定运动外，两组都接受了旨在改变腰椎在功能活动中使用的运动和对齐方式的训练；2)功能活动训练的坚持水平高于运动训练，且持续时间更长；3)治疗阶段结束后约6个月，结果继续改善，但随着对功能活动训练的坚持程度的下降，结果逐渐逆转。在当前的项目中，我们将利用训练人们改变他们的动作的效果 以及日常功能活动期间的排列模式。这将通过使用运动技能来完成 训练计划，强调通过适当的运动和对齐方式，无痛地进行具有挑战性的功能活动表演练习。我们还将尝试延长运动技能训练的有益效果，包括在最初治疗6个月后进行强化治疗。为了实现这一目标，我们将进行一项前瞻性、随机、对照的临床试验，在该试验中，慢性LBP患者将随机接受运动技能训练或常用处方、循证力量和灵活性练习的治疗。治疗将分两个阶段提供：1)初始阶段：6-1小时疗程，每周一次，为期6周；2)强化阶段：从初始阶段6个月后开始，1-3次疗程。我们将收集1)疼痛、功能受限、残疾和经济结果，2)坚持的报告， 3)功能活动期间的运动和排列模式的仪器化测量。在最初的治疗阶段之后，将对患者进行为期12个月的跟踪。我们将测试1)在治疗后12个月内，运动技能训练是否比力量和柔韧性训练产生更好的结果和更好的依从性，以及2)在治疗阶段6个月后提供强化治疗对功能限制和坚持治疗的影响。最后，我们将研究功能限制与1)治疗依从性和2)在功能活动期间显示的运动和排列模式之间的关系。该项目的预期结果是对LBP患者在功能活动期间运动技能训练的使用和时机的具体建议。该项目的成功完成将对LBP患者的康复研究和治疗产生立竿见影的影响。此外，所描述的方法可以用于研究其他类似的长期、昂贵和功能受限的肌肉骨骼疼痛情况。