Trunk Muscle Training+NMES: Improving Function in Elders With Chronic Back Pain

描述（由申请人提供）：腰痛（LBP）是75岁以上人群中最常报告的肌肉骨骼问题和第三种最常报告的症状。事实上，17.3%的腰痛患者超过65岁。在老年人中，腰痛与许多负面后果有关，包括身体功能下降、跌倒风险增加、情绪障碍增加和医疗保健利用率增加。令人惊讶的是，很少有研究关注65岁以上人群的腰痛。但是，最近的证据表明，腰痛与腹部和棘旁肌肌内脂肪浸润增加有关，并且这种肌肉成分的改变增加了老年人活动相关功能下降的风险。虽然躯干肌肉训练（TMT）已被用于年轻的LBP组，但它在老年人中尚未得到证实，并且考虑到老年肌肉的受损状态，单独使用可能不足以显著改善功能和症状。TMT与神经肌肉电刺激（NMES）相结合，已知可以提高力量和功能，而不仅仅是意志运动的能力，可能会提供更大的改善。使用运动干预治疗老年人慢性腰痛已被假设为防止功能下降和虚弱进展的一种方式；然而，这一假设尚未得到实验证实。在这一探索性研究中，我们将检验TMT加NMES与常规护理相比会降低老年慢性腰痛患者的残疾和疼痛严重程度的假设。采用随机对照实验设计，62名65-85岁的社区老年人患有慢性腰痛，从未做过脊柱手术，除背部外没有明显疼痛，将接受(1)TMT增强NMES或(2)被动对照干预，每周两次，持续12周。在随机化之前，在最后一次治疗后和3个月后，以下参数将由一个隐蔽的评估者进行评估：用Oswestry残疾问卷测量自我报告的残疾，用疼痛温度计测量疼痛严重程度，用基于表现的测量测量身体功能，和心理社会功能（情绪，自我效能，自评健康，和疼痛相关的恐惧）。磁共振成像将在基线和最后一次治疗后立即进行，以评估肌肉成分及其在持续疼痛-残疾循环中的潜在作用。如果本探索性研究表明TMT+NMES是有效的，未来将设计更长随访期的研究来调查其预防功能衰退的功效，并确定对医疗成本的影响。如果没有令人信服的证据表明，对患有慢性腰痛的老年人进行运动干预可以减少残疾，并且具有成本效益，则不会对实践指南进行修改。公共卫生相关性：鉴于慢性腰痛（LBP）在社区居住的老年人中的患病率以及相关的负面功能后果，本研究将对公共卫生产生广泛影响，因为针对老年腰痛人群减轻疼痛和残疾的研究有限。本研究的潜在益处包括：(a)通过改善疼痛管理以及身体和社会心理功能，改善社区居住的慢性下腰痛老年人的生活质量；(b)为患有慢性腰痛的老年人开发一种非药物治疗方法，从而保护未来的个人免受潜在毒性药物的影响；(c)未来研究的发展重点是降低医疗保健利用成本。

DESCRIPTION (provided by applicant): Low back pain (LBP) is the most frequently reported musculoskeletal problem and third most frequently reported symptom of any kind in people over the age of 75. In fact, 17.3% of all visits to physicians for LBP involve individuals over 65. In older adults, LBP has been associated with a host of negative consequences, including decreased physical function, increased fall risk, increased mood disturbance and increased healthcare utilization. Surprisingly, little research has focused on LBP in people over 65. But, recent evidence demonstrates that LBP is associated with increased intramuscular fat infiltration in the abdominal and paraspinal muscles and that this altered muscle composition increases the risk of mobility-related functional decline in older adults. While trunk muscle training (TMT) has been used in younger LBP groups, it is unproven in elders and, alone, may not be sufficient to substantially improve function and symptoms, given the compromised state of aged muscle. TMT augmented with neuromuscular electrical stimulation (NMES), known to improve strength and function beyond the capacity of volitional exercise alone, may provide greater improvements. Treatment of chronic LBP in older adults using an exercise intervention has been hypothesized as a way to prevent functional decline and frailty progression; however, this hypothesis has yet to be experimentally confirmed. In this exploratory study, we will test the hypothesis that TMT plus NMES will result in reduced disability and pain severity compared to usual care in elders with chronic LBP. Using a randomized controlled experimental design, 62 community dwelling older adults age 65-85 with chronic LBP who never had spinal surgery, and have no prominent pain in sites other than the back, will receive either (1) TMT augmented with NMES or (2) a passive, control intervention twice a week for 12 weeks. Prior to randomization, immediately after the last treatment session and 3 months later, the following parameters will be assessed by a masked evaluator: self-reported disability as measured by the Oswestry Disability Questionnaire, pain severity as measured by the Pain Thermometer, physical function as measured by performance-based measures, and psychosocial function (mood, self-efficacy, self-rated health, and pain-related fear). Magnetic resonance imaging will be done at baseline and immediately after last treatment session to evaluate muscle composition and its underlying role in perpetuating the pain-disability cycle. If this exploratory study suggests that TMT+NMES is effective, future studies with longer follow-up periods will be designed to investigate its efficacy for preventing functional decline and determine the impact on healthcare costs. Practice guideline changes will not occur without compelling evidence that exercise interventions for elders with chronic LBP result in reduced disability and are cost-effective. PUBLIC HEALTH RELEVANCE: Given the prevalence of chronic low back pain (LBP) in community dwelling older adults and the associated negative functional consequences, this research will have a broad impact on public health as there has been limited research aimed at reducing pain and disability in the geriatric population with LBP. The potential benefits of this research include: (a) improving quality of life for community-dwelling older adults with chronic LBP by improving pain management, as well as physical and psychosocial function; (b) developing a non-pharmacologic treatment for elders with chronic LBP, and thus protecting future individuals from exposure to potentially toxic medications; and (c) future development of studies focused on decreasing health care utilization costs.