Active Break Intervention on Low Back Pain and Musculoskeletal Discomfort During Prolonged Sitting Among Young People
Condition: Low Back Pain
MeSH terms: Back Pain; Low Back Pain
Study type: Interventional

Summary: 
      The most recent evidence showed that the COVID-19 (coronavirus disease 2019, National
      Institutes of Health) pandemic caused an increase in low back pain (LBP) prevalence and
      intensity among young people. This may be explained by the prolonged sitting time, next to
      reduced level of physical activity. Young people spend most of their time in a sitting
      position while studying (in school class, during homework) and using electronic devices
      (using the computer, laptop, mobile phone, tablets, or watching TV), and now using e-learning
      methods. E-learning, and thus prolonged sitting, is a topic that returned to higher education
      at the beginning of the 2022-2023 academic year because of the current energy crisis.
      Re-education on sitting posture is a common aspect of LBP management. Physiotherapists
      recommend many different sitting positions to prevent and treat the negative effects of
      prolonged sitting. However, there is debate regarding what is an optimal sitting posture.
      Studies showed that sitting posture with the backrest on the chair induced minimal changes in
      lumbar lordosis and significantly lesser pain compared to other types of the chair. Even
      though the sitting posture will be followed by proper ergonomic principles, every position
      (lordotic or kyphotic) maintained for a prolonged time leads to discomfort and soft tissue
      symptoms. Studies showed that body perceived discomfort scores increased over time during
      sitting and after 30 min of sitting is significantly greater than those at baseline.
      Currently, breaks are recommended for mitigating the adverse of prolonged sitting, but more
      evidence is needed to verify effectiveness of breaks. The aim of this study is to evaluate
      the effect of active break on reduce LBP and perceived musculoskeletal discomfort during
      prolonged sitting in young people with LBP. Optimal combination of sitting and breaks will
      help to develop ergonomic recommendations for young people. Main research outcomes - exercise
      protocol and intervention - will be developed to match the needs of young people with LBP and
      the possibilities of the environment, in order to reduce LBP and musculoskeletal discomfort
      during prolonged sitting, and consequently, maintain health and quality of life. The
      intervention will address the social and health needs of a particular social group: young
      people, with the possibility of extending the recommendations to other groups.
    

Detailed description: 
      Background:

      Young people tend to spend most of their time in sitting position while studying (in the
      school class, during homework) and using the electronic devices (using the computer, laptop,
      mobile phone, tablets or watching TV). Moreover, during the COVID-19 (coronavirus disease
      2019, National Institutes of Health) pandemic, many countries switched their teaching
      programs into e-learning, where students spend long hour using electronic devices. Now
      e-learning methods have been often used, not only during pandemic. The current energy crisis,
      exacerbated by the war in Ukraine, is causing e-learning back to educational institutions.
      However this change in learning methods is associated with musculoskeletal dysfunction
      including low back pain (LBP). Low back pain was one of the most common musculoskeletal
      disorders and today it is known that the COVID-19 pandemic has increased the prevalence and
      intensity of LBP. This may be explained by the prolonged sitting time, next to reduced level
      of physical activity. Most people sit for a long hours in a slumped sitting posture.
      Prolonged sitting causes changes in the passive structures of the spine and induces a low
      back compressive load significantly higher than that observed in standing. Physiotherapists
      recommend many different sitting positions to prevent and treat negative effects of prolonged
      sitting. However, there is debate regarding what is an optimal sitting posture. Periodic rest
      breaks have been identified as a way to reduce self-report discomfort at the low back and a
      standing breaks may be beneficial for the passive tissues of the spine. A combination of
      sitting and standing is beneficial for reducing musculoskeletal discomfort.

      Research aim:

      The aim of this study is to evaluate the effect of active break on reduce LBP and perceived
      musculoskeletal discomfort during prolonged sitting in young people with LBP.

      Methods:

      This will be a randomized controlled study with pre and post-intervention assessment. The
      participants will be recruited from students. Participants were randomly assigned to the
      intervention group consisting of an active break (n = 25) or the control group (n = 25). The
      group with an active break with postural change from sitting to standing will be recommended
      to take an active break for every 30 minutes of sitting. The primary outcome will be average
      pain intensity (Visual Analogue Scale, VAS), disability measured using the Oswestry
      Disability Index and perceived musculoskeletal discomfort during prolonged sitting (Borg
      scale) and The Global Perceived Effect (7-point Likert scale). Secondary outcome will
      Post-Intervention Questionnaire (5-item self-completed questionnaire).

      Expected outcomes:

      Research outcomes - exercise protocol and intervention - will be developed to match the needs
      of young people with LBP and the possibilities of the environment, in order to reduce LBP and
      musculoskeletal discomfort during prolonged sitting, and consequently, maintain health and
      quality of life. The intervention will address the social and health needs of a particular
      social group: young people, with the possibility of extending the recommendations to other
      groups. Research outcomes will build evidence-based practice for students, teachers, health
      professionals, personal trainers, and family doctors.
    

Intervention name(s): Active break with the proposed lumbar and hip extension exercises; Self-care recommendations
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Participants assigned to the experimental group will receive recommendation to take an active break with the proposed lumbar and hip extension exercises for every 30 minutes of sitting. In the experimental intervention, the exercise program include exercises and will be based on patient education. The participants will also explain the importance of regular training and receive a booklet with photographed and described exercises.; Participants assigned to the control group will receive an educational self-care book containing information on low back pain, anatomy of the spine and its relation to the muscular chain, care during daily life activities and the importance of regular physical exercises. The control group will perform their regular baseline activities.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: non-specific low back pain; young people; sitting position; break; active break