Please select the eligibility criteria that correspond to the clinical trial below.
Title: Effect of Thermal Therapy in Combination With Exercises to Relieve Acute Low Back Pain
Brief Summary: Low back pain (LBP) ranks among the first diseases in term of years lived with disability. The latest Clinical Guideline from the American College of Physicians for acute LBP recommends to select "nonpharmacologic treatment with superficial heat, massage, acupuncture or spinal manipulation". The application of superficial heat ("thermal therapy") may provide enough pain relief in the acute phase to remain active, which is recommended to prevent the development of chronicity. However, no studies have tested if the combination of heat and exercises provide additional benefit on short, middle and long-term follow-up in people with acute LBP.

Hence, the main objective of this study is to determine the immediate, short-, middle- and long-term effect of continuous low-level thermal therapy in combination or not with exercises on pain, disability, and physical activity level in people with acute LBP.

Project hypothesis : The Thermal care + Exercises group will show greater improvement in pain, disability and physical activity level than both Thermal care and Control groups for immediate, short-, middle- and long-term follow-ups.

Sixty individuals with acute LBP will be recruited. This study will include six assessments over 6 months. At the baseline evaluation, participants will complete questionnaires on symptoms, disability, pain-related fear and self-efficacy. Afterwards, participants will be randomly assigned to one of three intervention programs: 1) Thermal care group, 2) Exercises + Thermal care group, and 3) Control group. They will immediately meet a physical therapist to review and perform their assigned program.

Participants will then take part in their assigned 7-day intervention program, during which they will wear a fitness wristband to track physical activity level. Finally, the same outcomes will be reassessed to determine the effect of intervention at 1 week, 1 month, 3 months and 6 months after baseline.


Options:
A: Inclusion Criteria:

* Modified Oswestry Disability Index (ODI) ≥ 20%
* Numeric Pain Rating Scale (NPRS) of ≥ 2 points
* Primary complaint of low back pain with at least one hip impairment in one or both hips

Exclusion Criteria:

* Contraindications to manual therapy
* Severe trauma to the lumbar spine or hip(s) in the last 6 weeks
* 'Red flag' symptoms including:

  * Tumor
  * Metabolic disease
  * Rheumatoid arthritis or other systemic rheumatologic disorders
  * Acute fracture
  * Bowel/Bladder dysfunction
  * Prolonged history of corticosteroid use
  * Evidence of central nervous system involvement
* Two or more positive neurologic signs consistent with nerve root compression:

  * Diminished muscle stretch reflexes of lower extremity
  * Muscle weakness in any lower extremity myotome
  * Diminished or absent sensation in any lower extremity dermatome
* Spinal surgery in the last 6 months
* Total Hip Arthroplasty
* Currently pregnant or post-partum ≤ 6 months
* Osteoporosis
* History of cancer within the last 12 months
* Inability to understand the English language
B: Inclusion Criteria:

* industrial worker

Exclusion Criteria:

* trauma, life threatening diseases, pregnancy
C: Inclusion Criteria:

* acute or subacute perceived low back pain with or without pain radiating to one or both legs
* symptom duration of three months or less preceded by at least two months of relative freedom from symptoms
* consent to treatment and follow up for ten weeks
* agreement not to consult therapists other than those participating in the study during the treatment period

Exclusion Criteria:

* other conditions or circumstances that might jeopardize completion of treatment and follow up, such as pregnancy, malignant tumors, etcetera
* need for acute surgical or rheumatologic care
* previous treatment of current complaints with specific mobilisation or manipulation
* previous participation in the present study
D: Inclusion Criteria:

* to be suffering from low back pain (LBP) for a period of less than 6 weeks (with or without leg pain) that had limited one's activities or changed the daily routine for more than a day,
* to have been pain free for at least 3 months before the onset of the current LBP episode.

Exclusion Criteria:

* "red flag" signs that may suggest serious spinal pathology,
* history of spinal surgery,
* obvious lower limb radiculopathy
* fibromyalgia
* rheumatoid arthritis
* important skin lesion in the lumbar area
* alteration of cutaneous sensations or temperature perception
* being pregnant of trying to become

Answer: D