- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05706103
Exercise Therapy for Recurrent Low Back Pain: Unraveling the Puzzle of Peripheral Muscle and Central Brain Changes (ExTraS)
Efficacy of Specific Skilled Motor Versus General Exercise Training on Peripheral Muscle and Central Brain Alterations in Patients With Recurrent Low Back Pain
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Although the cause of persistent non-specific LBP remains unknown, structural and functional alterations of the brain and paravertebral muscles have been proposed as underlying mechanisms. As it is hypothesized that these alterations contribute to, or maintain non-specific LBP, exercise therapy is a key element in the rehabilitation of reoccurring LBP. Specific training of sensorimotor control of the lumbopelvic region (i.e. specific skilled motor training) has shown to decrease pain and disability in patients with LBP, but has not been found superior to other forms of exercise training regarding improvements in clinical outcome measures. On the other hand, this type of training seems to differentially impact the recruitment of the back muscles compared to general exercise training. However, research using multiple treatment sessions and including follow-up outcome assessments is scarce. Furthermore, it is unknown if improvements may be attributed to measurable peripheral changes in the muscle and/or central neural adaptations in the brain. The primary aim of this study is to examine the short and long-term effects of specific skilled motor control training versus unspecific general extension training on pain, functional disability, brain structure/function and muscle structure/function in recurrent LBP patients.
Method: In this double-blind, randomized controlled clinical trial 62 recurrent LBP patients will be randomly allocated (1:1) to receive either specific skilled motor training (i.e. the experimental group) or general extension training (i.e. control group). Each training group will receive 13 weeks of treatment, during which a total of 18 supervised treatment sessions will be delivered in combination with an individualized home-exercise program. Both groups will first receive low-load training (i.e. at 25-30% of the individual's repetition maximum, sessions 1-9) followed by high-load training (i.e. at 40-60% of the individual's one repetition maximum, sessions 10-18). Primary outcome measures include: LBP-related pain and disability (RMDQ, NRS and Margolis pain diagram), lumbar muscle structure and function (Dixon MRI and mf-MRI) and brain structure and function (MRI, DTI and fMRI). Secondary measures include: lumbopelvic control and proprioception (thoracolumbar dissociation test and position-reposition test), trunk muscle activity (RAM and QFRT) and psychosocial factors, including measures of physical activity (IPAQ-LF, SF-36), pain cognitions and perceptions (PCS, PCI and PVAQ), anxiety and depression (HADS), and kinesiophobia (TSK). Experimental data collection will be performed at baseline, immediately following the low-load training (i.e. after the 9th supervised treatment session), following the high-load training (i.e. after the 18th supervised treatment session), and at 3 months follow-up. Experimental data collection will comprise of magnetic resonance imaging of the brain and trunk muscles, clinical assessments assessing muscle function, and a battery of questionnaires evaluating psychosocial factors.
Study Type
Enrollment (Estimated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Jessica van Oosterwijck, Prof
- Phone Number: +3293326919
- Email: Jessica.VanOosterwijck@UGent.be
Study Contact Backup
- Name: Lieven Danneels, Prof
- Phone Number: +32 9 332 26 35
- Email: Lieven.Danneels@UGent.be
Study Locations
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-
Oost-Vlaanderen
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Ghent, Oost-Vlaanderen, Belgium, 9000
- Recruiting
- Ghent University, vakgroep revalidatiewetenschappen
-
Contact:
- Jessica Van Oosterwijck, Prof
- Phone Number: +32 9 332 69 19
- Email: jessica.vanoosterwijck@ugent.be
-
Contact:
- Jaap Wijnen, Msc
- Phone Number: +32 9 332 12 16
- Email: jaap.wijnen@ugent.be
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- History of non-specific recurrent LBP with the first onset being at least 6 months ago
- At least 2 episodes of LBP/year, with an 'episode' implying pain lasting a minimum of 24 hours which is preceded and followed by at least 1 month without LBP
- Minimum LBP intensity during episodes should be ≥2/10 on a numeric rating scale (NRS) from 0 to 10
- During remission the NRS intensity for LBP should be 0.
- LBP should be of that severity that it limits activities of daily living
- LBP should be of that severity that a (para)medic has been consulted at least once regarding the complaints
- Flexion pattern of LBP
Exclusion Criteria:
- Chronic LBP (i.e. duration remission <1 month)
- Subacute LBP (i.e. first onset between 3 and 6 months ago)
- Acute (i.e. first onset <3 months ago) LBP
- Specific LBP (i.e. LBP proportionate to an identifiable pathology, e.g. lumbar radiculopathy)
- Patients with neuropathic pain
- Patients with chronic widespread pain as defined by the criteria of the 1990 ACR (i.e. fibromyalgia)
- A lifetime history of spinal traumata (e.g. whiplash), surgery (e.g. laminectomy) or deformations (e.g. scoliosis)
- A lifetime history of respiratory, metabolic, neurologic, cardiovascular, inflammatory, orthopedic or rheumatologic diseases
- Concomitant therapies (i.e. rehabilitation, alternative medicine or therapies)
- Contra-indications for MRI (e.g. suffering from claustrophobia, the presence of metallic foreign material in the body, BMI >30kg/m²)
- Professional athletes
- Pregnant women
- Breastfeeding women
- Women given birth in the last year before enrolment
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: Specific skilled motor training
13 weeks of treatment, with 18 supervised treatment sessions in combination with an individualized home-exercise program.
This group will first receive low-load training (i.e. at 25-30% of the individual's repetition maximum, sessions 1-9) followed by high-load training (i.e. at 40-60% of the individual's one repetition maximum, sessions 10-18).
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Participants allocated to the skilled motor training group will receive sensorimotor training of the intrinsic muscles of the lumbopelvic region, namely the multifidus, transversus abdominis, and pelvic floor muscles.
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Active Comparator: General extension training
13 weeks of treatment, with 18 supervised treatment sessions in combination with an individualized home-exercise program.
This group will first receive low-load training (i.e. at 25-30% of the individual's repetition maximum, sessions 1-9) followed by high-load training (i.e. at 40-60% of the individual's one repetition maximum, sessions 10-18).
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Participants allocated to the general extension training group will receive general training exercises using the David Back equipment from the Back Unit at Ghent University Hospital
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Brain macro-structure
Time Frame: Baseline
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Whole brain T1-weighted structural MRI will be acquired.
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Baseline
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Brain macro-structure
Time Frame: After low-load training phase (i.e. after 9th supervised treatment session) assessed at approximately 8 weeks
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Whole brain T1-weighted structural MRI will be acquired.
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After low-load training phase (i.e. after 9th supervised treatment session) assessed at approximately 8 weeks
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Brain macro-structure
Time Frame: After high-load training phase (i.e. after 18th supervised treatment session) assessed at approximately 13 weeks
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Whole brain T1-weighted structural MRI will be acquired.
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After high-load training phase (i.e. after 18th supervised treatment session) assessed at approximately 13 weeks
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Brain macro-structure
Time Frame: At 3 months follow-up
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Whole brain T1-weighted structural MRI will be acquired.
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At 3 months follow-up
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Brain micro-structure
Time Frame: Baseline
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Whole-brain T2-weighted images will be obtained.
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Baseline
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Brain micro-structure
Time Frame: After low-load training phase (i.e. after 9th supervised treatment session) assessed at approximately 8 weeks
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Whole-brain T2-weighted images will be obtained.
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After low-load training phase (i.e. after 9th supervised treatment session) assessed at approximately 8 weeks
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Brain micro-structure
Time Frame: After high-load training phase (i.e. after 18th supervised treatment session) assessed at approximately 13 weeks
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Whole-brain T2-weighted images will be obtained.
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After high-load training phase (i.e. after 18th supervised treatment session) assessed at approximately 13 weeks
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Brain micro-structure
Time Frame: At 3 months follow-up
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Whole-brain T2-weighted images will be obtained.
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At 3 months follow-up
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Functional brain connectivity
Time Frame: Baseline
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Resting-state functional MRI will be performed to acquire insight into subnetworks relating to sensorimotor control and pain processing.
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Baseline
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Functional brain connectivity
Time Frame: After low-load training phase (i.e. after 9th supervised treatment session) assessed at approximately 8 weeks
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Resting-state functional MRI will be performed to acquire insight into subnetworks relating to sensorimotor control and pain processing.
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After low-load training phase (i.e. after 9th supervised treatment session) assessed at approximately 8 weeks
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Functional brain connectivity
Time Frame: After high-load training phase (i.e. after 18th supervised treatment session) assessed at approximately 13 weeks
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Resting-state functional MRI will be performed to acquire insight into subnetworks relating to sensorimotor control and pain processing.
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After high-load training phase (i.e. after 18th supervised treatment session) assessed at approximately 13 weeks
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Functional brain connectivity
Time Frame: At 3 months follow-up
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Resting-state functional MRI will be performed to acquire insight into subnetworks relating to sensorimotor control and pain processing.
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At 3 months follow-up
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Lumbar muscle structure
Time Frame: Baseline
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T1-weighted Dixon MRI will be performed.
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Baseline
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Lumbar muscle structure
Time Frame: After low-load training phase (i.e. after 9th supervised treatment session) assessed at approximately 8 weeks
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T1-weighted Dixon MRI will be performed.
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After low-load training phase (i.e. after 9th supervised treatment session) assessed at approximately 8 weeks
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Lumbar muscle structure
Time Frame: After high-load training phase (i.e. after 18th supervised treatment session) assessed at approximately 13 weeks
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T1-weighted Dixon MRI will be performed.
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After high-load training phase (i.e. after 18th supervised treatment session) assessed at approximately 13 weeks
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Lumbar muscle structure
Time Frame: At 3 months follow-up
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T1-weighted Dixon MRI will be performed.
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At 3 months follow-up
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Lumbar muscle function
Time Frame: Baseline
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T2-weighted mf-MRI will be conducted.
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Baseline
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Lumbar muscle function
Time Frame: After low-load training phase (i.e. after 9th supervised treatment session) assessed at approximately 8 weeks
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T2-weighted mf-MRI will be conducted.
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After low-load training phase (i.e. after 9th supervised treatment session) assessed at approximately 8 weeks
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Lumbar muscle function
Time Frame: After high-load training phase (i.e. after 18th supervised treatment session) assessed at approximately 13 weeks
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T2-weighted mf-MRI will be conducted.
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After high-load training phase (i.e. after 18th supervised treatment session) assessed at approximately 13 weeks
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Lumbar muscle function
Time Frame: At 3 months follow-up.
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T2-weighted mf-MRI will be conducted.
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At 3 months follow-up.
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Lumbopelvic control
Time Frame: Baseline
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Lumbopelvic control will be examined by means of a clinical thoracolumbar dissociation test which assesses the quality of performance of lumbopelvic motion with limited motion at the thoracolumbar junction.
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Baseline
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Lumbopelvic control
Time Frame: After low-load training phase (i.e. after 9th supervised treatment session) assessed at approximately 8 weeks
|
Lumbopelvic control will be examined by means of a clinical thoracolumbar dissociation test which assesses the quality of performance of lumbopelvic motion with limited motion at the thoracolumbar junction.
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After low-load training phase (i.e. after 9th supervised treatment session) assessed at approximately 8 weeks
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Lumbopelvic control
Time Frame: After high-load training phase (i.e. after 18th supervised treatment session) assessed at approximately 13 weeks
|
Lumbopelvic control will be examined by means of a clinical thoracolumbar dissociation test which assesses the quality of performance of lumbopelvic motion with limited motion at the thoracolumbar junction.
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After high-load training phase (i.e. after 18th supervised treatment session) assessed at approximately 13 weeks
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Lumbopelvic control
Time Frame: At 3 months follow-up.
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Lumbopelvic control will be examined by means of a clinical thoracolumbar dissociation test which assesses the quality of performance of lumbopelvic motion with limited motion at the thoracolumbar junction.
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At 3 months follow-up.
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Lumbopelvic proprioception
Time Frame: Baseline
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To evaluate lumbar proprioception, the position-reposition accuracy of the lumbar spine will be determined.
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Baseline
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Lumbopelvic proprioception
Time Frame: After low-load training phase (i.e. after 9th supervised treatment session) assessed at approximately 8 weeks
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To evaluate lumbar proprioception, the position-reposition accuracy of the lumbar spine will be determined.
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After low-load training phase (i.e. after 9th supervised treatment session) assessed at approximately 8 weeks
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Lumbopelvic proprioception
Time Frame: After high-load training phase (i.e. after 18th supervised treatment session) assessed at approximately 13 weeks
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To evaluate lumbar proprioception, the position-reposition accuracy of the lumbar spine will be determined.
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After high-load training phase (i.e. after 18th supervised treatment session) assessed at approximately 13 weeks
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Lumbopelvic proprioception
Time Frame: At 3 months follow-up.
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To evaluate lumbar proprioception, the position-reposition accuracy of the lumbar spine will be determined.
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At 3 months follow-up.
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Anticipatory postural adjustments
Time Frame: Baseline
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To examine anticipatory postural adjustments (APAs) trunk muscle onset latencies in response to internal-induced perturbations will be measured by means of surface electromyography (EMG).
APAs will be measured by inducing internal perturbations in the trunk muscles during a reliable and valid unilateral rapid arm movement task (RAM).
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Baseline
|
Anticipatory postural adjustments
Time Frame: After low-load training phase (i.e. after 9th supervised treatment session) assessed at approximately 8 weeks
|
To examine anticipatory postural adjustments (APAs) trunk muscle onset latencies in response to internal-induced perturbations will be measured by means of surface electromyography (EMG).
APAs will be measured by inducing internal perturbations in the trunk muscles during a reliable and valid unilateral rapid arm movement task (RAM).
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After low-load training phase (i.e. after 9th supervised treatment session) assessed at approximately 8 weeks
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Anticipatory postural adjustments
Time Frame: After high-load training phase (i.e. after 18th supervised treatment session) assessed at approximately 13 weeks
|
To examine anticipatory postural adjustments (APAs) trunk muscle onset latencies in response to internal-induced perturbations will be measured by means of surface electromyography (EMG).
APAs will be measured by inducing internal perturbations in the trunk muscles during a reliable and valid unilateral rapid arm movement task (RAM).
|
After high-load training phase (i.e. after 18th supervised treatment session) assessed at approximately 13 weeks
|
Anticipatory postural adjustments
Time Frame: At 3 months follow-up
|
To examine anticipatory postural adjustments (APAs) trunk muscle onset latencies in response to internal-induced perturbations will be measured by means of surface electromyography (EMG).
APAs will be measured by inducing internal perturbations in the trunk muscles during a reliable and valid unilateral rapid arm movement task (RAM).
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At 3 months follow-up
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Compensatory postural adjustments
Time Frame: Baseline
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To examine compensatory postural adjustments (CPAs), trunk muscle onset latencies in response to external-induced perturbations will be measured by means of surface electromyography (EMG).
CPAs will be measured by using external perturbations of trunk muscles during a quick-force-release test (QFRT).
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Baseline
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Compensatory postural adjustments
Time Frame: After low-load training phase (i.e. after 9th supervised treatment session) assessed at approximately 8 weeks
|
To examine compensatory postural adjustments (CPAs), trunk muscle onset latencies in response to external-induced perturbations will be measured by means of surface electromyography (EMG).
CPAs will be measured by using external perturbations of trunk muscles during a quick-force-release test (QFRT).
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After low-load training phase (i.e. after 9th supervised treatment session) assessed at approximately 8 weeks
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Compensatory postural adjustments
Time Frame: After high-load training phase (i.e. after 18th supervised treatment session) assessed at approximately 13 weeks
|
To examine compensatory postural adjustments (CPAs), trunk muscle onset latencies in response to external-induced perturbations will be measured by means of surface electromyography (EMG).
CPAs will be measured by using external perturbations of trunk muscles during a quick-force-release test (QFRT).
|
After high-load training phase (i.e. after 18th supervised treatment session) assessed at approximately 13 weeks
|
Compensatory postural adjustments
Time Frame: At 3 months follow-up
|
To examine compensatory postural adjustments (CPAs), trunk muscle onset latencies in response to external-induced perturbations will be measured by means of surface electromyography (EMG).
CPAs will be measured by using external perturbations of trunk muscles during a quick-force-release test (QFRT).
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At 3 months follow-up
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Nociceptive flexion reflex - threshold
Time Frame: Baseline
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The NFR will be elicited in the dominant leg by transcutaneous electrical stimulation of the sural nerve in its retromalleolar path using a stimulation bar electrode connected to a constant current stimulator.
Surface EMG electrodes will be placed on the skin of the muscle belly of the ipsilateral biceps femoris.
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Baseline
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Nociceptive flexion reflex - threshold
Time Frame: After low-load training phase (i.e. after 9th supervised treatment session) assessed at approximately 8 weeks
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The NFR will be elicited in the dominant leg by transcutaneous electrical stimulation of the sural nerve in its retromalleolar path using a stimulation bar electrode connected to a constant current stimulator.
Surface EMG electrodes will be placed on the skin of the muscle belly of the ipsilateral biceps femoris.
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After low-load training phase (i.e. after 9th supervised treatment session) assessed at approximately 8 weeks
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Nociceptive flexion reflex - threshold
Time Frame: After high-load training phase (i.e. after 18th supervised treatment session) assessed at approximately 13 weeks
|
The NFR will be elicited in the dominant leg by transcutaneous electrical stimulation of the sural nerve in its retromalleolar path using a stimulation bar electrode connected to a constant current stimulator.
Surface EMG electrodes will be placed on the skin of the muscle belly of the ipsilateral biceps femoris.
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After high-load training phase (i.e. after 18th supervised treatment session) assessed at approximately 13 weeks
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Nociceptive flexion reflex - threshold
Time Frame: At 3 months follow-up
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The NFR will be elicited in the dominant leg by transcutaneous electrical stimulation of the sural nerve in its retromalleolar path using a stimulation bar electrode connected to a constant current stimulator.
Surface EMG electrodes will be placed on the skin of the muscle belly of the ipsilateral biceps femoris.
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At 3 months follow-up
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Nociceptive flexion reflex - temporal summation
Time Frame: Baseline
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Five 1ms rectangular wave pulse train will be administered 3 times at a frequency of 2 Hz at a constant stimulation intensity.
This procedure will be repeated 5 times.
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Baseline
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Nociceptive flexion reflex - temporal summation
Time Frame: After low-load training phase (i.e. after 9th supervised treatment session) assessed at approximately 8 weeks
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Five 1ms rectangular wave pulse train will be administered 3 times at a frequency of 2 Hz at a constant stimulation intensity.
This procedure will be repeated 5 times.
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After low-load training phase (i.e. after 9th supervised treatment session) assessed at approximately 8 weeks
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Nociceptive flexion reflex - temporal summation
Time Frame: After high-load training phase (i.e. after 18th supervised treatment session) assessed at approximately 13 weeks
|
Five 1ms rectangular wave pulse train will be administered 3 times at a frequency of 2 Hz at a constant stimulation intensity.
This procedure will be repeated 5 times.
|
After high-load training phase (i.e. after 18th supervised treatment session) assessed at approximately 13 weeks
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Nociceptive flexion reflex - temporal summation
Time Frame: At 3 months follow-up
|
Five 1ms rectangular wave pulse train will be administered 3 times at a frequency of 2 Hz at a constant stimulation intensity.
This procedure will be repeated 5 times.
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At 3 months follow-up
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Conditioned pain modulation
Time Frame: Baseline
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The conditioning stimulus will comprise of immersion of the non-dominant hand until the proximal wrist crease in a hot circulating water bath of 45.5°C during 6 minutes.
The test stimulus will comprise of pressure pain threshold (PPT) assessments (as described above) during and after completion of the conditioning stimulus.
Before, after 2 min of immersion and 2 minutes after completion of immersion, the test stimulus will be repeated twice at each test location at the dominant body side.
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Baseline
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Conditioned pain modulation
Time Frame: After low-load training phase (i.e. after 9th supervised treatment session) assessed at approximately 8 weeks
|
The conditioning stimulus will comprise of immersion of the non-dominant hand until the proximal wrist crease in a hot circulating water bath of 45.5°C during 6 minutes.
The test stimulus will comprise of pressure pain threshold (PPT) assessments (as described above) during and after completion of the conditioning stimulus.
Before, after 2 min of immersion and 2 minutes after completion of immersion, the test stimulus will be repeated twice at each test location at the dominant body side.
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After low-load training phase (i.e. after 9th supervised treatment session) assessed at approximately 8 weeks
|
Conditioned pain modulation
Time Frame: After high-load training phase (i.e. after 18th supervised treatment session) assessed at approximately 13 weeks
|
The conditioning stimulus will comprise of immersion of the non-dominant hand until the proximal wrist crease in a hot circulating water bath of 45.5°C during 6 minutes.
The test stimulus will comprise of pressure pain threshold (PPT) assessments (as described above) during and after completion of the conditioning stimulus.
Before, after 2 min of immersion and 2 minutes after completion of immersion, the test stimulus will be repeated twice at each test location at the dominant body side.
|
After high-load training phase (i.e. after 18th supervised treatment session) assessed at approximately 13 weeks
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Conditioned pain modulation
Time Frame: At 3 months follow-up
|
The conditioning stimulus will comprise of immersion of the non-dominant hand until the proximal wrist crease in a hot circulating water bath of 45.5°C during 6 minutes.
The test stimulus will comprise of pressure pain threshold (PPT) assessments (as described above) during and after completion of the conditioning stimulus.
Before, after 2 min of immersion and 2 minutes after completion of immersion, the test stimulus will be repeated twice at each test location at the dominant body side.
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At 3 months follow-up
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Anxiety and depression
Time Frame: Baseline
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Hospital Anxiety and depression scale (HADS)
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Baseline
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Anxiety and depression
Time Frame: After low-load training phase (i.e. after 9th supervised treatment session) assessed at approximately 8 weeks
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Hospital Anxiety and depression scale (HADS)
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After low-load training phase (i.e. after 9th supervised treatment session) assessed at approximately 8 weeks
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Anxiety and depression
Time Frame: After high-load training phase (i.e. after 18th supervised treatment session) assessed at approximately 13 weeks
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Hospital Anxiety and depression scale (HADS)
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After high-load training phase (i.e. after 18th supervised treatment session) assessed at approximately 13 weeks
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Anxiety and depression
Time Frame: At 3 months follow-up
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Hospital Anxiety and depression scale (HADS)
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At 3 months follow-up
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Physical activity
Time Frame: Baseline
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International physical activity questionnaire - long form (IPAQ-LF)
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Baseline
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Physical activity
Time Frame: After low-load training phase (i.e. after 9th supervised treatment session) assessed at approximately 8 weeks
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International physical activity questionnaire - long form (IPAQ-LF)
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After low-load training phase (i.e. after 9th supervised treatment session) assessed at approximately 8 weeks
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Physical activity
Time Frame: After high-load training phase (i.e. after 18th supervised treatment session) assessed at approximately 13 weeks
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International physical activity questionnaire - long form (IPAQ-LF)
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After high-load training phase (i.e. after 18th supervised treatment session) assessed at approximately 13 weeks
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Physical activity
Time Frame: At 3 months follow-up.
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International physical activity questionnaire - long form (IPAQ-LF)
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At 3 months follow-up.
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Pain coping
Time Frame: Baseline
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Pain coping inventory (PCI), Pain Catastrophizing Scale (PCS)
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Baseline
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Pain coping
Time Frame: After low-load training phase (i.e. after 9th supervised treatment session) assessed at approximately 8 weeks
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Pain coping inventory (PCI), Pain Catastrophizing Scale (PCS)
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After low-load training phase (i.e. after 9th supervised treatment session) assessed at approximately 8 weeks
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Pain coping
Time Frame: After high-load training phase (i.e. after 18th supervised treatment session) assessed at approximately 13 weeks
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Pain coping inventory (PCI), Pain Catastrophizing Scale (PCS)
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After high-load training phase (i.e. after 18th supervised treatment session) assessed at approximately 13 weeks
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Pain coping
Time Frame: At 3 months follow-up
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Pain coping inventory (PCI), Pain Catastrophizing Scale (PCS)
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At 3 months follow-up
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Pain catastrophizing
Time Frame: Baseline
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Pain Catastrophizing Scale (PCS)
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Baseline
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Pain catastrophizing
Time Frame: After low-load training phase (i.e. after 9th supervised treatment session) assessed at approximately 8 weeks
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Pain Catastrophizing Scale (PCS)
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After low-load training phase (i.e. after 9th supervised treatment session) assessed at approximately 8 weeks
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Pain catastrophizing
Time Frame: After high-load training phase (i.e. after 18th supervised treatment session) assessed at approximately 13 weeks
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Pain Catastrophizing Scale (PCS)
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After high-load training phase (i.e. after 18th supervised treatment session) assessed at approximately 13 weeks
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Pain catastrophizing
Time Frame: At 3 months follow-up
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Pain Catastrophizing Scale (PCS)
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At 3 months follow-up
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Pain vigilance and awareness
Time Frame: Baseline
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Pain vigilance and awareness questionnaire (PVAQ)
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Baseline
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Pain vigilance and awareness
Time Frame: After low-load training phase (i.e. after 9th supervised treatment session) assessed at approximately 8 weeks
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Pain vigilance and awareness questionnaire (PVAQ)
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After low-load training phase (i.e. after 9th supervised treatment session) assessed at approximately 8 weeks
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Pain vigilance and awareness
Time Frame: After high-load training phase (i.e. after 18th supervised treatment session) assessed at approximately 13 weeks
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Pain vigilance and awareness questionnaire (PVAQ)
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After high-load training phase (i.e. after 18th supervised treatment session) assessed at approximately 13 weeks
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Pain vigilance and awareness
Time Frame: At 3 months follow-up
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Pain vigilance and awareness questionnaire (PVAQ)
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At 3 months follow-up
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Kinesiophobia
Time Frame: Baseline
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Tampa Scale for Kinesiophobia (TSK)
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Baseline
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Kinesiophobia
Time Frame: After low-load training phase (i.e. after 9th supervised treatment session) assessed at approximately 8 weeks
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Tampa Scale for Kinesiophobia (TSK)
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After low-load training phase (i.e. after 9th supervised treatment session) assessed at approximately 8 weeks
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Kinesiophobia
Time Frame: After high-load training phase (i.e. after 18th supervised treatment session) assessed at approximately 13 weeks
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Tampa Scale for Kinesiophobia (TSK)
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After high-load training phase (i.e. after 18th supervised treatment session) assessed at approximately 13 weeks
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Kinesiophobia
Time Frame: At 3 months follow-up
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Tampa Scale for Kinesiophobia (TSK)
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At 3 months follow-up
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Health status
Time Frame: Baseline
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Short Form Health Survey-36 items (SF-36)
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Baseline
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Health status
Time Frame: After low-load training phase (i.e. after 9th supervised treatment session) assessed at approximately 8 weeks
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Short Form Health Survey-36 items (SF-36)
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After low-load training phase (i.e. after 9th supervised treatment session) assessed at approximately 8 weeks
|
Health status
Time Frame: After high-load training phase (i.e. after 18th supervised treatment session) assessed at approximately 13 weeks
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Short Form Health Survey-36 items (SF-36)
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After high-load training phase (i.e. after 18th supervised treatment session) assessed at approximately 13 weeks
|
Health status
Time Frame: At 3 months follow-up
|
Short Form Health Survey-36 items (SF-36)
|
At 3 months follow-up
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Low back pain related pain
Time Frame: Baseline
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LBP related pain intensity will be evaluated by using an 11 point NRS
|
Baseline
|
Low back pain related pain
Time Frame: After low-load training phase (i.e. after 9th supervised treatment session) assessed at approximately 8 weeks
|
LBP related pain intensity will be evaluated by using an 11 point NRS
|
After low-load training phase (i.e. after 9th supervised treatment session) assessed at approximately 8 weeks
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Low back pain related pain
Time Frame: After high-load training phase (i.e. after 18th supervised treatment session) assessed at approximately 13 weeks
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LBP related pain intensity will be evaluated by using an 11 point NRS
|
After high-load training phase (i.e. after 18th supervised treatment session) assessed at approximately 13 weeks
|
Low back pain related pain
Time Frame: At 3 months follow-up
|
LBP related pain intensity will be evaluated by using an 11 point NRS
|
At 3 months follow-up
|
Low back pain related disability
Time Frame: Baseline
|
The Roland Morris Disability Questionnaire will be used to evaluate disability.
|
Baseline
|
Low back pain related disability
Time Frame: After low-load training phase (i.e. after 9th supervised treatment session) assessed at approximately 8 weeks
|
The Roland Morris Disability Questionnaire will be used to evaluate disability.
|
After low-load training phase (i.e. after 9th supervised treatment session) assessed at approximately 8 weeks
|
Low back pain related disability
Time Frame: After high-load training phase (i.e. after 18th supervised treatment session) assessed at approximately 13 weeks
|
The Roland Morris Disability Questionnaire will be used to evaluate disability.
|
After high-load training phase (i.e. after 18th supervised treatment session) assessed at approximately 13 weeks
|
Low back pain related disability
Time Frame: At 3 months follow-up
|
The Roland Morris Disability Questionnaire will be used to evaluate disability.
|
At 3 months follow-up
|
Low back pain recurrence
Time Frame: At 6 months follow-up
|
Self-report via telephone interview: (1) the number of episode(s), (2) the duration of the LBP episode(s), (3) pain intensity, measured with three NRS for average-, worst- and current pain during the LBP episode(s), (4) location and quality of pain (i.e.
sharp, burning, etc. sensation), (5) subjects opinion about what caused the new episode of LBP, (6) degree of impairments in daily life activities due to the LBP, (7) whether participants sought treatment (i.e.
physiotherapist, general practitioner, etc.) and (8) strategies to cope with the new LBP episode.
|
At 6 months follow-up
|
Low back pain recurrence
Time Frame: At 12 months follow-up
|
Self-report via telephone interview: (1) the number of episode(s), (2) the duration of the LBP episode(s), (3) pain intensity, measured with three NRS for average-, worst- and current pain during the LBP episode(s), (4) location and quality of pain (i.e.
sharp, burning, etc. sensation), (5) subjects opinion about what caused the new episode of LBP, (6) degree of impairments in daily life activities due to the LBP, (7) whether participants sought treatment (i.e.
physiotherapist, general practitioner, etc.) and (8) strategies to cope with the new LBP episode.
|
At 12 months follow-up
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Study Director: Jessica van Oosterwijck, Prof, Ghent University, Pain in Motion
Publications and helpful links
General Publications
- Saragiotto BT, Maher CG, Yamato TP, Costa LO, Menezes Costa LC, Ostelo RW, Macedo LG. Motor control exercise for chronic non-specific low-back pain. Cochrane Database Syst Rev. 2016 Jan 8;2016(1):CD012004. doi: 10.1002/14651858.CD012004.
- Iizuka Y, Iizuka H, Mieda T, Tsunoda D, Sasaki T, Tajika T, Yamamoto A, Takagishi K. Prevalence of Chronic Nonspecific Low Back Pain and Its Associated Factors among Middle-Aged and Elderly People: An Analysis Based on Data from a Musculoskeletal Examination in Japan. Asian Spine J. 2017 Dec;11(6):989-997. doi: 10.4184/asj.2017.11.6.989. Epub 2017 Dec 7.
- Goubert D, Oosterwijck JV, Meeus M, Danneels L. Structural Changes of Lumbar Muscles in Non-specific Low Back Pain: A Systematic Review. Pain Physician. 2016 Sep-Oct;19(7):E985-E1000.
- Moseley GL, Flor H. Targeting cortical representations in the treatment of chronic pain: a review. Neurorehabil Neural Repair. 2012 Jul-Aug;26(6):646-52. doi: 10.1177/1545968311433209. Epub 2012 Feb 13.
- Hartvigsen J, Hancock MJ, Kongsted A, Louw Q, Ferreira ML, Genevay S, Hoy D, Karppinen J, Pransky G, Sieper J, Smeets RJ, Underwood M; Lancet Low Back Pain Series Working Group. What low back pain is and why we need to pay attention. Lancet. 2018 Jun 9;391(10137):2356-2367. doi: 10.1016/S0140-6736(18)30480-X. Epub 2018 Mar 21.
- Hurwitz EL, Randhawa K, Yu H, Cote P, Haldeman S. The Global Spine Care Initiative: a summary of the global burden of low back and neck pain studies. Eur Spine J. 2018 Sep;27(Suppl 6):796-801. doi: 10.1007/s00586-017-5432-9. Epub 2018 Feb 26.
- Scholz J, Klein MC, Behrens TE, Johansen-Berg H. Training induces changes in white-matter architecture. Nat Neurosci. 2009 Nov;12(11):1370-1. doi: 10.1038/nn.2412. Epub 2009 Oct 11.
- Taubert M, Draganski B, Anwander A, Muller K, Horstmann A, Villringer A, Ragert P. Dynamic properties of human brain structure: learning-related changes in cortical areas and associated fiber connections. J Neurosci. 2010 Sep 1;30(35):11670-7. doi: 10.1523/JNEUROSCI.2567-10.2010.
- Hodges PW. Core stability exercise in chronic low back pain. Orthop Clin North Am. 2003 Apr;34(2):245-54. doi: 10.1016/s0030-5898(03)00003-8.
- Masse-Alarie H, Beaulieu LD, Preuss R, Schneider C. Influence of paravertebral muscles training on brain plasticity and postural control in chronic low back pain. Scand J Pain. 2016 Jul;12:74-83. doi: 10.1016/j.sjpain.2016.03.005. Epub 2016 May 11.
- Tsao H, Galea MP, Hodges PW. Driving plasticity in the motor cortex in recurrent low back pain. Eur J Pain. 2010 Sep;14(8):832-9. doi: 10.1016/j.ejpain.2010.01.001. Epub 2010 Feb 23.
- Tsao H, Druitt TR, Schollum TM, Hodges PW. Motor training of the lumbar paraspinal muscles induces immediate changes in motor coordination in patients with recurrent low back pain. J Pain. 2010 Nov;11(11):1120-8. doi: 10.1016/j.jpain.2010.02.004.
- Panjabi MM. The stabilizing system of the spine. Part I. Function, dysfunction, adaptation, and enhancement. J Spinal Disord. 1992 Dec;5(4):383-9; discussion 397. doi: 10.1097/00002517-199212000-00001.
- da Silva T, Mills K, Brown BT, Herbert RD, Maher CG, Hancock MJ. Risk of Recurrence of Low Back Pain: A Systematic Review. J Orthop Sports Phys Ther. 2017 May;47(5):305-313. doi: 10.2519/jospt.2017.7415. Epub 2017 Mar 29.
- Foster NE, Anema JR, Cherkin D, Chou R, Cohen SP, Gross DP, Ferreira PH, Fritz JM, Koes BW, Peul W, Turner JA, Maher CG; Lancet Low Back Pain Series Working Group. Prevention and treatment of low back pain: evidence, challenges, and promising directions. Lancet. 2018 Jun 9;391(10137):2368-2383. doi: 10.1016/S0140-6736(18)30489-6. Epub 2018 Mar 21.
- Panjabi MM. The stabilizing system of the spine. Part II. Neutral zone and instability hypothesis. J Spinal Disord. 1992 Dec;5(4):390-6; discussion 397. doi: 10.1097/00002517-199212000-00002.
- Kregel J, Meeus M, Malfliet A, Dolphens M, Danneels L, Nijs J, Cagnie B. Structural and functional brain abnormalities in chronic low back pain: A systematic review. Semin Arthritis Rheum. 2015 Oct;45(2):229-37. doi: 10.1016/j.semarthrit.2015.05.002. Epub 2015 May 16.
- da C Menezes Costa L, Maher CG, Hancock MJ, McAuley JH, Herbert RD, Costa LO. The prognosis of acute and persistent low-back pain: a meta-analysis. CMAJ. 2012 Aug 7;184(11):E613-24. doi: 10.1503/cmaj.111271. Epub 2012 May 14.
- Danneels LA, Vanderstraeten GG, Cambier DC, Witvrouw EE, De Cuyper HJ. CT imaging of trunk muscles in chronic low back pain patients and healthy control subjects. Eur Spine J. 2000 Aug;9(4):266-72. doi: 10.1007/s005860000190.
- Hodges PW, Moseley GL. Pain and motor control of the lumbopelvic region: effect and possible mechanisms. J Electromyogr Kinesiol. 2003 Aug;13(4):361-70. doi: 10.1016/s1050-6411(03)00042-7.
- D'hooge R, Cagnie B, Crombez G, Vanderstraeten G, Dolphens M, Danneels L. Increased intramuscular fatty infiltration without differences in lumbar muscle cross-sectional area during remission of unilateral recurrent low back pain. Man Ther. 2012 Dec;17(6):584-8. doi: 10.1016/j.math.2012.06.007. Epub 2012 Jul 10.
- D'hooge R, Cagnie B, Crombez G, Vanderstraeten G, Achten E, Danneels L. Lumbar muscle dysfunction during remission of unilateral recurrent nonspecific low-back pain: evaluation with muscle functional MRI. Clin J Pain. 2013 Mar;29(3):187-94. doi: 10.1097/AJP.0b013e31824ed170.
- D'hooge R, Hodges P, Tsao H, Hall L, Macdonald D, Danneels L. Altered trunk muscle coordination during rapid trunk flexion in people in remission of recurrent low back pain. J Electromyogr Kinesiol. 2013 Feb;23(1):173-81. doi: 10.1016/j.jelekin.2012.09.003. Epub 2012 Oct 15.
- Tavor I, Botvinik-Nezer R, Bernstein-Eliav M, Tsarfaty G, Assaf Y. Short-term plasticity following motor sequence learning revealed by diffusion magnetic resonance imaging. Hum Brain Mapp. 2020 Feb 1;41(2):442-452. doi: 10.1002/hbm.24814. Epub 2019 Oct 9.
- Deyo RA. Diagnostic evaluation of LBP: reaching a specific diagnosis is often impossible. Arch Intern Med. 2002 Jul 8;162(13):1444-7; discussion 1447-8. doi: 10.1001/archinte.162.13.1444. No abstract available.
- Itz CJ, Geurts JW, van Kleef M, Nelemans P. Clinical course of non-specific low back pain: a systematic review of prospective cohort studies set in primary care. Eur J Pain. 2013 Jan;17(1):5-15. doi: 10.1002/j.1532-2149.2012.00170.x. Epub 2012 May 28.
- Goubert D, Meeus M, Willems T, De Pauw R, Coppieters I, Crombez G, Danneels L. The association between back muscle characteristics and pressure pain sensitivity in low back pain patients. Scand J Pain. 2018 Apr 25;18(2):281-293. doi: 10.1515/sjpain-2017-0142.
- Ranger TA, Cicuttini FM, Jensen TS, Peiris WL, Hussain SM, Fairley J, Urquhart DM. Are the size and composition of the paraspinal muscles associated with low back pain? A systematic review. Spine J. 2017 Nov;17(11):1729-1748. doi: 10.1016/j.spinee.2017.07.002. Epub 2017 Jul 26.
- Coppieters I, Meeus M, Kregel J, Caeyenberghs K, De Pauw R, Goubert D, Cagnie B. Relations Between Brain Alterations and Clinical Pain Measures in Chronic Musculoskeletal Pain: A Systematic Review. J Pain. 2016 Sep;17(9):949-62. doi: 10.1016/j.jpain.2016.04.005. Epub 2016 Jun 3.
- Yuan C, Shi H, Pan P, Dai Z, Zhong J, Ma H, Sheng L. Gray Matter Abnormalities Associated With Chronic Back Pain: A Meta-Analysis of Voxel-based Morphometric Studies. Clin J Pain. 2017 Nov;33(11):983-990. doi: 10.1097/AJP.0000000000000489.
- Brumagne S, Diers M, Danneels L, Moseley GL, Hodges PW. Neuroplasticity of Sensorimotor Control in Low Back Pain. J Orthop Sports Phys Ther. 2019 Jun;49(6):402-414. doi: 10.2519/jospt.2019.8489.
- Kilgour AH, Todd OM, Starr JM. A systematic review of the evidence that brain structure is related to muscle structure and their relationship to brain and muscle function in humans over the lifecourse. BMC Geriatr. 2014 Jul 10;14:85. doi: 10.1186/1471-2318-14-85.
- Goossens N, Rummens S, Janssens L, Caeyenberghs K, Brumagne S. Association Between Sensorimotor Impairments and Functional Brain Changes in Patients With Low Back Pain: A Critical Review. Am J Phys Med Rehabil. 2018 Mar;97(3):200-211. doi: 10.1097/PHM.0000000000000859.
- Panjabi M, Abumi K, Duranceau J, Oxland T. Spinal stability and intersegmental muscle forces. A biomechanical model. Spine (Phila Pa 1976). 1989 Feb;14(2):194-200. doi: 10.1097/00007632-198902000-00008.
- Cagnie B, Dhooge F, Schumacher C, De Meulemeester K, Petrovic M, van Oosterwijck J, Danneels L. Fiber Typing of the Erector Spinae and Multifidus Muscles in Healthy Controls and Back Pain Patients: A Systematic Literature Review. J Manipulative Physiol Ther. 2015 Nov-Dec;38(9):653-663. doi: 10.1016/j.jmpt.2015.10.004. Epub 2015 Nov 5.
- Agten A, Stevens S, Verbrugghe J, Timmermans A, Vandenabeele F. Biopsy samples from the erector spinae of persons with nonspecific chronic low back pain display a decrease in glycolytic muscle fibers. Spine J. 2020 Feb;20(2):199-206. doi: 10.1016/j.spinee.2019.09.023. Epub 2019 Sep 27.
- Knox MF, Chipchase LS, Schabrun SM, Romero RJ, Marshall PWM. Anticipatory and compensatory postural adjustments in people with low back pain: a systematic review and meta-analysis. Spine J. 2018 Oct;18(10):1934-1949. doi: 10.1016/j.spinee.2018.06.008. Epub 2018 Jun 12.
- Prins MR, Griffioen M, Veeger TTJ, Kiers H, Meijer OG, van der Wurff P, Bruijn SM, van Dieen JH. Evidence of splinting in low back pain? A systematic review of perturbation studies. Eur Spine J. 2018 Jan;27(1):40-59. doi: 10.1007/s00586-017-5287-0. Epub 2017 Sep 12.
- Geisser ME, Ranavaya M, Haig AJ, Roth RS, Zucker R, Ambroz C, Caruso M. A meta-analytic review of surface electromyography among persons with low back pain and normal, healthy controls. J Pain. 2005 Nov;6(11):711-26. doi: 10.1016/j.jpain.2005.06.008.
- Ebenbichler GR, Oddsson LI, Kollmitzer J, Erim Z. Sensory-motor control of the lower back: implications for rehabilitation. Med Sci Sports Exerc. 2001 Nov;33(11):1889-98. doi: 10.1097/00005768-200111000-00014.
- Macedo LG, Saragiotto BT, Yamato TP, Costa LO, Menezes Costa LC, Ostelo RW, Maher CG. Motor control exercise for acute non-specific low back pain. Cochrane Database Syst Rev. 2016 Feb 10;2(2):CD012085. doi: 10.1002/14651858.CD012085.
- Liu KP, Chan CC, Lee TM, Hui-Chan CW. Mental imagery for promoting relearning for people after stroke: a randomized controlled trial. Arch Phys Med Rehabil. 2004 Sep;85(9):1403-8. doi: 10.1016/j.apmr.2003.12.035.
- Taubert M, Lohmann G, Margulies DS, Villringer A, Ragert P. Long-term effects of motor training on resting-state networks and underlying brain structure. Neuroimage. 2011 Aug 15;57(4):1492-8. doi: 10.1016/j.neuroimage.2011.05.078. Epub 2011 Jun 7.
- Draganski B, Gaser C, Busch V, Schuierer G, Bogdahn U, May A. Neuroplasticity: changes in grey matter induced by training. Nature. 2004 Jan 22;427(6972):311-2. doi: 10.1038/427311a. No abstract available.
- Boyke J, Driemeyer J, Gaser C, Buchel C, May A. Training-induced brain structure changes in the elderly. J Neurosci. 2008 Jul 9;28(28):7031-5. doi: 10.1523/JNEUROSCI.0742-08.2008.
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Estimated)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- B670201420984
- U1111-1283-4631 (Registry Identifier: Universal Trial Number (UTN))
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.
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