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: 9038401
• 负责人: LINDA R VANDILLEN
• 金额: $ 46.25万
• 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/9038401
• 关键词: Address; Adherence; Aftercare; Analgesics; Attenuated; Chronic low back pain; Classification; Clinical Trials; Exercise; Grant; Health; 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; Spinal; Sum; Testing; Time; Training; Training Programs; Vertebral column; Work; base; disability; economic outcome; evidence base; flexibility; health care service; improved; innovation; instrument; physical conditioning; programs; prospective; skills training; time use; treatment adherence; treatment group

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性腰痛 (LBP) 的昂贵的长期病程。在最近的工作中，我们发现分类特异性治疗组和非特异性治疗组的患者在疼痛和功能方面均表现出具有临床意义的改善，但组间差异小于预期。组间差异减弱的可能原因可以在 3 个相关事实中找到：1）除了特定或非特定的锻炼之外，两组都接受了旨在改变功能活动期间腰椎的运动模式和对齐方式的训练， 2) 功能活动训练的坚持水平比运动更高、持续时间更长，3) 治疗阶段后约 6 个月内，结果持续改善，但随后随着功能活动训练的坚持程度下降而逐渐逆转。在当前的项目中，我们将利用训练人们改变动作的效果 以及日常功能活动期间的对齐模式。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无痛地执行功能活动的挑战性练习。我们还将尝试通过在初始治疗后 6 个月进行加强治疗来延长运动技能训练的有益效果。为了实现这一目标，我们将进行一项前瞻性、随机、对照临床试验，其中慢性腰痛患者将被随机分配接受运动技能训练或常用的循证力量和灵活性练习治疗。治疗将分两个阶段进行：1) 初始阶段：6 - 1 小时疗程，每周一次，持续 6 周；2) 加强阶段：初始阶段后 6 个月开始 1-3 次疗程。我们将收集 1) 疼痛、功能限制、残疾和经济结果，2) 依从性报告， 3）功能活动期间运动和对齐模式的仪器测量。在初始治疗阶段后，人们将被跟踪 12 个月。我们将测试 1 治疗后 12 个月内运动技能训练是否比力量和灵活性锻炼能带来更好的结果和更好的依从性，以及 2) 治疗阶段后 6 个月提供的加强治疗对功能限制和治疗依从性的影响。最后，我们将检查功能限制与 1）治疗依从性和 2）功能活动期间显示的运动和对齐模式之间的关系。该项目的预期成果是针对腰痛患者在功能性活动期间运动技能训练的使用和时机的具体建议。该项目的成功完成将对腰痛患者的康复研究和治疗产生立竿见影的重大影响。此外，所描述的方法还可用于研究其他类似的长期、昂贵和功能限制性肌肉骨骼疼痛病症。