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| Name | Class |
|---|---|
| Coordenação de Aperfeiçoamento de Pessoal de NÃvel Superior. | OTHER_GOV |
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Nowadays, the research priority in low back pain area have been find subgroup of patients with the same characteristics that might achieve better outcomes in a specific intervention. However, even though the studies in this area have increased, questions of this nature remaining without an adequate answer, or with limited evidence. Therefore, the investigators propose to examine the ability of clinical tests, developed to assess alterations related to clinical lumbar instability, to identify subgroups of patients with non specific chronic low back pain that may have better outcomes after a motor control exercises intervention.
Changes relative to clinical instability are well established in individuals with non specific chronic low back pain. However, in this population, these changes vary widely, characterizing them as an heterogenous group. Motor Control Exercises (MCE) aims to improve the impaired coordination of deep and superficial muscles of the trunk, to reestablish the stability of the lumbar spine reducing the common alterations in this population, and are associated with reduction of pain and disability of patients with non specific chronic low back pain. To specific assessment of the changes found in this population, clinical tests are often used: in the assessment to identify motor control alterations; during intervention as parameter for treatment progress (e.g. to increase exercises difficulty); and after intervention, to ensure that there was normalization of the motor control. There are several clinical tests to assess changes relative to clinical instability, such as: Clinical Classification Scale (CCS) to assess abdominal muscles and the coordination between superficial and deep trunk muscles; Clinical Test of Thoracolumbar Dissociation (CTTD) to assess anterior/posterior tilt while maintain a constant position of thoracolumbar junction; and the Prone Instability Test (PIT) and Passive Lumbar Extension Test (PLET) used to detect structural lumbar instability.
Therefore, primary objectives of this study are: to investigate the ability of clinical tests in predict clinical outcomes, pain and disability, in motor control exercises program, and to investigate the association of two or more tests to predict clinical outcomes.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Motor Control Exercises | Experimental | (Costa LOP et al. 2009; Hodges PW et al. 2009) |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Motor Control Exercises | Other | Subjects performed 8 weeks of motor control exercises intervention, 2 weekly 1 hour per session, instructed by trained physiotherapists to apply this program following a protocol developed in programs previously reported (Costa et al. 2009; Hodges et al. 2009). The first stage aims to improve the activity of muscles that have poor control and reduce overactivity of superficial muscles, previously assessed, through drawing in maneuver with feedback real-time ultrasound and via palpation. The second stage of the treatment involved more functional exercises, first using static and then dynamic tasks. |
| Measure | Description | Time Frame |
|---|---|---|
| Pain (Numerical Rating Scale (0-10) | After Intervention (2 months), 6 months | |
| Disability (measured by 24-item Roland Morris Disability Questionnaire) | Disability will be measured by 24-item Roland Morris Disability Questionnaire | After Intervention (2 months), 6 months |
| Measure | Description | Time Frame |
|---|---|---|
| Function (Patient Specific Functional Scale (0-10) | After Intervention (2 months) | |
| Global Perceived Effect (11-point Global Perceived Effect Scale (-5-+5) | 11-point Global Perceived Effect Scale (-5-+5) |
| Measure | Description | Time Frame |
|---|---|---|
| Clinical Classification Scale (CCS) | To assess abdominal muscles coordination (0-10) | After Intervention (2 months) |
| Thoracolumbar Dissociation Clinical Test (TDCT) | To assess thoracolumbar dissociation (0-10) |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Ruben FN Filho, PhD | UNIVERSIDADE ESTADUAL PAULISTA JULIO DE MESQUITA FILHO | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Centro de Atendimento em Reabilitação e Fisioterapia - FCT/UNESP | Presidente Prudente | São Paulo | 957 | Brazil |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| Background | Hodges PW, Ferreira PH, Ferreira ML. Lumbar spine: Treatment of instability and disorders of movement control. Magee DJ, Zachazewski JE, Quillen WS, editors. Pathology and Intervention in Musculoskeletal Rehabilitation. St. Louis: Saunders Elsevier. 2009;401 | ||
| 24853256 | Background | Elgueta-Cancino E, Schabrun S, Danneels L, Hodges P. A clinical test of lumbopelvic control: development and reliability of a clinical test of dissociation of lumbopelvic and thoracolumbar motion. Man Ther. 2014 Oct;19(5):418-24. doi: 10.1016/j.math.2014.03.009. Epub 2014 Mar 30. | |
| 16181938 |
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| ID | Term |
|---|---|
| D017116 | Low Back Pain |
| ID | Term |
|---|---|
| D001416 | Back Pain |
| D010146 | Pain |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
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|
| After Intervention (2 months) |
| Depression (Beck Inventory (0-63) | Beck Inventory (0-63) | After Intervention (2 months) |
| Kinesiophobia (Tampa Scale for Kinesiophobia (17-68) | Tampa Scale for Kinesiophobia (17-68) | After Intervention (2 months) |
| Kinesiophobia (Fear Avoidance Beliefs Questionnaire (0-66) | Fear Avoidance Beliefs Questionnaire (0-66) | After Intervention (2 months) |
| Kinesiophobia (Photograph Series of Daily Activities - Short Electronic Version (PHODA-SEV) (0-100) | Photograph Series of Daily Activities - Short Electronic Version (PHODA-SEV) (0-100) | After Intervention (2 months) |
| After Intervention (2 months) |
| Changes Thickness of abdominal muscles (Transversus Abdominis, Internal and External Oblique) Measured by Ultrasound Images | Measured by Ultrasound Images made with a 7.5-MHz linear transducer (Siemens, Sonoline Sienna, Issaquah, WA, USA) | After Intervention (2 months) |
| Structural Lumbar Instability (Prone Instability Test (PIT) and Passive Lumbar Extension Test (PLET) | Prone Instability Test (PIT) and Passive Lumbar Extension Test (PLET) | After Intervention (2 months) |
| Background |
| Hicks GE, Fritz JM, Delitto A, McGill SM. Preliminary development of a clinical prediction rule for determining which patients with low back pain will respond to a stabilization exercise program. Arch Phys Med Rehabil. 2005 Sep;86(9):1753-62. doi: 10.1016/j.apmr.2005.03.033. |
| 17033040 | Background | Kasai Y, Morishita K, Kawakita E, Kondo T, Uchida A. A new evaluation method for lumbar spinal instability: passive lumbar extension test. Phys Ther. 2006 Dec;86(12):1661-7. doi: 10.2522/ptj.20050281. Epub 2006 Oct 10. |
| 23492976 | Background | Bystrom MG, Rasmussen-Barr E, Grooten WJ. Motor control exercises reduces pain and disability in chronic and recurrent low back pain: a meta-analysis. Spine (Phila Pa 1976). 2013 Mar 15;38(6):E350-8. doi: 10.1097/BRS.0b013e31828435fb. |
| 30822389 | Derived | Oliveira CB, Pinto RZ, Schabrun SM, Franco MR, Morelhao PK, Silva FG, Damato TM, Negrao Filho RF. Association Between Clinical Tests Related to Motor Control Dysfunction and Changes in Pain and Disability After Lumbar Stabilization Exercises in Individuals With Chronic Low Back Pain. Arch Phys Med Rehabil. 2019 Jul;100(7):1226-1233. doi: 10.1016/j.apmr.2019.01.019. Epub 2019 Feb 26. |
| D013568 |
| Pathological Conditions, Signs and Symptoms |