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This study aims to evaluate the effects of adding Pain Neuroscience Education (PNE) to motor control exercises in individuals with chronic non-specific low back pain (CNSLBP) who also present with central sensitization. The study focuses on changes in pain intensity, pain-related factors, trunk muscle activation, gait, functionality, kinesiophobia, and quality of life.
This randomized controlled study aims to investigate the effects of combining PNE with motor control exercises in individuals with CNSLBP who demonstrate central sensitization (≥28 points on the Central Sensitization Inventory). Participants are randomly assigned into two groups: the intervention group (motor control exercises + PNE) and the control group (motor control exercises only). Both groups participate in motor control exercises twice a week for 8 weeks, under the supervision of a physiotherapist. The intervention group additionally receives six PNE sessions once per week for six weeks. PNE sessions are delivered by a certified physiotherapist using interactive presentations and question-answer discussions.
Assessments are performed pre- and post-intervention using the following tools:
Data will be analyzed using SPSS version 27. Normality of distribution will be tested with the Shapiro-Wilk test. Depending on the distribution, either parametric (paired t-test, independent t-test) or non-parametric tests (Wilcoxon signed-rank, Mann-Whitney U) will be applied. Pearson or Spearman correlation analyses will be used where appropriate.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Motor Control Exercises | Active Comparator | This group will receive motor control exercises only. |
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| Motor Control Exercises + Pain Neuroscience Education | Experimental | This group will receive the same motor control exercise program as the control group, plus a 6-week PNE program delivered once per week. The PNE program consists of 6 weekly sessions, delivered via slide presentations and interactive discussions, covering topics such as nociception, central sensitization, neuroplasticity, and pain coping strategies. Sessions are delivered by a certified physiotherapist. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Motor Control Exercises | Other | Participants will perform these exercises under physiotherapist supervision twice per week for 8 weeks. Exercises focus on improving deep trunk muscle coordination and stability. |
| Measure | Description | Time Frame |
|---|---|---|
| Pain Intensity (Numerical Pain Rating Scale - NPRS) | Change in pain intensity will be assessed using a 0-10 Numerical Pain Rating Scale at baseline and post-intervention. Higher scores indicate greater pain severity. | Baseline and post-intervention (8 weeks) |
| Pressure Paın Threshold Measurement | PPT will be measured using a digital algometer on the lumbar region. Higher values indicate reduced pain sensitivity. | Baseline and post-intervention (8 weeks) |
| Central Sensitization (Central Sensitization Inventory - CSI) | The CSI-A section will be used to evaluate symptoms related to central sensitization. Total scores range from 0-100, with higher scores indicating greater sensitization. | Baseline and post-intervention (8 weeks) |
| Pain Knowledge (Revised Neurophysiology of Pain Questionnaire - rNPQ) | Participants' knowledge about pain neurophysiology will be assessed. The number of correct responses will be calculated. | Baseline and post-intervention (8 weeks) |
| Disability (Roland-Morris Disability Questionnaire - RMDQ) | Functional disability due to low back pain will be assessed using the RMDQ, a 24-item self-report questionnaire. | Baseline and post-intervention (8 weeks) |
| Muscle Activation (Surface EMG Analysis) | Surface EMG will evaluate activation levels of bilateral external oblique, internal oblique, transversus abdominis, and tibialis anterior muscles during gait. | Baseline and post-intervention (8 weeks) |
| Measure | Description | Time Frame |
|---|---|---|
| Kinesiophobia (Tampa Scale for Kinesiophobia - TSK) | Fear of movement will be evaluated with the TSK. Total scores range from 17-68. Higher scores represent more fear-avoidance behavior. | Baseline and post-intervention (8 weeks) |
| Pain Catastrophizing (Pain Catastrophizing Scale - PCS) |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Hacettepe University | Ankara | Karabük Province | 06100 | Turkey (Türkiye) |
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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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Participants will be randomly assigned to either a control group receiving motor control exercises or an intervention group receiving motor control exercises plus PNE. Both groups will receive treatment twice weekly for 8 weeks.
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| Pain Neuroscience Education | Other | A 6-week educational program with weekly sessions using slide presentations and interactive discussions, covering pain neurophysiology, central sensitization, and pain coping strategies, delivered by a certified physiotherapist. |
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| Motor Control Exercises | Other | Participants will perform these exercises under physiotherapist supervision twice per week for 8 weeks. Exercises focus on improving deep trunk muscle coordination and stability. |
|
Total PCS scores will be used to assess exaggerated negative thoughts related to pain. Higher scores indicate greater catastrophizing. |
| Baseline and post-intervention (8 weeks) |
| Gait Analysis (OptoGait Photocell System) | Spatiotemporal characteristics of gait will be assessed using a validated and reliable treadmill-based OptoGait photocell system (Version 1.6.4.0, Microgate, Bolzano, Italy). All participants will be asked to walk on the treadmill and select a speed at which they feel most comfortable. After the participant has become accustomed to walking on the treadmill and determined their preferred speed, spatiotemporal parameters will be recorded during a one-minute walking trial. | Baseline and post-intervention (8 weeks) |
| Gait Analysis (Noraxon Ultium Insole) | Spatiotemporal gait parameters will be assessed using the Ultium Insole SmartLead pedobarographic analysis system (SmartLead, Noraxon, Scottsdale, AZ, USA). Participants will walk at a self-selected comfortable speed in a controlled laboratory environment, and each will perform the walking task three times. Data will be collected via Noraxon software during overground walking, including stance phase percentage, swing phase percentage, step duration (ms), double support duration (ms), and cadence (steps/min). | Baseline and post-intervention (8 weeks) |
| Quality of Life (Nottingham Health Profile - NHP) | Quality of life will be evaluated using the Nottingham Health Profile, covering six dimensions: physical mobility, pain, sleep, energy, social isolation, and emotional reactions. | Baseline and post-intervention (8 weeks) |
| D013568 |
| Pathological Conditions, Signs and Symptoms |