Water Versus Land Based Perturbation Exercises in Elderly Participants With Back Pain

The Effectiveness of Perturbation Exercises in Elderly Back Pain

The aim of this study was to compare the effectiveness of land based versus water based perturbation exercises on the pain, disability, fear of falling, and fear avoidance beliefs in elderly participants. Overweight/obese subgroup was compared with healthy weight with chronic low back pain participants to investigate any effect on BMI on both interventions. The results of the study revealed that both exercise groups i.e., land and water based exercise had a significant reduction in pain level, fear of falling, fear avoidance belief related to work, disability and improved SLR.

Study Overview

• Status: Completed
• Conditions: Back Pain; Back Pain Lower Back Chronic; Back Pain With Radiation; Back Pain Without Radiation
• Intervention / Treatment: Behavioral: Exercises

Detailed Description

Twenty-four grouped into 12 per group participated water based and land based exercise protocol. Both groups were given McKenzie Method of exercises in 1st week based on the treatment-based classification (TBC) approach or personalized to the need of participants as per TBC.

Perturbation-based postural exercises were given to participants, which were performed on land or water for 6 weeks.

The perturbation based exercises were categorized into four levels, where level 1:static postural control, 2:dynamic postural control 3:Extremity loaded postural control and 4: cognitive task associated postural control. The perturbation were provided at shoulder and hip level, by intervention providers progressive enough to initiate anticipatory or compensatory postural adjustments.

Both groups were educated on pain assurance and spinal ergonomics feedback. The Outcomes were measured using a Visual analog scale, Oswestry disability index, Fear avoidance belief questionnaire, Straight leg raise, Modified fall efficacy scale, and Borg scale. The pain level were assessed for personalized progression from level 1 to level 4 progression of perturbation exercises.

Both the exercise groups of land and water showed improvement in measured clinical outcomes in terms of reduction in pain level, fear of falling, fear avoidance belief related to work, SLR, and disability. Water-based group showed additional benefits and significant improvement in fear avoidance belief related to physical activity and exercised with low rate of perceived exertion.

• Study Type: Interventional
• Enrollment (Actual): 24
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United Arab Emirates
  • Ajman, United Arab Emirates
    • Gulf Medical University
  • Ajman, United Arab Emirates
    • Gulf Medical University, Thumbay Physical Therapy and Rehabiliation Hospital, Thumbay University Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 55 years to 85 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Pain history of minimum 12 weeks duration in below labels
• Participants with the diagnostic labels of spondylosis
• Non-specific chronic low back pain
• Back pain radiating to leg or sciatica
• Subacute back pain

Exclusion Criteria:

• Unstable blood pressure
• Cardiac failure
• Incontinence
• Uncontrolled epilepsy
• Open wounds
• Acute infections
• Neurological disorders
• Orthopedic conditions affecting exercise participation in pool and land
• Cardio-respiratory conditions affecting exercise participation in pool and land.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Non-Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Water based perturbation exercise group; In both groups, the participants screened for Treatment-based classification of back pain and based on TBC interventions were provided. From second week, water based perturbation exercise were initiated personalized to the level of participants. Treatment-based classification of back pain intervention was gradually tapered in orderly fashion during 6 weeks, concurrently introduced land based perturbation exercise gradually phased from level 1 to level 4.	Behavioral: Exercises; Perturbation exercises: A new protocol of perturbation exercises aimed to disturb static and dynamic posture or equilibrium at primarily at body segments at hip and shoulder level were provided. The perturbation was initially started as anticipatory postural adjustment and progressed to compensatory postural adjustment, where stepping on various directions were challenged. The nature of perturbation or push or nudges applied by physiotherapists were progressed from a) self-generated to therapist applied, anticipated to unanticipated, stable to unstable platforms, static to dynamic postural tasks with loaded extremities and at higher level simple to higher cognitive tasks were also incorporated.; Other Names: Mckenzie extension exercise, mobilization and spinal lumbar traction therapy tailored based on TBC system
Active Comparator: Land based perturbation exercise group; All procedures were followed similar to Water based perturbation exercise group except perturbation based exercises were provided in land.	Behavioral: Exercises; Perturbation exercises: A new protocol of perturbation exercises aimed to disturb static and dynamic posture or equilibrium at primarily at body segments at hip and shoulder level were provided. The perturbation was initially started as anticipatory postural adjustment and progressed to compensatory postural adjustment, where stepping on various directions were challenged. The nature of perturbation or push or nudges applied by physiotherapists were progressed from a) self-generated to therapist applied, anticipated to unanticipated, stable to unstable platforms, static to dynamic postural tasks with loaded extremities and at higher level simple to higher cognitive tasks were also incorporated.; Other Names: Mckenzie extension exercise, mobilization and spinal lumbar traction therapy tailored based on TBC system

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Low back pain	Visual Analogue Scale (VAS) was used where 0 indicates no pain and 10 indicate extremely painful.	6 weeks
Disability caused by the chronic low back pain	A standard Oswestry Disability Index (ODI) was used to evaluate the disability caused by the chronic low back pain. The lower the score lower disability and higher scores indicates that high level of disability associated with back pain.	6 weeks
Physical activity associated fear avoidance behavior	The percentage of fear avoidance of behavior ranges from 0 to 100% where 0%-indicates no fear and 100%-indicate highest level of fear avoidance behavior.	6 weeks
Fall risk	Fall risk of participants was assessed using the Modified fall efficacy scale (MFES), where Higher scores reflect more confidence and less fear of falling while lower scores reflect less confidence and more fear of falling.	6 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Rate of perceived exertion	Borg scale utilised to measue the exertion during the exercise. Grades were obtained with 6 being no exertion at all, and 20 being maximum effort.	6 weeks
Impairment - Straight Leg Raise as hip joint range of motion	Straight leg raise range of motion was measured to identify the level of impairment and to confirm any leg pain associated with back pain	6 weeks

Collaborators and Investigators

• Sponsor: Gulf Medical University
• Collaborators: Srinivas University

Publications and helpful links

General Publications

• Alrwaily M, Timko M, Schneider M, Stevans J, Bise C, Hariharan K, Delitto A. Treatment-Based Classification System for Low Back Pain: Revision and Update. Phys Ther. 2016 Jul;96(7):1057-66. doi: 10.2522/ptj.20150345. Epub 2015 Dec 4.

Study record dates

Study Major Dates

• Study Start (Actual): December 21, 2019
• Primary Completion (Actual): November 1, 2022
• Study Completion (Actual): November 30, 2022

Study Registration Dates

• First Submitted: October 13, 2022
• First Submitted That Met QC Criteria: October 15, 2022
• First Posted (Actual): October 18, 2022

Study Record Updates

• Last Update Posted (Actual): April 14, 2023
• Last Update Submitted That Met QC Criteria: April 12, 2023
• Last Verified: April 1, 2023

More Information

Terms related to this study

• Keywords: Rehabilitation; Exercises; Back Pain; Hydrotherapy; Old Age
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Back Pain
• Other Study ID Numbers: INT/COHS/UG/012-2019; COHS_UG_Research_6122017 (Other Identifier: GMU Ethical commitee)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: Upon receipt of a request from other parties, for scientific purposes such as Systematic review and meta-analysis, the data will be shared, without disclosing the personal data.
• IPD Sharing Time Frame: The data is available and processed final.
• IPD Sharing Access Criteria: Upon receipt of a request from other parties, for scientific purposes such as Systematic review and meta-analysis, the data will be shared, without disclosing the personal data.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; CSR

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No