Effectiveness of Pain and Exercise Training With Telerehabilitation on Lumbar Facet Joint Arthrosis
Condition: Facet Joint Arthrosis; Low Back Pain
MeSH terms: Osteoarthritis; Joint Diseases; Back Pain; Low Back Pain
Study type: Interventional

Summary: 
      The study investigates the effects of pain and exercise training via telerehabilitation
      method on pain, pain beliefs, trunk mobility, functionality, and quality of life in
      individuals with low back pain caused by facet joint arthrosis. Forty - five individuals are
      planning to include in the study. Participants will be randomly assigned to one of the three
      groups: Group 1: Pain education + exercise training group, Group 2: Exercise training group,
      and Group 3: Control group. The same physiotherapist will make evaluations via an online
      conference system. Group 1 will have pain neuroscience education and progressive therapeutic
      exercise training in a session for six weeks, twice a week, and Group 2 will have progressive
      therapeutic exercise training in a session for six weeks, twice a week, for six weeks, in
      total twelve sessions. Group 3 participants will be taken to the waiting list. Clinical and
      demographic data of the 45 participants in the study will be taken pre and post
      interventions. The primary outcomes are; the Numeric Pain Rating Scale (NPRS) and the
      Oswestry Disability Index (ODI). Secondary outcomes are the Active Straight Leg Raise Test
      (A- SLR), The Pain Belief Questionnaire (PBQ), and the Short Form Quality of Life Form
      (SF-12). Statistical analysis will be run through the SPSS 20.0 package program.
    

Detailed description: 
      'Pain Neuroscience Education (PNE) is one of the cognitive approaches among conservative
      treatments, and has been one of the most inquisitive approaches. The content of the education
      includes the physiology of pain, types of pain, the areas in which it is represented in the
      brain, its effect on body image, and psychosocial dimensions. Education aims to break the
      patient's misinformation and perception about pain and teach how to manage pain. It aims to
      inform patients about the neurophysiological and neurobiological processes related to the
      pain experience and help change their misinformation about pain conditions. Improved pain
      knowledge changes attitudes and beliefs about pain, reduces destructive thoughts, and fear of
      pain, and improves physical performance. It is known to reduce pain and disability according
      to short-term results in patients with chronic pain with central sensitization. According to
      systematic reviews, PNE is moderately effective in patients with chronic musculoskeletal
      pain. In addition, it is stated that the use of educational approaches based on the
      neurophysiology of pain offers clinical benefits not only in physical terms but also in
      psychosocial terms. Since maladaptive psychosocial factors (for example, negative emotions,
      poor self-efficacy, and maladaptive beliefs) are associated with pain behaviors, it is
      thought that increasing pain knowledge will have an impact on pain perception. In a study
      conducted on patients with musculoskeletal pain who experience different types of pain, an
      inverse relationship between pain intensity and knowledge level was shown.

      Due to the COVID-19 pandemic, the interest in the telerehabilitation method has increased,
      and it has become reachable easier with more evidence value on this subject. However,
      physiotherapists are healthcare professionals who work face-to-face with patients; depending
      on the pandemic curfews, the World Health Organization (WHO) has recommended not to continue
      face-to-face practices, except in emergencies, to protect patients' and physiotherapists'
      health. While digital options such as sensors, wearable technologies, virtual reality, and
      artificial intelligence are considered a solution, Tele-Rehabilitation (TR) can be the most
      practical, reachable, and cheaper solution to existing problems.

      Systematic research and meta-analyses examining the effect of the telerehabilitation method
      and comparing it with traditional rehabilitation have revealed similar gains in outcome
      measures such as pain intensity and quality of life. It has been reported that simultaneous
      TR has comparable and effective results with face-to-face rehabilitation on pain and function
      in musculoskeletal problems. The telerehabilitation method is effective and cost-effective,
      especially in low back pain. Revealing the effects with more specific patient groups is the
      common recommendation of the studies.

      In line with this information, the study's primary purpose is to determine the effects of PNE
      and progressive therapeutic exercise training given by the physiotherapist with the
      telerehabilitation method on pain, disability, pain beliefs, and quality of life. The
      secondary aim is to compare the effectiveness of progressive therapeutic exercise training
      alone or with PNE.
    

Intervention name(s): Pain Neuroscience education + Progressive therapeutic exercise training; Progressive therapeutic exercise training
Intervention type(s): Behavioral; Behavioral
Intervention description(s): The education group will have a comprehensive patient education which includes; description, transmission, representation of pain, central sensitization, neuroplasticity, its relation to body systems, psychosocial and emotional factors affecting pain, pain behavior, and lifestyle changes to cope with pain, etc. Plus, the group will have supervised progressive therapeutic exercises via the telerehabilitation method.; The exercise group will have supervised progressive therapeutic exercises via the telerehabilitation method.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: facet joint arthrosis; low back pain; exercise; education; telerehabilitation