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: 10183358
• 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 2022-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10183358
• 关键词: Activities of Daily Living; Acute; Address; Affect; 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; prescription pain reliever; 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.

腰痛 (LBP) 与退伍军人中阿片类药物的使用密切相关，临床改善 LBP 的管理可能会减少退伍军人中多达 60% 的急性发作患者对阿片类药物的依赖。 非特异性腰痛的发作要么症状持续，要么一年内症状复发。 可能表明未能解决疼痛的根本机制或开始新的治疗 病因学；两者都可能源于患者和治疗之间的不匹配。 是开发、验证和实施与已知 LBP 机制相关的措施，这些措施可以 然后用于除了自我报告症状之外，全面评估患者下背部的健康状况。 更准确的测量将有助于患者更好地匹配现有治疗或开发 这项研究的具体目标是提供支持的证据。 我们的方法的可行性：1）评估下背部组织对脊柱负荷的相对贡献，以及 2）对患有非特异性腰痛的退伍军人所产生的脊柱负荷进行调查我们开发了一种方法。 一套强大的工具，用于综合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异常的存在或发展并降低 在[五]组具有不同非特定 LBP 经验的退伍军人中支持 MB。 包括 [1) 患有慢性、非特异性 LBP 和高度残疾的退伍军人 (n=10)，2) 患有慢性、非特异性腰痛和高度残疾的退伍军人， 非特异性腰痛和低度残疾 (n=10),] 3) 患有非慢性、非特异性腰痛的退伍军人 (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)，以及 5) 近期无非特异性腰痛病史的无症状退伍军人（n=10；作为对照组）。 该可行性项目的成功完成将为未来的研究（奖学金申请）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。 这种理解有可能帮助受影响的退伍军人消除非特异性腰痛。 具体来说，下背部 MB 和脊柱负荷的测量不仅可以用来识别退伍军人 下背部机械异常的人将来可能会经历 LBP，但也可以指导 新颖的综合身体和心理预防治疗旨在改善腰部力学。 最终，非特异性腰痛治疗的目标和临床结果的改善 是减少对阿片类药物的依赖来控制症状，特别是患有慢性病的退伍军人 腰痛。