Water Versus Land Based Perturbation Exercises in Elderly Participants With Back Pain

Study Overview
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Brief Summary
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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
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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.

Official Title
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The Effectiveness of Perturbation Exercises in Elderly Back Pain

Conditions
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Back Pain, Back Pain With Radiation, Back Pain Without Radiation, Back Pain Lower Back Chronic

Intervention / Treatment
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* Behavioral: Exercises


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Pain history of minimum 12 weeks duration in below labels Participants with the diagnostic labels of spondylosis Non-specific chronic low back pain Back pain radiating to leg or sciatica Subacute back pain Exclusion Criteria: Unstable blood pressure Cardiac failure Incontinence Uncontrolled epilepsy Open wounds Acute infections Neurological disorders Orthopedic conditions affecting exercise participation in pool and land Cardio-respiratory conditions affecting exercise participation in pool and land.

Ages Eligible for Study
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Minimum Age: 55 Years
Maximum Age: 85 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: pre and post outcomes comparison after clinical intervention
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Water based perturbation exercise group<br>In both groups, the participants screened for Treatment-based classification of back pain and based on TBC interventions were provided. From second week, water based perturbation exercise were initiated personalized to the level of participants. Treatment-based classification of back pain intervention was gradually tapered in orderly fashion during 6 weeks, concurrently introduced land based perturbation exercise gradually phased from level 1 to level 4. | Behavioral: Exercises<br>* 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.<br>* Other names: Mckenzie extension exercise, mobilization and spinal lumbar traction therapy tailored based on TBC system;|
| Active Comparator: Land based perturbation exercise group<br>All procedures were followed similar to Water based perturbation exercise group except perturbation based exercises were provided in land. | Behavioral: Exercises<br>* 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.<br>* Other names: Mckenzie extension exercise, mobilization and spinal lumbar traction therapy tailored based on TBC system;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Low back pain | Visual Analogue Scale (VAS) was used where 0 indicates no pain and 10 indicate extremely painful. | 6 weeks | 
| Disability caused by the chronic low back pain | A standard Oswestry Disability Index (ODI) was used to evaluate the disability caused by the chronic low back pain. The lower the score lower disability and higher scores indicates that high level of disability associated with back pain. | 6 weeks | 
| Physical activity associated fear avoidance behavior | The percentage of fear avoidance of behavior ranges from 0 to 100% where 0%-indicates no fear and 100%-indicate highest level of fear avoidance behavior. | 6 weeks | 
| Fall risk | Fall risk of participants was assessed using the Modified fall efficacy scale (MFES), where Higher scores reflect more confidence and less fear of falling while lower scores reflect less confidence and more fear of falling. | 6 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Rate of perceived exertion | Borg scale utilised to measue the exertion during the exercise. Grades were obtained with 6 being no exertion at all, and 20 being maximum effort. | 6 weeks | 
| Impairment - Straight Leg Raise as hip joint range of motion | Straight leg raise range of motion was measured to identify the level of impairment and to confirm any leg pain associated with back pain | 6 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Rehabilitation, Back Pain, Old Age, Exercises, Hydrotherapy