Improving self-management of lower back pain with a core activity detecting belt

下腰痛是英国国民健康保险制度最常见的疾病之一，也是导致病假和残疾的主要原因。英国政府建议一线治疗应该是锻炼，锻炼通常比止痛药或背部手术更有效、更安全、更便宜。然而，只有经常和适当地进行锻炼才能有效。这可能解释了为什么给背部开运动处方通常不起作用--因为人们厌倦了运动，或者动作不正确。虽然物理疗法可以通过提供一对一的个人训练来帮助背部锻炼，但这是一种有限的资源。通常情况下，英国国民健康保险制度会提供少量的个性化锻炼课程或培训课程。但除此之外，背痛患者只需提供一张练习单，并希望自己“继续下去”。这个项目将开发一种简单的装置，可以鼓励人们自己进行背部锻炼。该设备是一条腰带，可以检测后备箱中“核心”肌肉的活动，然后通过智能手机或智能手表将这一活动显示给用户。这使用户能够“看到”他们的肌肉收缩；跟踪他们的运动表现，并努力达到日常锻炼目标。这不仅可以激励人们--就像计步器激励人们走路一样--而且腰带还会向人们表明他们是否正确地进行了锻炼。目标肌肉的核心是那些在背部锻炼的肌肉。其中一组肌肉是健身狂热分子非常熟悉的“腹肌”(或“六块肌”)；但另一组肌肉是更深更薄的腹部肌肉，另一组肌肉沿着脊柱两边延伸。当这些其他肌肉进行定期锻炼时，它们可以减轻或防止背部疼痛。然而，人们往往不知道如何让他们参与进来，即使当他们被物理治疗师展示时也是如此。因此，腰带可以向患者展示如何进行适当的锻炼，使他们能够直观地看到需要收缩的正确肌肉。在我们早期的研究中，我们表明，与黄金标准方法相比，我们的腰带设备是测量核心肌肉收缩的可靠方法，这是一种名为肌电的复杂仪器，仅在实验室使用。我们还表明，当人们在背部练习中使用我们的设备并结合反馈应用时，他们增加了锻炼的工作量和时间，无论是在提示下还是在没有提示的情况下。我们还发现，使用带有肌肉反馈的设备的受试者进行背部练习更合适，激活了正确的一组肌肉。这些效应在有或没有背痛的人身上都能发现。当研究参与者使用我们的发明时，他们感觉更投入和更有动力去锻炼；感觉腰带很舒服，应用程序易于理解，许多人想再次使用它或购买它。鉴于我们早期研究的令人鼓舞的结果，我们现在希望进一步开发这种设备，以确保腰带设计足够舒适，并且易于应用，让人们想要在家里重复使用它几周、几个月甚至几年。我们也希望该应用程序易于理解，这样就可以在没有专业帮助的情况下使用。我们将在背部疼痛、看过家庭医生或看过治疗师帮助的人身上测试腰带和应用程序。我们的设备将补充标准治疗。使用两个月后，我们将看到该设备对他们的运动水平和背部疼痛有什么影响。我们预计，当配备肌肉反馈腰带时，下腰痛患者的运动将更有效、更频繁，这可能会减少疼痛和残疾。鉴于我们的设备的预期成本很低，而且足够简单，任何人都可以戴上它并使用它，我们预计我们的发明可以在整个NHS中推广，实现有效的自我护理。这将减少残疾、依赖和降低成本。

Lower back pain is one of the commonest ailments seen by the NHS, and a leading cause of sick leave and disability. The UK Government recommends that first line treatment should be exercise, which is often more effective, safer and cheaper, than painkillers or back surgery. However exercise is only effective if performed regularly and appropriately. This may explain why prescribing exercise for the back often does not work - because people tire of exercises, or perform manoeuvres incorrectly. While physiotherapy can help with back exercises - by offering one-to-one personal training - this is a limited resource. Typically the NHS offers a small number of personalised exercise sessions, or a training class. But beyond this, back pain sufferers are merely provided with an exercise sheet, and expected to "get on with it" themselves.This project will develop a simple device that can encourage people to perform back exercises by themselves. The device is a belt that detects activity of "core" muscles in the trunk; and then displays this activity back to the user via a smartphone or smartwatch. This enables users to "see" their muscles contract; track their exercise performance, and strive to reach daily workout goals. Not only can this incentivize - in the same way that step-counters motivate walking - but the belt will also indicate to people if they are performing exercises correctly or not.The core muscles targeted are those that are worked on with back exercises. One set of muscles are the "Abs" (or "6-pack") that fitness fanatics know only too well; but others are a deeper thinner tummy muscle, and another one that runs down either side of the spine. When these other muscles are engaged with regular exercise, they can reduce or prevent back pain. However often people don't know how to engage them, even when they are shown by a physiotherapist. Hence the belt can show patients how to perform suitable exercises by enabling them to visualise the correct muscles that need to be contracted.In our earlier research we showed that our belt device is a reliable way of measuring core muscles contracting, by comparison with a gold standard method, that is a sophisticated instrument called EMG, used only in laboratories. We also showed that when people used our device, in combination with a feedback App during back exercises, they increased the amount of effort and time they put into exercise, whether prompted or unprompted. We also found that subjects using the device with muscle feedback performed back exercises more appropriately, activating the right set of muscles. These effects were found in people with or without back pain.Research participants felt more engaged and motivated to exercise when they used our invention; felt the belt was comfortable and the App easy to understand, and many wanted to use it again or purchase it.Given encouraging results from our early studies, we now wish to develop the device further to ensure that the belt design is sufficiently comfortable, and simple to apply, for people to want to use it at home, repeatedly for weeks, months or even years. We also want the App to be easily understood, so it can be used without professional assistance. We shall test the belt and App out on people who have back pain, who have attended their GP or seen a therapist to help with this. Our device will supplement standard treatment. After 2 months of use, we shall see what effect the device has had on their level of exercise, and back pain.We expect that patients with lower back pain will exercise more effectively and more often when provided with the muscle feedback belt, which is likely to reduce pain and disability. Given the expected cost of our device is low, and simple enough that anyone could put it on and use it, we expect our invention could be rolled out across the NHS, enabling effective self-care. This will reduce disability, dependency and reduce costs.