Spinal Control during Functional Activities to Improve Low Back Pain Outcomes

功能活动期间的脊柱控制可改善腰痛结果

• 批准号: 8656378
• 负责人: LINDA R VANDILLEN
• 金额: $ 48.33万
• 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 2018-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8656378
• 关键词: Address; Adherence; Aftercare; Analgesics; Attenuated; Chronic low back pain; Classification; Clinical Trials; Exercise; Grant; Healthcare; Hour; Laboratories; Low Back Pain; Measurement; Measures; Mechanical Low Back Pain; Medical; Mental Health; Motor Skills; Movement; Musculoskeletal Pain; Outcome; Pain; Pain Measurement; Pain intensity; Pattern; Performance; Phase; Productivity; Randomized; Randomized Controlled Clinical Trials; Recommendation; Recurrence; Rehabilitation Research; Reporting; Role; Services; Spinal; Sum; Testing; Time; Training; Training Programs; Vertebral column; Work; base; disability; economic outcome; evidence base; flexibility; improved; innovation; instrument; physical conditioning; programs; prospective; public health relevance; skills training; time use; treatment adherence

DESCRIPTION (provided by applicant): Our overall objective is to improve the costly long-term course of mechanical low back pain (LBP). In recent work we found that people in both classification-specific and non-specific treatment groups displayed clinically meaningful improvements in pain and function, but differences between groups were smaller than expected. A possible reason for the attenuated group differences can be found in 3 related facts: 1) in addition to specific or non-specific exercise, both groups received training aimed at modifying the pattern of movement and alignment used in the lumbar spine during functional activities, 2) adherence levels were higher and more prolonged for training in functional activities than for exercise, and 3) outcomes continued to improve for about 6 months after the treatment phase but then gradually reversed along with declines in adherence to training in functional activities. In the current project we will capitalize on the effect of training people to modify their movement and alignment patterns during daily functional activities. This will be done by using a motor skill training program which emphasizes challenging practice in performance of functional activities painlessly with appropriate patterns of movement and alignment. We will also attempt to prolong the beneficial effects of the motor skill training by including a booster treatment 6 months after the initial treatment. To accomplish this we will conduct a prospective, randomized, controlled clinical trial in which people with chronic LBP will be randomized to a treatment of either motor skill training or commonly prescribed, evidence-based, strength and flexibility exercises. Treatment will be provided in 2 phases: 1) initial phase: 6 - 1 hour sessions, once/week for 6 weeks, and 2) booster phase: 1-3 sessions beginning 6 months after the initial phase. We will collect 1) pain, functional limitation, disability, and economic outcomes, 2) reports of adherence, and 3) instrumented measurements of movement and alignment patterns during functional activities. People will be followed for 12 months after the initial treatment phase. We will test 1 if motor skill training results in better outcomes and better adherence than strength and flexibility exercise in the 12 months after treatment, and 2) the effect of a booster treatment provided 6 months after the treatment phase on functional limitations and adherence to treatment. Finally we will examine the relationship between functional limitations and 1) treatment adherence, and 2) movement and alignment patterns displayed during functional activities. Expected outcomes from this project are specific recommendations for the use and timing of motor skill training during functional activities for people with LBP. Successful completion of this project will have an immediate, high impact on rehabilitation research and treatment of people with LBP. In addition, the approach described could be used to study other similarly long-term, costly, and function-limiting musculoskeletal pain conditions.

描述（由申请人提供）：我们的总体目标是改善机械腰痛（LBP）的昂贵长期过程。在最近的工作中，我们发现，分类特异性和非特异性治疗组中的人们在疼痛和功能方面都表现出有意义的改善，但组之间的差异小于预期。在3个相关事实中可以找到衰减群体差异的可能原因：1）除了特定或非特异性锻炼外，两组旨在修改腰椎运动和对齐方式在功能活动期间使用的运动和对齐方式，2）依从性水平较高，在锻炼中延长了培训，并且在锻炼中的培训均更高，并且在锻炼中的培训均更高，并且在锻炼中的培训均更高，而3个月份的培训均在锻炼中均更高；遵守功能活动的培训。在当前的项目中，我们将利用培训人们修改其运动的影响 和日常功能活动期间的对齐方式。这将通过使用运动技能来完成 培训计划强调通过适当的运动和对齐方式轻松地进行功能活动的挑战实践。我们还将尝试通过在初次治疗后6个月内包括助推器治疗来延长运动技能训练的有益效果。为此，我们将进行一项前瞻性，随机，对照临床试验，其中慢性LBP患者将随机分配到运动技能训练或常规，循证，基于循证的，强度和灵活性练习的治疗。治疗将分为2个阶段：1）初始阶段：6-1小时会话，每周一次，持续6周，而2）助推阶段：1-3次疗程在初始阶段后6个月开始。我们将收集1）疼痛，功能限制，残疾和经济成果，2）依从性的报告， 3）在功能活动期间的运动和对齐方式的仪器测量。初始治疗阶段后的12个月将被追踪。我们将测试1，如果在治疗后的12个月内，运动技能训练比强度和柔韧性运动取得更好的结果和更好的依从性，以及2）治疗阶段后6个月提供的助推器治疗对功能局限性和对治疗的依从性。最后，我们将研究功能局限性与1）治疗依从性之间的关系，以及2）在功能活动期间显示的运动和对准模式。该项目的预期结果是在功能活动中为LBP患者提供运动技能培训的特定建议。该项目的成功完成将对LBP患者的康复研究和治疗产生直接，高影响。此外，所描述的方法可用于研究其他类似的长期，昂贵和功能限制的肌肉骨骼疼痛条件。