Significance of Spinal Movement Impairments in Acute Low Back Pain

脊柱运动障碍在急性腰痛中的意义

• 批准号: 10586886
• 负责人: LINDA R VANDILLEN
• 金额: $ 63.03万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-14 至 2028-02-29
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10586886
• 关键词: Accident and Emergency department; Acute; Age; Back; Behavior; Characteristics; Chronic; Chronic low back pain; Clinical; Data; Emergency department visit; Evaluation; Exercise; Goals; Health Care Costs; Image; Impairment; Individual; Learning; Low Back Pain; Measures; Medical Care Costs; Motor Skills; Movement; Outcome; Pain; Pain intensity; Patient Self-Report; Patients; Persistent pain; Persons; Phase; Prevalence; Randomized; Recording of previous events; Recovery; Recurrence; Research; Role; Sampling; Spinal; Surveys; Testing; Time; Training; Vertebral column; Work; care seeking; clinical examination; comorbidity; cost; design; experience; flexibility; improved; innovation; interest; motor impairment; novel; observational cohort study; prognostic value; prospective; psychosocial; remediation; skills training; treatment as usual

Project Summary Non-specific low back pain (LBP) is a highly prevalent and costly health condition characterized for many by recurrent, fluctuating or persistent pain and limitations in function over time. The overall objective of this project is to curtail the costly long-term course of LBP. The goal of the current project is to understand the role of specific spinal movement impairments to the course of recovery of people presenting with acute LBP, and to examine the immediate and short-term effects of treating the impairments in people with acute LBP. Spinal movement impairments in people with acute LBP are of particular interest because the impairments have been found to be highly relevant to the clinical course in people with chronic LBP. Our central hypothesis is that the spinal movement impairments will 1) be prevalent in patients with acute LBP, 2) persist to varying degrees over time, 3) be related to the course of recovery of acute LBP and function, and 4) be a viable target for treatment in the acute stage. We will conduct a prospective, observational cohort study of 212 people (ages 18-60) who have acute LBP but do not have a history of chronic LBP. We will collect 1) measures of spinal movement impairments, 2) self-report surveys of patient characteristics, LBP history, psychosocial behavior, comorbidities, treatment use, imaging, LBP intensity and functional limitations, and 3) findings from our clinical exam. The measures of movement, self-report surveys and exam data will be collected at baseline of the acute episode, and at 2 and 6 months thereafter. We will collect a subset of the self-report surveys electronically weekly from baseline-to-8 weeks and monthly from 3-12 months. At baseline and 2 and 6 months after the acute episode we will 1) examine the prevalence of the impairments, 2) test if the degree of the impairments at baseline, as well as change over time in the degree is related to LBP and functional limitations, and 3) test if the degree of impairments at baseline and change in impairments over the 6 months after the acute episode will predict transition to chronic LBP. To test the effect of treating the impairments in the acute stage, we will conduct an early phase learning trial (Phase 2A) in a 2nd sample of people (n=68) who present to an Emergency Department (ED). We will randomize people to 1) motor skill training in functional activities (MST) + usual care (UC) or 2) UC. MST will be provided in the ED and twice in the following 2 weeks. In the ED and 2 weeks after the ED visit we will collect self-report surveys and movement data. Then for each of 10 weeks, we will collect a subset of the self-report surveys electronically. We will test the immediate (within-session) and short-term (2 and 12 week) effect of MST+UC to UC. Expected outcomes will be specific information about the 1) change in prevalence of the impairments over the course of recovery, 2) relevance of change in the impairments to change in the person’s pain and function over time, including the transition to chronicity, and 3) effects of treating the impairments. Successful completion of this project will have an immediate, high impact on research and evaluation and treatment of people with acute LBP that could improve the costly course of LBP for people who have incomplete recovery from an acute episode.

项目摘要 非特异性下腰痛(LBP)是一种非常普遍和昂贵的健康状况，其特点是 随着时间的推移，反复发作的、波动的或持续性的疼痛和功能限制。这个项目的总体目标是 就是缩减LBP代价高昂的长期路线。当前项目的目标是了解特定的角色 急性LBP患者康复过程中脊柱运动的损害，并检查 治疗急性LBP患者损害的即时和短期效果。脊柱运动 急性LBP患者的损害特别令人感兴趣，因为已经发现这些损害是 与慢性LBP患者的临床病程高度相关。我们的中心假设是脊椎 运动障碍将1)在急性LBP患者中普遍存在，2)随着时间的推移持续不同程度， 3)与急性LBP的恢复过程和功能有关；4)成为治疗急性LBP的可行靶点 急性期。我们将对212人(年龄在18-60岁之间)进行前瞻性、观察性队列研究 急性LBP，但无慢性LBP病史。我们将收集脊柱运动损伤的测量数据， 2)患者特征、腰痛病史、心理社会行为、合并症、治疗情况的自我报告调查 使用、成像、LBP强度和功能限制，以及3)我们的临床检查结果。采取的措施 运动、自我报告调查和检查数据将在急性发作的基线以及第2和第6天收集 几个月后。我们将每周以电子方式收集从基线到8个月的自我报告调查的子集 每周和每月，从3到12个月不等。在基线和急性发作后2个月和6个月，我们将1)检查 损害的流行率，2)测试是否在基线时损害的程度，以及改变 在程度上的时间与LBP和功能限制有关，以及3)测试基线时的损害程度 急性发作后6个月内损害的变化将预示过渡到慢性LBP。至 测试急性期治疗损伤的效果，我们将进行早期学习试验(阶段 在向急诊科(ED)就诊的第二个样本(n=68)中。我们将随机选择人们 到1)功能活动(MST)+日常护理(UC)的运动技能训练或2)UC。教育部将提供MST 并在接下来的两周内两次。在教育署内及教育署访问后两周内，我们会收集自我报告调查 和移动数据。然后，在每10周的每一周，我们将以电子方式收集自我报告调查的子集。 我们将测试MST+UC对UC的即时(期内)和短期(2周和12周)效果。预期 结果将是关于1)在以下过程中损害患病率变化的具体信息 恢复，2)损伤的变化与人的疼痛和功能随时间的变化的相关性， 包括向慢性化的过渡，以及3)治疗损伤的影响。成功完成这项工作 该项目将对急性LBP患者的研究、评估和治疗产生直接、高度的影响 对于那些从急性发作中恢复得不完全的人来说，这可能会改善LBP昂贵的疗程。