Spinal Control During Functional Activities to Improve Low Back Pain Outcomes
Condition: Mechanical Low Back Pain; Chronic Low Back Pain
MeSH terms: Back Pain; Low Back Pain
Study type: Interventional

Summary: 
      Exercise is one of the primary interventions used with people with chronic, mechanical low
      back pain. It is unknown, however, which exercise is best for which person, which exercises a
      person will adhere to and for how long, and the effect of adhering to a specific type of
      exercise on how the person functions, particularly in the long run. The purpose of this study
      is to examine if the short- and long-term effects are different between 1) commonly
      prescribed strength and flexibility exercises for the trunk and limbs, and 2) individualized
      practice in daily functional activities that are difficult or painful to perform. Adherence
      to the different interventions, the relationship between adherence and outcomes,as well as
      the effect of a booster intervention also will be examined.
    

Detailed description: 
      For many people, mechanical low back pain (LBP) is a long-term, function-limiting condition
      rather than a short-term, self-limiting condition. Exercise is one of the primary
      non-surgical approaches used worldwide for managing LBP. Specifically in people with chronic
      LBP, exercise has been found to be as efficacious, if not more efficacious than 1) no
      treatment, 2) usual care, and 3) many other treatments, such as massage or laser therapy.
      Despite the growing body of evidence for the beneficial effects of exercise, however, there
      is limited evidence about 1) which exercise is best for which person, 2) how long the effects
      of different exercises last, 3) which types of exercise people will adhere to, and for how
      long, and 4) the mechanisms underlying the effects of different types of exercise.

      This study aims to address these limitations by directly comparing the effects of 1) exercise
      to increase strength of the trunk and increase flexibility of the trunk and extremities, and
      2) individualized, motor skill training directed at performance of daily functional
      activities that are painful or limited due to the person's LBP. This study also will examine
      1) the effects of a booster phase of intervention, 2) the relationship between adherence to
      intervention and function, and 3) the relationship between performance of functional
      activities and function-related outcomes. People with chronic LBP will be randomized to 1) an
      intervention of strength and flexibility exercise or motor skill training, and 2) a booster
      or no-booster intervention. Intervention will be provided in 2 phases: 1) initial phase: 6 -
      1 hour sessions, once/week for 6 weeks, and 2) booster phase: # of sessions needed to regain
      independence in home program, beginning 6 months after the initial phase. The investigators
      will collect 1) measurements of pain, function, disability, and economic outcomes, 2) reports
      of adherence, and 3) laboratory-based measures of performance of functional activities.
      People will be followed for 12 months after the initial intervention phase. Three sets of
      hypotheses are proposed. First, the investigators hypothesize that both interventions will
      result in improvements in pain, function, disability, and economic outcomes, but that the
      motor skill training will result in more long lasting improvements than the strength and
      flexibility exercise. Second, the investigators hypothesize that the effect of a booster
      phase of intervention will 1) result in longer lasting improvement in function and better
      adherence than a no-booster intervention, and 2) be greater for motor skill training than for
      strength and flexibility exercise. Finally, the investigators hypothesize that 1) adherence
      to motor skill training will be more strongly related to function than will adherence to
      strength and flexibility exercise, and 2) performance of functional activities by people
      receiving motor skill training will be more strongly related to function than performance of
      functional activities by people receiving strength and flexibility exercise.
    

Intervention name(s): Motor skill training; Strength and flexibility exercise
Intervention type(s): Behavioral; Behavioral
Intervention description(s): The participant will assist in selecting both simple and complex functional activities to practice. Difficulty will be graded to match the participant's motor capabilities. Three activities will be practiced per session. Within the practice of activities the training will emphasize 1) contraction of groups of specific trunk muscles, 2) earlier and greater movement of the hip, knee, and/or thoracic spine relative to the lumbar spine, 3) later and less movement of the lumbar spine relative to other regions. Within each activity the conditions of practice will vary based on 1) the participant's ability to perform the activity, and 2) the level of challenge the participant is faced with when performing the activity during his day. Equipment will be provided as needed.; Exercises based on best evidence for effectiveness in people with chronic low back pain will be prescribed. Strengthening exercises will target all trunk muscles. Flexibility exercises will target all trunk and hip motions. All exercises will be performed at the intensity appropriate for the person's musculoskeletal fitness level based on the American College of Sports Medicine guidelines. Difficulty level, frequency, and number of repetitions will be modified based on guidelines described in the literature. Equipment will be provided as needed.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Mechanical low back pain; Non-specific low back pain; Exercise; Motor skill training