Use of Biofeedback Training to Correct Abnormal Neuromechanical Pattern in Chronic Low Back Pain Patients

Correction of Abnormal Flexion-relaxation Phenomenon in Chronic Low Back Pain: the Benefit Associated With Biofeedback Training

The purpose of the present study is to evaluate the benefit of biofeedback training on the capacity of chronic low back pain patients to decrease their lumbar paraspinal muscles activity during trunk full flexion and its relationship with changes in clinical outcomes. To do so, twenty patients with nonspecific mechanical low back pain will be recruited and all participants will take part in four sessions of supervised biofeedback training, consisting of 5 blocks with at least 12 trunk flexion-extension tasks. It is hypothesized that participants will have improved neuromechanical parameters with the biofeedback training and that this improvement will be positively associated to changes in clinical outcomes. This study will also allow for generation of preliminary data, in order to plan for a larger randomized control trial.

Study Overview

• Status: Completed
• Conditions: Chronic Low Back Pain; Mechanical Low Back Pain
• Intervention / Treatment: Other: Biofeedback

• Study Type: Interventional
• Enrollment (Actual): 21
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Canada
  • Quebec
    • Trois-Rivières, Quebec, Canada, G9A 5H7
      • Université du Québec à Trois-Rivières

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 60 years (Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Being between 18 and 60 years of age.
• Presence of non-specific chronic low back pain.

Exclusion Criteria:

• Prior surgery or major spine trauma.
• Lumbar scoliosis greater than 20°.
• Neuromuscular disease.
• Malignant tumor.
• Uncontrolled hypertension.
• Infection.
• Neurological deficit.
• Symptomatic lumbar disc herniation.
• Pregnancy.
• Recent lumbar cortisone injection.
• Active lower body injury and/or disabling pain limiting the capacity to complete the experimentation.
• Being under medications known to impair physical effort and pain perception.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Biofeedback; Subjects will be provided with four sessions of supervised biofeedback training	Other: Biofeedback; Idem as described in the arm section (above)

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Flexion-relaxation Ratio	Flexion-relaxation ratio is calculated by dividing muscle activity (EMG) during trunk flexion by muscle activity during full-flexed position. EMG of lumbar paraspinal muscles is recorder through surface EMG during every trials of each session.	Week 1
Flexion-relaxation Ratio	Flexion-relaxation ratio is calculated by dividing muscle activity (EMG) during trunk flexion by muscle activity during full-flexed position. EMG of lumbar paraspinal muscles is recorder through surface EMG during every trials of each session.	Week 2
Flexion-relaxation Ratio	Flexion-relaxation ratio is calculated by dividing muscle activity (EMG) during trunk flexion by muscle activity during full-flexed position. EMG of lumbar paraspinal muscles is recorder through surface EMG during every trials of each session.	Week 3
Flexion-relaxation Ratio	Flexion-relaxation ratio is calculated by dividing muscle activity (EMG) during trunk flexion by muscle activity during full-flexed position. EMG of lumbar paraspinal muscles is recorder through surface EMG during every trials of each session.	Week 4

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Lumbo-pelvic Range of Motion During Trunk Flexion-extension	Range of motion is recorder throught 8 kinematic markers placed on the right lower limb and the back of each participant during every trials of each session.	Week 1
Disability Level	Oswestry disability index ranges from 0 to 100. A higher score indicates higher disability.	Week 4
Pain Intensity in the Past Week	101-points numerical rating scale that ranges from 0 (no pain) to 100 (worst possible pain).	Week 2
Current Pain Intensity	101-points numerical rating scale that ranges from 0 (no pain) to 100 (worst possible pain).	Week 3
Fear of Movement Level	Tampa scale for kinesiophobia ranges from 0 to 68. Higher score indicates higher fear of movement level.	Week 4
Current Pain Intensity	101-points numerical rating scale that ranges from 0 (no pain) to 100 (worst possible pain).	Week 2
Current Pain Intensity	101-points numerical rating scale that ranges from 0 (no pain) to 100 (worst possible pain).	Week 4
Pain Intensity in the Past Week	101-points numerical rating scale that ranges from 0 (no pain) to 100 (worst possible pain).	Week 3
Pain Intensity in the Past Week	101-points numerical rating scale that ranges from 0 (no pain) to 100 (worst possible pain).	Week 4
Lumbo-pelvic Range of Motion During Trunk Flexion-extension	Range of motion is recorder throught 8 kinematic markers placed on the right lower limb and the back of each participant during every trials of each session.	Week 2
Lumbo-pelvic Range of Motion During Trunk Flexion-extension	Range of motion is recorder throught 8 kinematic markers placed on the right lower limb and the back of each participant during every trials of each session.	Week 3
Lumbo-pelvic Range of Motion During Trunk Flexion-extension	Range of motion is recorder throught 8 kinematic markers placed on the right lower limb and the back of each participant during every trials of each session.	Week 4

Collaborators and Investigators

• Sponsor: Université du Québec à Trois-Rivières
• Investigators: Principal Investigator: Martin Descarreaux, DC, PhD, Université du Québec à Trois-Rivières

Publications and helpful links

General Publications

• Giggins OM, Persson UM, Caulfield B. Biofeedback in rehabilitation. J Neuroeng Rehabil. 2013 Jun 18;10:60. doi: 10.1186/1743-0003-10-60.
• Hodges PW. Pain and motor control: From the laboratory to rehabilitation. J Electromyogr Kinesiol. 2011 Apr;21(2):220-8. doi: 10.1016/j.jelekin.2011.01.002.
• Frank DL, Khorshid L, Kiffer JF, Moravec CS, McKee MG. Biofeedback in medicine: who, when, why and how? Ment Health Fam Med. 2010 Jun;7(2):85-91.
• Demoulin C, Crielaard JM, Vanderthommen M. Spinal muscle evaluation in healthy individuals and low-back-pain patients: a literature review. Joint Bone Spine. 2007 Jan;74(1):9-13. doi: 10.1016/j.jbspin.2006.02.013. Epub 2006 Nov 13.

Study record dates

Study Major Dates

• Study Start: March 1, 2014
• Primary Completion (Actual): September 1, 2014
• Study Completion (Actual): November 1, 2014

Study Registration Dates

• First Submitted: September 4, 2014
• First Submitted That Met QC Criteria: September 10, 2014
• First Posted (Estimate): September 12, 2014

Study Record Updates

• Last Update Posted (Estimate): July 23, 2015
• Last Update Submitted That Met QC Criteria: July 10, 2015
• Last Verified: July 1, 2015

More Information

Terms related to this study

• Keywords: Rehabilitation; Low back pain; Electromyography; Biofeedback; Kinematic
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Back Pain; Low Back Pain
• Other Study ID Numbers: FIR UQTR 2013-2014