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）：大多数人在成年后会经历腰痛（LBP），而体验LBP发作的人中有50％以上会复发。尽管与管理这种状况相关的医疗保健成本很高，但尚未发现治疗在改善经常持续的症状和相关的残疾方面始终有效，更重要的是减少了复发。有人提出，任何一种治疗方法的缺乏支持是对LBP患者进行的研究的结果，并且需要将LBP患者分类为更均匀群体的系统。最近，已经描述了和测试了一种基于运动系统相关障碍的LBP患者进行分类的系统。用于对LBP进行分类的障碍与运动和（1）临床检查期间与人的症状始终相关的运动和比对的特定方向有关，以及（2）功能活动。该提案的主要目的是进行一项前瞻性，随机，对照临床试验，以确定一个人的特定基于特定损伤的LBP分类的治疗是否比非特异性物理治疗护理在改善慢性LBP患者的短期和长期结局方面更有效。这项研究的具体目的是确定分类特定治疗与非特异性治疗的影响（1）损伤，包括症状（包括强度，强度，频率，频率，持续时间，位置和复发），运动和对齐损害对临床检查测试的运动和对齐损害对运动和对准的临床测试的影响（2）功能限制（2）功能限制（2）（2）以及Baecke习惯活动问卷，以及（3）用SF-36和LBP相关活性限制天数测量的残疾。特定于分类的治疗将强调（1）改变人在功能活动中使用运动和对齐障碍的使用，（2）锻炼以减轻损害，以及（3）教育，以了解运动和对齐的特定方向如何导致症状。非特异性物理治疗将包括一般的躯干加强，躯干和肢体灵活性，以及​​有关身体力学的教育以及功能活动的执行指南。还将检查预后因素。这项研究的发现在对LBP患者康复的检查和治疗方法方面做出的决策具有重要意义，这通常是一种持久，经常性和昂贵的状况。