Significance of Spinal Movement Impairments in Acute Low Back Pain

项目摘要 非特异性腰痛（LBP）是一种非常普遍和昂贵的健康状况，其特征在于许多人 随着时间的推移，复发性、波动性或持续性疼痛以及功能受限。本项目的总体目标 是为了减少LBP昂贵的长期过程。当前项目的目标是了解特定 脊髓运动障碍的人提出与急性腰痛的恢复过程中，并检查 治疗急性LBP患者损伤的即时和短期效果。脊柱运动 急性LBP患者的损伤特别令人感兴趣，因为已经发现这些损伤 与慢性LBP患者的临床病程高度相关。我们的中心假设是 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和功能的恢复过程相关，以及4）是治疗急性LBP的可行靶点。 急性期我们将对212名（年龄18-60岁）患有以下疾病的人进行前瞻性观察性队列研究： 急性LBP，但没有慢性LBP病史。我们将收集1）脊柱运动障碍的测量， 2)患者特征、LBP病史、心理社会行为、合并症、治疗的自我报告调查 使用，成像，LBP强度和功能限制，以及3）我们临床检查的结果。 将在急性发作的基线以及第2和6天收集运动、自我报告调查和检查数据 几个月后。我们将收集一个子集的自我报告调查电子每周从基线到8 每周和每月从3-12个月。在基线和急性发作后2个月和6个月，我们将1）检查 损伤的患病率，2）测试基线时的损伤程度，以及 程度的时间与LBP和功能限制有关，以及3）测试基线时的损伤程度 急性发作后6个月内损伤的变化将预测向慢性LBP的转变。到 为了测试治疗急性期损伤的效果，我们将进行早期学习试验（第 2A）在第二个样本的人（n=68）谁出席了急诊室（艾德）。我们会随机挑选 1）功能活动中的运动技能训练（MST）+日常护理（UC）或2）UC。MST将在艾德提供 在接下来的两周内两次。在艾德和艾德访视后2周，我们将收集自我报告调查 和移动数据。然后，在10周的每一周，我们将以电子方式收集自我报告调查的一个子集。 我们将测试MST+UC对UC的即时（会话内）和短期（2周和12周）效果。预计 结果将是关于1）在整个过程中损伤患病率的变化的具体信息， 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， 包括向慢性化的转变，以及3）治疗损伤的效果。成功完成本 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 这可以改善那些从急性发作中恢复不完全的人的LBP昂贵的过程。

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.