Relationship Between Clinical Tests and Clinical Outcomes After Motor Control Exercises Intervention
Condition: Chronic Low Back Pain
MeSH terms: Back Pain; Low Back Pain
Study type: Interventional

Summary: 
      Nowadays, the research priority in low back pain area have been find subgroup of patients
      with the same characteristics that might achieve better outcomes in a specific intervention.
      However, even though the studies in this area have increased, questions of this nature
      remaining without an adequate answer, or with limited evidence. Therefore, the investigators
      propose to examine the ability of clinical tests, developed to assess alterations related to
      clinical lumbar instability, to identify subgroups of patients with non specific chronic low
      back pain that may have better outcomes after a motor control exercises intervention.
    

Detailed description: 
      Changes relative to clinical instability are well established in individuals with non
      specific chronic low back pain. However, in this population, these changes vary widely,
      characterizing them as an heterogenous group. Motor Control Exercises (MCE) aims to improve
      the impaired coordination of deep and superficial muscles of the trunk, to reestablish the
      stability of the lumbar spine reducing the common alterations in this population, and are
      associated with reduction of pain and disability of patients with non specific chronic low
      back pain. To specific assessment of the changes found in this population, clinical tests are
      often used: in the assessment to identify motor control alterations; during intervention as
      parameter for treatment progress (e.g. to increase exercises difficulty); and after
      intervention, to ensure that there was normalization of the motor control. There are several
      clinical tests to assess changes relative to clinical instability, such as: Clinical
      Classification Scale (CCS) to assess abdominal muscles and the coordination between
      superficial and deep trunk muscles; Clinical Test of Thoracolumbar Dissociation (CTTD) to
      assess anterior/posterior tilt while maintain a constant position of thoracolumbar junction;
      and the Prone Instability Test (PIT) and Passive Lumbar Extension Test (PLET) used to detect
      structural lumbar instability.

      Therefore, primary objectives of this study are: to investigate the ability of clinical tests
      in predict clinical outcomes, pain and disability, in motor control exercises program, and to
      investigate the association of two or more tests to predict clinical outcomes.
    

Intervention name(s): Motor Control Exercises
Intervention type(s): Other
Intervention description(s): Subjects performed 8 weeks of motor control exercises intervention, 2 weekly 1 hour per session, instructed by trained physiotherapists to apply this program following a protocol developed in programs previously reported (Costa et al. 2009; Hodges et al. 2009). The first stage aims to improve the activity of muscles that have poor control and reduce overactivity of superficial muscles, previously assessed, through drawing in maneuver with feedback real-time ultrasound and via palpation. The second stage of the treatment involved more functional exercises, first using static and then dynamic tasks.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Low Back Pain; Clinical Instability; Motor Control Exercises; Clinical Tests