Spinal Kinematics in Chronic Low Back Pain
Condition: Chronic Low Back Pain
MeSH terms: Back Pain; Low Back Pain
Study type: Observational

Summary: 
      Chronic low back pain (CLBP) is one of the most frequent causes for limitations in daily,
      leisure and work-related activities. Although alterations in spinal motor behavior were
      consistently reported in CLBP patients, it remains unclear how improvements in spinal motor
      behavior through rehabilitation treatment affect pain and disability. Psychological factors,
      such as pain-related fear, were suggested as a possible main cause of spinal motor behavior
      in CLBP and better understanding their relationships with kinematic and muscle activity
      alterations is required to enhance care, particularly physiotherapy. Therefore, this study
      will test CLBP patients before and after a 3 week rehabilitation program to test the
      hypotheses that: 1) improvements in spinal motor behavior (kinematics and trunk muscle
      activity) are associated with decreased pain and disability; 2) decrease in pain-related fear
      is associated with spinal motor behavior improvements.
    

Detailed description: 
      The research project is a prospective observational cohort study. CLBP patients participating
      to a 3 weeks' multimodal rehabilitation program will be tested in the motion analysis
      laboratory before (T1) and after (T2) the program. This program is an intensive 3-weeks
      multidisciplinary rehabilitation program. Patients come daily for individual and group
      treatments, with a total of 100 hours of intervention during 3 weeks. The program includes
      physiotherapy treatments, occupational therapy, psychologists encounters and education
      session. The programs encompasses a multidimensional view of chronic low back pain.
      Therefore, this setting is a unique opportunity to improve our understanding of the role of
      motor behavior alterations in CLBP because it will allow connecting changes in spinal
      kinematics and muscle activity with changes in pain, disability and pain-related fear.

      This project has two aims in relation to motor behavior in patients with CLBP:

      The first aim is to analyse the relationship between changes in spinal kinematics and changes
      in pain and disability during and after a multimodal rehabilitation program. First, changes
      in spinal kinematics and muscle activity between T1 and T2 will be calculated. The
      relationship between these changes and changes in pain and disability during the program will
      be tested. Pain and disability will be also measured at 3 months (T3) and one year (T4) after
      the program, which will allow to further analyze the relationship between spinal motor
      behavior and pain and disability.

      The second aim concerns the role of pain-related fear, and its decrease, in spinal motor
      behavior alterations. Consequently, the second aim is to analyse if changes in pain-related
      fear are associated with changes in spinal kinematics during a multimodal rehabilitation
      program.
    

Intervention name(s): Multidisciplinary rehabilitation program
Intervention type(s): Other
Intervention description(s): The multimodal rehabilitation program (MRP) based at the University Hospital is an intensive 3-weeks multidisciplinary rehabilitation program. Patients come daily for individual and group treatments, with a total of 100 hours of intervention during 3 weeks. The MRP includes physiotherapy treatments, aiming at improving cardio-vascular endurance, long-term physical activity adherence, proprioception, mobility and strength. Additionally, occupational therapy is mainly focussed on reassuring patients that spinal movements are safe. Finally, psychologists are involved in the MRP to discuss the meaning of LBP, the psychological implications and the patient's resources.
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Patients with chronic low back pain for more than three months participating to a 3 weeks'
        multidisciplinary rehabilitation program
      
Keywords: Movement analysis; Spinal kinematics; Muscle activity; Pain-related fear; Rehabilitation; Spine