Manual Therapy as a Form of Sensory Discrimination in Chronic Low Back Pain

Study Overview
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Brief Summary
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This study evaluates whether different explanations given to patients with long lasting back pain influence a physical therapy treatment technique. Half of the patients will receive an explanation of the proposed treatment technique focusing on how their joints are moving and not moving. The second half of the group will receive the same treatment technique as the first group, but their explanation of the technique's purpose will focus on how their brain interprets the information. The study aims to determine if patients have a different response to the treatment based on the words chosen to explain the technique.

Detailed Description
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Traditional treatment provided by physical therapists to patients with chronic low back pain focuses on the biomechanical or anatomical impact to local tissues. Recent research has shown that treatment effects may be more related to the understanding of the structural and functional changes in the brain of someone suffering from chronic low back pain. This research implicates that the patients understanding and interpretation of input to the brain may change the patient's perceived representation and interpretation of output of pain within the brain.

Official Title
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A Randomized Controlled Trial of Manual Therapy as a Form of Sensory Discrimination in Chronic Low Back Pain

Conditions
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Low Back Pain

Intervention / Treatment
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* Procedure: Neuroplasticity Explanation (Experimental)
* Procedure: Biomechanical Explanation (Control)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adults over the age of 18 Presenting at Physical Therapy with a primary complaint of Low Back Pain Low Back Pain being present for 6 months or more Fluent in English and willing to participate in the study. Exclusion Criteria: Medical precautions to the use of manual therapy (metal, skin lesions, etc.) Prior spine surgery Unable to lay prone for the treatment.

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 |
| --- | --- |
| Experimental: Neuroplasticity Education Group<br>Patients who receive manual physical therapy treatment with a neuroplasticity explanation of the basis for the technique | Procedure: Neuroplasticity Explanation (Experimental)<br>* Patients were given an explanation of how the brain uses the information from a manual therapy technique to help it remain sharp in identifying where this input is coming from.<br>|
| Active Comparator: Biomechanical Education Group<br>Patients who receive manual physical therapy treatment with a traditional, biomechanical explanation of the basis for the technique | Procedure: Biomechanical Explanation (Control)<br>* Patients were given an explanation of how the manual therapy technique affects the anatomy and physiology of the back.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Low back pain rating change | Change, measured within a single, one hour session, of baseline measurements taken, followed immediately by the education / treatment, followed immediately by post-education / treatment measurement of the patient's pain in low back on a numeric pain rating scale of 0 to 10 | Within a single, one hour session | 
| Leg pain rating | Change, measured within a single, one hour session, of baseline measurements taken, followed immediately by the education / treatment, followed immediately by post-education / treatment measurement, level of patient's leg pain on a numeric pain rating scale of 0 to 10. | Within a single, one hour session | 
| Active trunk forward flexion | Change, measured within a single, one hour session, of baseline measurements taken, followed immediately by the education / treatment, followed immediately by post-education / treatment measurement of distance from longest finger to the floor when patient bends forward (in cm). | Within a single, one hour session | 
| Straight Leg Raise | Change, measured within a single, one hour session, of baseline measurements taken, followed immediately by the education / treatment, followed immediately by post-education / treatment measurement of angle to which the patient's most affected leg can be lifted (measured in degrees using an inclinometer). | Within a single, one hour session | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Pain, Brain, Plasticity, Education, Manual Therapy, Straight Leg Raise, Remapping