- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03572452
Can Sciatica Patients Avoid Surgery? (CASPAS)
Can Sciatica Patients Due to Intervertebral Disc Herniation Avoid Surgery by Treatment Using the McKenzie Method or by Advice to Stay Active?
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
One hundred seventy two (N=172) patients with sciatica for at least six weeks with radicular pain below the knee will be involved this study. The patients with non-urgent referrals due to sciatica symptoms will be directed to specialized medical care hospitals (the district central hospitals of Central Finland and South Ostrobothnia and the University hospital of Kuopio, Finland) to the physiatrists and orthopedic outpatient clinics for further investigations for possible surgery. The patient will be seen for a doctor's examination within a week. If the clinical examination reveals that a patient needs spinal disc herniation surgery, and the patient is willing to undergo surgery, they will be referred for X-ray imaging if it has not already been done in basic health care, in accordance with the regular treatment procedure, and to an MRI scan.
While patients are waiting for their MRI scan, they will undergo a clinical McKenzie-based mechanical assessment and be put into sub-groups of "centralizers"or "non-centralizers". These will be randomly assigned into a McKenzie group and into an advice to stay active group. Based on their MRI findings and clinical signs and symptoms they will be assigned to surgery or continue their non-surgical treatments. If the MRI scan does not reveal a spinal disc herniation finding that fulfills the criteria of the study, the patient is removed from the study in accordance with the selection criteria, regardless of whether they belong to the MDT or advice to stay active group, and their treatment will continue according to the hospital's normal procedures.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
Central Finland
-
Jyväskylä, Central Finland, Finland, 40620
- Central Finland Central Hospital,
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria: The participants are 18 - 60-year-old Finnish speaking sciatica patients for whom magnetic resonance imaging confirmed disc herniation compressing a nerve root canal, and who have related symptoms radiating to the lower limb +/- neurological disorders. Their sciatica has lasted at least 6 weeks.
Exclusion Criteria:
Pregnancy, previous surgery or treated by using MDT- method, fibromyalgia, signs of serious diseases or "red-flags" symptoms. Symptoms indicating the Cauda Equina Syndrome (CES) or lower limb palsy that hinders normal functioning, previous injury from a car accident or a high fall, or osteoporotic fractures for the elderly, cancer anamnesis, tumor, or inflammation, general symptoms such as fever, chills, or losing weight for an unknown reason, back problems complicated by other serious diseases such as polyneuropathy, neurological diseases, circulatory brain diseases, central spinal stenosis, myelopathy, syringomyelia, and long-term neuropathic pain not related to sciatica, unwillingness to undergo surgery.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: McKenzie - method group
Participants will be sent to an experienced MDT therapist for therapy.
They are 1) assessed clinically, 2) treated according the MDT-approach which includes home exercise program, consisting i) an educational component, and ii) an active therapy component with directional preference exercises, several times a day with sustained end range positions according to symptom response, and with avoiding aggravating positions.
Participants have a maximum of 7 treatment visits.
They will also have physiotherapy counselling at study entry about the good prognosis of sciatica.
|
Treatment according to the Mechanical Diagnosis and Therapy Approach
|
Active Comparator: Advice to stay active group
Participants enrolled into this group will receive physiotherapist's counselling at study entry for at least 60 minutes time about the good prognosis of sciatica, the spontaneous regression of the intervertebral disc herniation and pain tolerance ("natural healing").
In addition, they will get ergonomic advice and advice to stay normally active.
The participants are also told to avoid bed rest and advised to continue their normal routines as actively as possible including exercise activities with limits permitted by their signs and symptoms.
A two-page summary booklet related to these items will be given to them.
|
Physiotherapy councelling advicing to stay normally active
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Number of patients who avoided surgery
Time Frame: Changes are reported from baseline to short term (3 months), longer term (12months) and in long term (24months) follow-ups
|
Number of patients who avoided surgery treated by using the McKenzie- method or by advice to stay active
|
Changes are reported from baseline to short term (3 months), longer term (12months) and in long term (24months) follow-ups
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Pain Intensity
Time Frame: Changes are reported from baseline to short term (3 months), longer term (12months) and in long term (24months) follow-ups
|
Low back and leg pain intensity reported with Visual Analog Scale (VAS) (0 - 100mm scales, 0 mm = no pain, 100mm = worst possible pain).
|
Changes are reported from baseline to short term (3 months), longer term (12months) and in long term (24months) follow-ups
|
Disability
Time Frame: Changes are reported from baseline to short term (3 months), longer term (12months) and in long term (24months) follow-ups.
|
Disability is reported with Oswestry disability index Finnish version 2.0 total score (scale 0-100%): 0= minimal disability, 100 = bed-bound or exaggeration of symptoms.
|
Changes are reported from baseline to short term (3 months), longer term (12months) and in long term (24months) follow-ups.
|
Health-Related Quality of Life
Time Frame: Changes are reported from baseline to longer term (12months) and in long term (24months) follow-ups
|
Quality of life is assessed with the SF-36.These eight scale scores are weighted sums of the questions in each section.
Scores range from 0 - 100.
Lower scores equals more disability, higher scores equals less disability.
Physical and mental components will be calculated separately.
|
Changes are reported from baseline to longer term (12months) and in long term (24months) follow-ups
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Fear Avoidance
Time Frame: Changes are reported from baseline to short term (3 months), longer term (12months) and in long term (24months) follow-ups
|
Fear-avoidance beliefs about physical activity and work was measures with the Fear Avoidance Beliefs Questionnaire (FABQ).
It consists of 16 questions, for each statement has a 7-point Likert scale with scoring alternatives ranging from "0 = completely disagree" to "6 = completely agree".
|
Changes are reported from baseline to short term (3 months), longer term (12months) and in long term (24months) follow-ups
|
Kinesiophobia
Time Frame: Changes are reported from baseline to short term (3 months), longer term (12months) and in long term (24months) follow-ups.
|
The fear to move was assessed with the Tampa Scale for Kinesiophopia (TSK) questionnaire.
It comprises 17 items assessing the subjective rating of kinesiophopia.
Each item has a 4-point Likert scale with scoring alternatives ranging from "strongly disagree" to "strongly agree".
|
Changes are reported from baseline to short term (3 months), longer term (12months) and in long term (24months) follow-ups.
|
Depression
Time Frame: Changes are reported from baseline to short term (3 months), longer term (12months) and in long term (24months) follow-ups.
|
Depression during last month is measured with the Depression Scale (DEPS) questionnaire.This self-rating depression scale in Finnish consists of 10 items.
Each item has a 4-point scale with alternatives ranging from "0 = not at all" to "3 = very much".
|
Changes are reported from baseline to short term (3 months), longer term (12months) and in long term (24months) follow-ups.
|
Work ability
Time Frame: Changes are reported from baseline to short term (3 months), longer term (12months) and in long term (24months) follow-ups.
|
Work ability is measured with the Visual Analogue Scale (VAS) from 0 to 100mm scales (0 mm = completely able to work and 100mm = unable to work).
|
Changes are reported from baseline to short term (3 months), longer term (12months) and in long term (24months) follow-ups.
|
Sick leave
Time Frame: Changes are reported from baseline to short term (3 months), longer term (12months) and in long term (24months) follow-ups.
|
Number of sick leave days
|
Changes are reported from baseline to short term (3 months), longer term (12months) and in long term (24months) follow-ups.
|
Collaborators and Investigators
Investigators
- Study Director: Jari Ylinen, MD,PhD., Central Finland HD
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- CentralFinlandHD
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Sciatic Nerve Compression
-
Peking Union Medical College HospitalUnknownThe Difference in Duration of Sciatic Nerve Block Between Diabetic and Non-diabetic Patients (DSNBD)Sciatic Nerve BlockChina
-
W. Dalton DietrichThe Miami Project to Cure ParalysisNo longer availableSciatic Nerve InjuryUnited States
-
Asan Medical CenterCompleted
-
Ain Shams UniversityCompletedSciatic Nerve Block
-
Mogilev Regional Clinical HospitalCompletedUltrasonography | Sciatic Nerve | Nerve Block | EfficiencyBelarus
-
Universidad de MurciaCompletedSciatic Nerve | Flexibility | Hamstring MusclesSpain
-
University of California, San DiegoFerrosan Medical Devices, Roskilde, DenmarkCompletedRegional Anesthesia | Sciatic Nerve BlockUnited States
-
ASST Gaetano Pini-CTOCompletedUS-guided Sciatic Nerve BlockItaly
-
Mogilev Regional Clinical HospitalCompletedUltrasonography | Sciatic Nerve | Nerve Block | Efficiency | Minimum Effective DoseBelarus
Clinical Trials on McKenzie Method
-
Universidade Cidade de Sao PauloFundação de Amparo à Pesquisa do Estado de São PauloCompletedNon-specific Chronic Low Back PainBrazil
-
Daemen CollegeCompleted
-
Ayesha JamilCompleted
-
Riphah International UniversityRecruitingForward Head Posture | Neck SyndromePakistan
-
Foundation University IslamabadRecruitingMechanical Low Back PainPakistan
-
Superior UniversityNot yet recruitingSacroiliac Joint Somatic DysfunctionPakistan
-
Cairo UniversityNot yet recruitingNon Specific Low Back Pain
-
Foundation University IslamabadCompleted
-
Superior UniversityRecruitingSacroiliac Joint DysfunctionPakistan
-
Istanbul Medipol University HospitalCompleted