Comparison of Extensible and Inextensible Lumbosacral Orthoses for Lower Back Pain

Study Overview
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Brief Summary
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This study is designed to discern if the use of a lumbosacral orthesis (LSO, also call a back support) improves the short-term outcome of lower back pain. participants will receive standard care (physical therapy, physician treatment), with one group also receiving an extensible LSO, and another group receiving an inextensible LSO. The inextensible LSO has been shown to increase stiffness of the trunk in individuals while wearing it. The hypothesis is that the group wearing the inextensible LSO will have improved outcomes over the other two groups (standard care or standard care plus the extensible LSO).

Official Title
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Comparison of Inextensible and Extensible Lumbosacral Orthoses for the Management of Episodes of Lower Back Pain

Conditions
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Low Back Pain

Intervention / Treatment
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* Other: Inextensible LSO (stiff back support)
* Other: Extensible LSO, a back support that is flexible
* Other: Standard of Care


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: chief complaint of lower back pain, with or without lower extremity (LE) symptoms 150 subjects will be recruited from patients seeking treatment for lower back pain from spine specialty orthopaedic clinics, family practice physicians, and out-patient physical therapy clinics Exclusion Criteria: Exclusion criteria are: previous spinal surgery workman's compensation or litigation is involved neurological disease or injury systemic inflammatory disease pulmonary disease which restricts breathing capacity current pregnancy acute fracture tumor or metastatic disease infection neurological disease the presence of pathological reflexes (e.g., Babinski) the presence of lower extremity pain upon cervical motion and / or the presence of two or more of the following signs of nerve compression: diminished lower extremity strength in a myotomal distribution, diminished sensation, and / or absence deep tendon reflexes.

Ages Eligible for Study
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Minimum Age: 18 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: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: Standard of Care<br>Medication based on physician prescriptions or overcounter use not germane to the study. Subjects also receive physical therapy for 2 weeks. | Other: Standard of Care<br>* Physician visit, physician advice, medications as determined by physician, over the counter medications, and physical therapy.<br>|
| Experimental: Extensible lumbosacral orthoses plus standard of care<br>This group receives a flexible/extensible lumbosacral orthosis, one that is commonly available over the counter | Other: Extensible LSO, a back support that is flexible<br>* Back support is constructed from lycra and neoprene with velcro fasteners.<br>|
| Experimental: Inextensible lumbosacral orthoses and standard of care<br>This group receives an inextensible lumbosacral orthoses which leads to 14% increase in trunk stiffness compared to the other conditions. | Other: Inextensible LSO (stiff back support)<br>* Cotton/nylon canvas back support with velcro fasteners.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change Score in the Self-assessment of Disability as Measured by Oswestry Disability Index (ODI) | Change score from baseline and the score at the second week. The Oswestry Disabilty Index is a 100 point self-assessment of disabilty due to lower back pain or complications from lower back pain. A score of 40 or more points is interpreted as signficant disability due to lower back pain. A score between 20 and 40 respresents disability, but the individual is still able to function to some degree with activities of daily living, but has to modify their behavior. A score less than 20 implies that the disabilty due to the lower back pain is not greatly impacting a wide range of functions. Compare score change to the minimal clinically important difference between the baseline and the 2nd week score, and the difference in the change scores across the 3 groups. | Baseline and 2 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change Score in the Patient Specific Activity Scale | Change score from baseline and the score at the second week. Compare score change to the minimal clinically important difference and analyze for statistical significance between the baseline and the 2nd week score, and the statistical difference in the change scores across the 3 groups. Scores from 0 to 10 with a higher score representing higher function and a lower score representing a decrease function. | Baseline and 2-weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Low back pain, Back brace, Lumbar orthoses, Lumbosacral orthoses, Low back pain treatment