Physical Activity for Older Adults Chronic Low Back Pain (PACe-LBP)
Physical Activity for Older Adults With Chronic Low Back Pain: PACe-LBP
調査の概要
詳細な説明
Chronic low back pain (cLBP) is one of the most common and disabling conditions among US military Veterans, and the prevalence is rising even more rapidly than other chronic conditions such as diabetes and hypertension. Studies have shown that physical activity (PA) can improve outcomes in patients with cLBP, but a major gap in this research is the lack of studies focusing on older adults; patient samples have been primarily middle-aged and have included few patients' age 65 years. Therefore, the investigators' lack an evidence base for the feasibility and effectiveness of PA interventions in this vulnerable group of patients with cLBP. This is particularly important given the accumulating evidence showing that older adults with cLBP have significant lower extremity functional limitations, resulting in difficulty performing necessary daily tasks. Another area of limited investigation among older adults with cLBP is whether there is added benefit of incorporating cognitive behavioral therapy for pain management (CBT-P) skills with PA interventions. CBT-P can help to restructure pain perception and improve pacing of PA. Some patients with cLBP do not respond favorably to isolated PA interventions, and it is possible that heightened pain sensitization may underlie this lack of response in some patients. Since CBT-P has been shown to alter pain processing, older adults with cLBP who have greater pain sensitization may respond better to a program that combines PA and CBT-P (vs. PA alone); however, this has not been studied. This information has practical implications for a larger trial to determining whether a subset of patients with greater central pain sensitivity may need additional intervention to supplement a PA program.
The investigators will conduct a pilot study of a 12-week home-based PA and PA + CBT-P programs, both with weekly telephone support, compared with a waiting list control group. Participants will be 60 older Veterans (age 65) with cLBP. Enrollment of participants will occur via referrals from geriatric and primary care clinics at the Durham VAMC. The PA program will be comprehensive, including stretching, strengthening, and aerobic activities, and the specific types and intensities of the activities will be geared toward older adults. The CBT-P program will include five different skills, woven into the telephone-based sessions, with specific application to PA and cLBP. Both interventions will be jointly delivered by a physical therapist and exercise counselor, who has complementary areas of expertise (e.g., training in clinical exercise prescription and motivational interviewing skills to encourage PA adherence, respectively). Telephone calls will involve patient-specific goal-setting and address barriers to PA and CBT-P skills. Participants will receive a booklet with instructions and photographs for stretching and strengthening exercises, as well as an exercise video appropriate for older adults with cLBP. Participants in the combined intervention will also receive written and audio instructions regarding CBT-P skills. Feasibility measures will include the proportion of completed intervention calls, adherence to home-based PA recommendations and CBT-P skills use, and participant feedback on the programs. Outcomes will be assessed at baseline and 12-week follow-up. Primary measures of efficacy will be assessments of general physical function, both objective and self-reported (PROMIS Health Assessment Questionnaire). Secondary outcomes will include measures cLBP-specific pain and disability. Central pain sensitivity will be assessed via Pain Pressure Threshold (PPT) testing and the Central Sensitization Inventory (CSI). Statistical analyses will include comparison of baseline and follow-up outcomes across study groups, as well as examination of potential trends for differential intervention response according to baseline PPT and CSI scores.
研究の種類
入学 (実際)
段階
- 適用できない
連絡先と場所
研究場所
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North Carolina
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Durham、North Carolina、アメリカ、27705
- Durham VA Medical Center, Durham, NC
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参加基準
適格基準
就学可能な年齢
健康ボランティアの受け入れ
受講資格のある性別
説明
Inclusion Criteria:
- Self-report having had lower back pain on most days for greater than three months.
- Can complete a 10 second semi-tandem stand and walk 8' in 6.0 seconds.
- Report they are not satisfied with their current state of functional ability, based on reporting "dissatisfied" with at least one aspect of physical function on the Satisfaction with Physical Function Scale.
- Can safely participate in the intervention based upon the physical therapist baseline examination and clinical expertise.
Exclusion Criteria:
- unilateral or bilateral sciatica that physical therapist determines could make the study intervention unsafe or inappropriate; isolated coccyx pain (based on self-report at screener);
- dementia or other significant cognitive impairment;
- movement or motor neuron disorders (e.g., Parkinson's Disease, Multiple Sclerosis, Amyotrophic Lateral Sclerosis);
- rheumatoid arthritis, fibromyalgia, or other systemic rheumatic disease;
- hospitalization for a stroke, myocardial infarction, heart failure, or coronary artery revascularization in the past 3 months;
- significant hearing impairment (must be able to talk on the telephone);
- psychosis or current, uncontrolled substance abuse disorder;
- any other health conditions determined by the study team to be contraindications to performing mild to moderate home exercises.
研究計画
研究はどのように設計されていますか?
デザインの詳細
- 主な目的:処理
- 割り当て:ランダム化
- 介入モデル:並列代入
- マスキング:独身
武器と介入
参加者グループ / アーム |
介入・治療 |
---|---|
実験的:Physical Activity Only
12-week home-based physical activity program with telephone support.
Delivered by a physical therapist and exercise counselor.
Comprehensive program including stretching, strengthening and aerobic activity.
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12-week home-based physical activity program with telephone support.
Delivered by a physical therapist and exercise counselor.
Comprehensive program including stretching, strengthening and aerobic activity.
|
実験的:Physical Activity + Cognitive Behavioral Therapy
12-week combined home-based physical activity and cognitive behavioral program with telephone support.
Delivered by a physical therapist and exercise counselor.
Comprehensive physical activity program including stretching, strengthening and aerobic activity.
Cognitive behavioral component includes training in multiple skills for managing pain.
|
12-week home-based physical activity program with telephone support.
Delivered by a physical therapist and exercise counselor.
Comprehensive program including stretching, strengthening and aerobic activity.
Telephone-based training in multiple skills for managing low back pain.
|
介入なし:Wait List Control Group
Will receive the physical activity only or physical activity + cognitive behavioral therapy (based on participant choice) after completing all follow-up assessments.
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この研究は何を測定していますか?
主要な結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
---|---|---|
Timed Get-Up-And Go
時間枠:Change from baseline to 12-week follow-up
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This test requires the participants to stand from a standard arm chair, walk 3 meters and then return to sitting in the same chair.
Greater number of seconds is associated with poorer physical function.
Therefore, a positive change from baseline to follow-up means worsening function; a negative change (e.g., lower score at follow-up than at baseline) indicated improving function.
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Change from baseline to 12-week follow-up
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PROMIS Health Assessment Questionnaire
時間枠:Change from baseline to 12-week follow-up
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Self-reported physical function/disability measure that captures both activities of daily living and instrumental activities of daily living.
It consists of 20-items scored on a 0-3 scale with a summed 0-100-unit scale.
Higher scores are associated with worse function.
Therefore a positive change score indicates worsening over time; negative change score (e.g., lower score at follow-up) indicates improvement.
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Change from baseline to 12-week follow-up
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二次結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
---|---|---|
Patient Specific Functional Scale
時間枠:Change from baseline to 12-week follow-up
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This measure captures items that are specific functional tasks that may be missed on standardized questionnaires.
The measure consists of 3 items specifically provided by the patient.
Each item provided by the patient is score from a 0 (Unable to perform task) to 10 (able to complete the activity without difficulty) scale.
Higher change scores from baseline to follow up indicate more improvement (total range 0-30).
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Change from baseline to 12-week follow-up
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Roland-Morris Disease Specific Disability Questionnaire
時間枠:Change from baseline to 12-week follow-up
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24-item self-report measure of low back pain-specific disability.
Higher scores indicate worse function, with a range of 0=no disability to 24=maximum disability measured by the scale.
Therefore a positive change score indicates worsening.
A negative change score (e.g., lower score at follow-up) indicates improvement.
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Change from baseline to 12-week follow-up
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Satisfaction With Physical Function Scale
時間枠:Change from baseline to 12-week follow-up
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This is a validated 5-item questionnaire that assesses patients' satisfaction with their ability to complete basic functional tasks that are often affected by lower extremity OA, including stair-climbing, walking, doing housework (light and heavy, and lifting and carrying.
All items are rated on a 7-point scale ranging from Very Dissatisfied (-3) Very Satisfied (+3).
A positive change score indicates improvement, and a negative change score indicates worsening.
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Change from baseline to 12-week follow-up
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協力者と研究者
出版物と役立つリンク
研究記録日
主要日程の研究
研究開始 (実際)
一次修了 (実際)
研究の完了 (実際)
試験登録日
最初に提出
QC基準を満たした最初の提出物
最初の投稿 (見積もり)
学習記録の更新
投稿された最後の更新 (実際)
QC基準を満たした最後の更新が送信されました
最終確認日
詳しくは
この情報は、Web サイト clinicaltrials.gov から変更なしで直接取得したものです。研究の詳細を変更、削除、または更新するリクエストがある場合は、register@clinicaltrials.gov。 までご連絡ください。 clinicaltrials.gov に変更が加えられるとすぐに、ウェブサイトでも自動的に更新されます。
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