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: 9303396
• 负责人: LINDA R VANDILLEN
• 金额: $ 46.27万
• 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 2020-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9303396
• 关键词: Address; Adherence; Aftercare; Analgesics; Attenuated; Chronic low back pain; Classification; Clinical; Clinical Trials; Exercise; Grant; 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; Painless; Pattern; Performance; Phase; Productivity; Randomized; Randomized Controlled Clinical Trials; Recommendation; Recurrence; Rehabilitation Research; Reporting; Role; Spinal; Sum; Testing; Time; Training; Training Programs; Vertebral column; Work; base; cost; disability; economic outcome; evidence base; flexibility; health care service; improved; innovation; instrument; physical conditioning; programs; prospective; public health relevance; skills training; treatment adherence; treatment group

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.

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.

项目成果

Clinical examination procedures to determine the effect of axial decompression on low back pain symptoms in people with chronic low back pain.

临床检查程序以确定轴向减压对慢性腰痛患者腰痛症状的影响。

• DOI: 10.2519/jospt.2012.3724
• 发表时间: 2012
• 期刊: The Journal of orthopaedic and sports physical therapy
• 作者: Holtzman,Gregory;Harris-Hayes,Marcie;Hoffman,ShannonL;Zou,Dequan;Edgeworth,RebeccaA;VanDillen,LindaR
• 通讯作者: VanDillen,LindaR

Diagnosis and treatment of movement system impairment syndromes.

• DOI: 10.1016/j.bjpt.2017.08.001
• 发表时间: 2017-11
• 期刊: Brazilian journal of physical therapy
• 影响因子: 3.4
• 作者: Sahrmann S;Azevedo DC;Dillen LV
• 通讯作者: Dillen LV

Low interrater reliability of examiners performing the prone instability test: a clinical test for lumbar shear instability.

进行俯卧不稳定性测试的检查者间可靠性较低：腰椎剪切不稳定性的临床测试。

• DOI: 10.1016/j.apmr.2010.12.042
• 发表时间: 2011
• 期刊: Archives of physical medicine and rehabilitation
• 影响因子: 4.3
• 作者: Ravenna,MargaretM;Hoffman,ShannonL;VanDillen,LindaR
• 通讯作者: VanDillen,LindaR

Validity of a Paradigm for Low Back Pain Symptom Development During Prolonged Standing.

长时间站立期间腰痛症状发展范例的有效性。

• DOI: 10.1097/ajp.0000000000000148
• 发表时间: 2015
• 期刊: The Clinical journal of pain
• 作者: Sorensen,ChristopherJ;Johnson,MollyB;Callaghan,JackP;George,StevenZ;VanDillen,LindaR
• 通讯作者: VanDillen,LindaR

Use of a Patient-Specific Outcome Measure and a Movement Classification System to Guide Nonsurgical Management of a Circus Performer with Low Back Pain: A Case Report.

使用特定于患者的结果测量和运动分类系统来指导腰痛马戏表演者的非手术治疗：病例报告。

• DOI: 10.12678/1089-313x.21.4.185
• 发表时间: 2017
• 期刊: Journal of dance medicine & science : official publication of the International Association for Dance Medicine & Science
• 作者: Chimenti,RuthL;VanDillen,LindaR;Khoo-Summers,Lynnette
• 通讯作者: Khoo-Summers,Lynnette