Effects of a multidisciplinary programme on postural stability in patients with chronic recurrent low back pain: preliminary findings

Effects of a multimodal exercise intervention on physical and cognitive functions in patients with chronic low back pain (MultiMove): study protocol for a randomized controlled trial

BACKGROUND

Chronic low back pain (CLBP) is a common medical condition in adults over the age of 50. It is associated with severe disability, ranging from physical impairments to psychosocial distress. Since current treatments provide only small to moderate short-term effects, alternative interventions are required, whereby guidelines recommended multimodal approaches. Dancing can be considered as an inherently multimodal approach, as it requires a combination of physical and cognitive functions. Furthermore, it has already been applied effectively in neurorehabilitation. Therefore, it seems promising to merge a dance-therapeutic component together with motor-cognitive, strength and flexibility exercises in a novel multimodal treatment (MultiMove) to target the impaired everyday mobility and cognition of CLBP patients. The aim of this study is to analyse specific physical, cognitive and psychosocial effects of MultiMove in CLBP patients.

METHODS

A prospective, two-arm, single-blinded, randomized controlled trial will be conducted with an estimated sample size of 100 CLBP patients, assigned to either the MultiMove group or a control group. The intervention group will receive MultiMove twice a week for 60 min each over a period of 12 weeks. The primary outcome will be the mobility and function of the lower extremities assessed by the Timed Up-and-Go Test. Secondary outcomes comprise further physical and physiological functions (e.g. gait variability and haemodynamic response in the prefrontal cortex during motor-cognitive dual tasks), subjective health state (e.g. disability in daily life), executive functions (e.g. cognitive flexibility) and psychosocial aspects (e.g. kinesiophobia). Measures will be taken at baseline, after the intervention and at a 12-week follow-up. It is assumed that MultiMove improves the mentioned outcome parameters.

DISCUSSION

The combined assessment of changes in physical and cognitive functions as well as neuropsychological aspects in response to MultiMove will allow a better understanding of the motor-cognitive adaptations induced by multimodal exercises in CLBP patients. The specific conclusions will lead to recommendations for the conservative treatment approach in this clinically relevant patient group.

TRIAL REGISTRATION

German Clinical Trial Register (ID: DRKS00021696 / 10.07.2020), https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00021696.

Effects of Whole Body Vibration Therapy and Classic Physiotherapy on Postural Stability in People With Back Pain: A Randomized Trial

STUDY DESIGN

This 2-step prospective randomized parallel trial evaluated postural stability in 65 back pain participants (61.6±7.9 y) and 50 nonback pain participants (61.2±8.6 y) in a first step using the MFT-S3-Check. In a second step, postural stability and questionnaires were evaluated in back pain participants before and after therapy with either whole body vibration therapy or classic physiotherapy.

OBJECTIVE

The first aim was to investigate whether the MFT-S3-Check is suitable to evaluate differences in postural stability in back pain and nonback pain participants. The second aim was to evaluate the effect of whole body vibration therapy and classic physiotherapy on postural stability and the influence of depressive symptoms and pain.

SUMMARY OF BACKGROUND DATA

Objective bodily measurement values in chronic back pain are rare; therefore, the evaluation of effectiveness of different therapies is difficult.

METHODS

Postural stability was investigated using stability-, sensorimotor-, and symmetry indexes, in standing and seated positions with the MFT-S3-Check. The following standard questionnaires were used to investigate pain and depressive symptoms: HADS, ODI, NASS, SF-36.

RESULTS

No significant difference in postural stability was found between back pain participants and the nonback pain group. None of the two training concepts in back pain participants was superior, concerning postural stability and pain. Both treatments showed positive effects, with significant improvements in postural stability in the classic physiotherapy group. Depressive symptoms had a significant correlation with pain intensity in back pain participants.

CONCLUSIONS

The MFT-S3-Check could not find a significant difference in postural stability between the back pain and nonback pain group in the study setting. Postural stability improved after treatment.

Comparison of the effectiveness of two physiotherapy programs for female patients with lumbar spine discopathy

Background. Lower back pain is one of the most common problems in the human body relat-ed to the disturbances of the motor organ’s structure and function. It challenges contemporary physiotherapy which aim is to reduce or, when possible, eliminate pain, restore fitness for eve-ryday life and prevent recurrences. The aim of the study was to compare two physiotherapy programmes in terms of lowering pain intensity, improvement of lumbar and thoracolumbar spine mobility, as well as functional ability in females with lumbar spine discopathy. Material and methods. The study included 100 women aged 45-50 with lumbar spine disco-pathy being treated in outpatient conditions. The patients were divided into two 50-subject groups depending on the programme used. The physiotherapy programme for group I patients included classic massage, kinesiotherapy and interferential currents, and in group II: classic massage, kinesiotherapy and ultrasound. The research tool was the Numeric Pain Rating Scale (NRS), the Roland Morris Disability Questionnaire (RMDQ) and measurements of lumbar and thoracolumbar spine mobility. The Wilcoxon and Mann-Whitney U tests were used for the analysis. Results. After completion of the physiotherapy programme, the women in group I experi-enced significantly lower pain (p=0.037) and higher functional efficiency (p=0,001). The range of improvement, assessed by the difference in the results of study II and III, was signif-icantly higher for the II group of women (p=0,002). One month after completion of therapeu-tic treatment, there were no statistically significant differences between the groups (p=0,169, p=0,067). Conclusions. The use of interferential currents in the physiotherapy of individuals with lum-bar spine discopathy compared to ultrasound therapy allows for greater improvement in reduc-ing pain intensity, lumbar and thoracolumbar spine mobility, as well as higher functional effi-ciency. The effectiveness of ultrasound had increased over time since the end of therapy and only after one month in the case of both physiotherapy programmes, similar effects could be observed.

Unique approach to sensorimotor training with a new device combining air cushion with stochastic translations-A prospective randomized controlled clinical trial

Sensorimotor training with a wide variety of available devices represents an important component in rehabilitation and prevention of different sports injuries and chronic diseases. The purpose of this study was to evaluate the effects of a sensorimotor training with a newly developed device, which consists of an instable platform moving on an air cushion, providing dynamic balance training by tilting and unanticipated stochastic translations on postural control. Seventy-two healthy young subjects were included in this prospective, randomized, controlled, and observer-blinded study. Balance was objectively assessed by posturography and Functional Reach Test (FRT). Additionally we evaluated the subjective rating of balance. After randomization the sensorimotor training group performed a training program on the new device over a 5-6 week study period. After this time improvement in objective and subjective measurements as a result of training became evident. A significant difference in challenging posturographic parameters (Sensory Organization Test 5: training group 5.32±5.25 vs. control group 1.78±5.05, p=0.006 and Head Shake Sensory Organization Test 5: training group 11.94±8.97 vs. control group 5.41±10.17, p=0.01) as well as a significant difference in the FRT (training group 3.34±3.35cm vs. control group 0.01±2.97cm, p=0.0001) was found. Subjective assessment revealed a significant improvement in the participants' rating of balance and alteration of balance. Subjects showed a high satisfaction with the new training device. Our findings suggest that the newly developed device could be a promising option for sensorimotor training to improve postural control.