Water Versus Land Based Perturbation Exercises in Elderly Participants With Back Pain
Condition: Back Pain; Back Pain With Radiation; Back Pain Without Radiation; Back Pain Lower Back Chronic
MeSH terms: Back Pain
Study type: Interventional

Summary: 
      The aim of this study was to compare the effectiveness of land based versus water based
      perturbation exercises on the pain, disability, fear of falling, and fear avoidance beliefs
      in elderly participants. Overweight/obese subgroup was compared with healthy weight with
      chronic low back pain participants to investigate any effect on BMI on both interventions.
      The results of the study revealed that both exercise groups i.e., land and water based
      exercise had a significant reduction in pain level, fear of falling, fear avoidance belief
      related to work, disability and improved SLR.
    

Detailed description: 
      Twenty-four grouped into 12 per group participated water based and land based exercise
      protocol. Both groups were given McKenzie Method of exercises in 1st week based on the
      treatment-based classification (TBC) approach or personalized to the need of participants as
      per TBC.

      Perturbation-based postural exercises were given to participants, which were performed on
      land or water for 6 weeks.

      The perturbation based exercises were categorized into four levels, where level 1:static
      postural control, 2:dynamic postural control 3:Extremity loaded postural control and 4:
      cognitive task associated postural control. The perturbation were provided at shoulder and
      hip level, by intervention providers progressive enough to initiate anticipatory or
      compensatory postural adjustments.

      Both groups were educated on pain assurance and spinal ergonomics feedback. The Outcomes were
      measured using a Visual analog scale, Oswestry disability index, Fear avoidance belief
      questionnaire, Straight leg raise, Modified fall efficacy scale, and Borg scale. The pain
      level were assessed for personalized progression from level 1 to level 4 progression of
      perturbation exercises.

      Both the exercise groups of land and water showed improvement in measured clinical outcomes
      in terms of reduction in pain level, fear of falling, fear avoidance belief related to work,
      SLR, and disability. Water-based group showed additional benefits and significant improvement
      in fear avoidance belief related to physical activity and exercised with low rate of
      perceived exertion.
    

Intervention name(s): Exercises
Intervention type(s): Behavioral
Intervention description(s): Perturbation exercises: A new protocol of perturbation exercises aimed to disturb static and dynamic posture or equilibrium at primarily at body segments at hip and shoulder level were provided. The perturbation was initially started as anticipatory postural adjustment and progressed to compensatory postural adjustment, where stepping on various directions were challenged. The nature of perturbation or push or nudges applied by physiotherapists were progressed from a) self-generated to therapist applied, anticipated to unanticipated, stable to unstable platforms, static to dynamic postural tasks with loaded extremities and at higher level simple to higher cognitive tasks were also incorporated.
Other intervention name(s): Mckenzie extension exercise, mobilization and spinal lumbar traction therapy tailored based on TBC system
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Intervention model description: pre and post outcomes comparison after clinical intervention
Masking: Double (Care Provider, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Back Pain; Old Age; Exercises; Hydrotherapy; Rehabilitation