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: 10004812
• 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 2022-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10004812
• 关键词: Activities of Daily Living; Acute; Address; Affect; Analgesics; 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; 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.

下腰痛(LBP)与退伍军人中阿片类药物的消费密切相关，并改善了临床 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%的急性胰腺炎患者 非特异性LBP发作1年内可出现症状持续或症状复发。这 很可能是在解决疼痛的潜在机制或启动新的 病因；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 是制定、验证和实施与LBP已知机制相关的措施，这些机制可以 然后被用来全面衡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与现有治疗或发展中的 更有效的新疗法。这项研究的具体目标是产生证据来支持 我们方法的可行性：1)评估下背部组织对脊柱负荷的相对贡献，以及 2)非特异性腰背痛退伍军人脊柱负荷的研究。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机械行为 (MB)，这将使我们能够检查脊柱负荷及以下异常的存在或发展 在[五]组有不同非特定LBP经历的退伍军人中进行MB检查。这些团体将 包括[1]患有慢性、非特异性下腰痛和高度残疾退伍军人(n=10)，2)患有慢性腰背痛退伍军人， 非特异性LBP和低残疾水平(n=10)，]3)患有非慢性、非特异性LBP的退伍军人(n=10)，4) 最近(即过去一年)有非特异性LBP病史的无症状退伍军人(n=10)，和5) 无症状、无近期非特异性LBP病史的退伍军人(n=10，作为对照组)。 这一可行性项目的成功完成将为今后的研究(优异奖申请)铺平道路。 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禁用非特定的LBP。 具体地说，下背部MB和脊柱负荷的测量不仅可以用来识别退伍军人 腰背部机械异常的人可能会在未来经历LBP，但也要引导 新的综合身体和心理的预防性治疗，旨在改善下背部的机械性能。 最终，治疗非特异性LBP的目标和由此带来的临床结果的改善 减少对阿片类药物的依赖，特别是对患有慢性阻塞性肺病的退伍军人的症状处理 伦敦金融城。