Classification - Directed Treatment of Low Back Pain

分类 - 腰痛的定向治疗

• 批准号: 7035984
• 负责人: LINDA R VANDILLEN
• 金额: $ 36.34万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-06-10 至 2010-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7035984
• 关键词: backache; biomechanics; clinical research; clinical trials; disease /therapy duration; exercise; functional ability; health education; human subject; human therapy evaluation; medical rehabilitation related tag; muscle function; outcomes research; patient oriented research; physical therapy; questionnaires; relapse /recurrence

DESCRIPTION (provided by applicant): Most people will experience low back pain (LBP) during their adult lives and more than 50% of the people who experience an episode of LBP will have a recurrence. Despite the high health care costs associated with managing this condition, no treatment has been found to be consistently effective in improving the often persistent symptoms and related disability, and more importantly, curtailing the recurrences. It has been suggested that the lack of support of any one treatment is the result of studies being conducted on heterogeneous groups of people with LBP, and a system for classifying people with LBP into more homogeneous groups is needed. Recently, a system of classifying people with LBP based on movement-system related impairments has been described and tested. The impairments used to classify LBP are related to the specific directions of movements and alignments consistently related to the person's symptoms during (1) a clinical examination, and (2) functional activities. The primary purpose of this proposal is to conduct a prospective, randomized, controlled clinical trial to determine if treatment directed by a person's specific impairment- based LBP classification is more effective than non-specific physical therapy care in improving short- and long-term outcomes in people with chronic LBP. The specific aims of this study are to determine the effect of classification- specific treatment versus non-specific treatment across an 18 month period on (1) impairments which include symptoms (intensity, frequency, duration, location, and recurrences), movement and alignment impairments on clinical examination tests, and kinematics of movement and alignment impairments with standardized clinical tests, (2) functional limitations measured with the Oswestry LBP questionnaire and the Baecke Habitual Activity questionnaire, and (3) disability measured with the SF-36 and number of LBP-related activity limitations days. Classification-specific treatment will emphasize (1) changing the person's use of movement and alignment impairments in functional activities, (2) exercise to alleviate impairments, and (3) education to understand how specific directions of movements and alignments contribute to symptoms. The non-specific physical therapy treatment will include general trunk strengthening, trunk and extremity flexibility, and education about body mechanics and guidelines for performance of functional activities. Prognostic factors also will be examined. The findings from this study have important implications with regard to decisions made about examination and treatment methods used in rehabilitation of people with LBP, an often persistent, recurrent and costly condition.

描述（由申请人提供）：大多数人在成年后都会经历腰痛 (LBP)，并且超过 50% 经历过腰痛发作的人会复发。尽管与治疗这种疾病相关的医疗费用很高，但尚未发现任何治疗方法能够持续有效地改善通常持续存在的症状和相关残疾，更重要的是，可以减少复发。有人认为，任何一种治疗方法均缺乏支持是对异质腰痛患者群体进行研究的结果，因此需要一种将腰痛患者分类为更同质群体的系统。最近，已经描述并测试了一种基于运动系统相关损伤对腰痛患者进行分类的系统。用于对 LBP 进行分类的损伤与特定的运动方向和对齐方式有关，这些方向始终与人在 (1) 临床检查和 (2) 功能活动期间的症状相关。该提案的主要目的是进行一项前瞻性、随机、对照临床试验，以确定基于个人特定损伤的腰痛分类指导的治疗在改善短期和长期结果方面是否比非特定物理治疗更有效患有慢性腰痛的人。本研究的具体目的是确定 18 个月内分类特异性治疗与非特异性治疗对 (1) 损伤的影响，包括症状（强度、频率、持续时间、位置和复发）、运动和排列临床检查测试的损伤，以及标准化临床测试的运动学和对准损伤，(2) 使用 Oswestry LBP 问卷和 Baecke 习惯活动问卷测量的功能限制，以及 (3) 使用 SF-36 测量的残疾以及 LBP 相关活动限制天数。分类特定的治疗将强调（1）改变人在功能活动中对运动和对齐障碍的使用，（2）通过锻炼来减轻障碍，以及（3）教育以了解特定的运动方向和对齐方式如何导致症状。非特异性物理治疗将包括一般躯干强化、躯干和四肢灵活性以及有关身体力学和功能活动执行指南的教育。还将检查预后因素。这项研究的结果对于腰痛患者康复中使用的检查和治疗方法的决策具有重要意义，腰痛是一种经常持续、复发且昂贵的疾病。