Are Supervised Exercises and TENS Necessary Along With Prescribed Home Exercises for Chronic Low Back Pain?
2022年3月28日 更新者：Saurab Sharma、Kathmandu University School of Medical Sciences
Effectiveness of TENS and Supervised Motor Control Exercises Compared To Unsupervised Exercises in Subjects With Chronic Low Back Pain: A Randomized Clinical Trial
The purpose of this study is to compare the added effects of TENS and Supervised Motor Control Exercises (SMCE) over Unsupervised Home Exercise Program (UHEP) on disability, pain and other outcomes.
調査の概要
詳細な説明
Chronic low back pain (CLBP) is a common problem causing disability and high economic burden in globally as well as in Nepal.
There is no consensus on treatment of CLBP, however motor control exercises have good evidence on improvement in pain and disability in CLBP population, whereas transcutaneous electrical nerve stimulation (TENS) is a common treatment of choice with some evidence.
But, we do not know if supervising these motor control exercises (SMCE) and TENS have any added benefit over home exercise program (HEP) which is commonly prescribed mode of exercises.
We plan to conduct a three armed randomized control trial to answer this question to compare effects of SMCE, TENS and HEP versus SMCE and HEP versus HEP alone on disability and pain at two weeks and six months follow up.
Three way-mixed model analysis of Variance (ANOVA) will be used as the statistical test.
Appropriate post hoc analysis will be done to compare within group and between group differences.
研究の種類
介入
段階
- 適用できない
参加基準
研究者は、適格基準と呼ばれる特定の説明に適合する人を探します。これらの基準のいくつかの例は、人の一般的な健康状態または以前の治療です。
適格基準
就学可能な年齢
18年～65年 (大人、高齢者)
健康ボランティアの受け入れ
いいえ
受講資格のある性別
全て
説明
Inclusion Criteria:
- Nonspecific Low back pain for more than 3 months with pain primarily localized between T12 and gluteal folds, if patients report that their pain is provoked and relieved with postures, movement and activities.
- Age between 18 to 65 years
- Male or female
- All educational backgrounds (educated or uneducated)
- Pain intensity more than 2/10 on NPRS and
- Disability of more than 20/100 on NODI
Exclusion Criteria:
- Red flags noted in the participant's general medical screening questionnaire (i.e. tumor, metabolic diseases, Rheumatoid Arthritis, osteoporosis, prolonged history of steroid use, etc.)
Signs consistent with nerve root compression, this includes any one of the following:
- Reproduction of low back or leg pain with straight leg raise at less than 45 degrees
- Muscle weakness involving a major muscle group of the lower extremity
- Diminished lower extremity muscle stretch reflex (Quadriceps or Achilles tendon)
- Diminished or absent sensation to pinprick in any lower extremity dermatome
- Prior surgery to the lumbar spine or buttock
- Current pregnancy
- Past medical history of osteoporosis or spinal compression fracture
Participants who do not provide informed consent for the study
-
研究計画
このセクションでは、研究がどのように設計され、研究が何を測定しているかなど、研究計画の詳細を提供します。
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：TENS
Participants will receive Active-TENS along with SMCE and UHEP.
Six treatment sessions will be given over two weeks.
Total duration of the treatment session may last from 40 - 60 minutes.
|
Six treatment sessions will be given over two weeks. Total duration of the treatment session may last from 40 - 60 minutes.
他の名前：
Six sessions of supervised Motor control exercises will be provided over the period of two weeks. Exercises will be provided in order to target the function of core muscles of the spine. Each participant in the SMCE group will be trained by a physical therapist to recruit the deep muscles of the spine and reduce the activity of superficial muscles. Initially participants will be taught how to contract the transversus abdominis and multifidus muscles in isolation from the more superficial trunk muscles, but in conjunction with the pelvic floor muscles. Pressure biofeedback will be used in order to provide feedback about muscle recruitment to the participant. Exercises will be provided to the participants in the progressive manner. Later, movement of limbs will be incorporated with the contraction of the core muscles. Finally, these core muscle activation will be emphasized during the functional activities.
他の名前：
All the participants will receive the following treatments:
他の名前：
|
|
実験的：SMCE
Participants will receive SMCE and UHEP.
Six sessions of supervised Motor control exercises will be provided over the period of two weeks.
|
Six sessions of supervised Motor control exercises will be provided over the period of two weeks. Exercises will be provided in order to target the function of core muscles of the spine. Each participant in the SMCE group will be trained by a physical therapist to recruit the deep muscles of the spine and reduce the activity of superficial muscles. Initially participants will be taught how to contract the transversus abdominis and multifidus muscles in isolation from the more superficial trunk muscles, but in conjunction with the pelvic floor muscles. Pressure biofeedback will be used in order to provide feedback about muscle recruitment to the participant. Exercises will be provided to the participants in the progressive manner. Later, movement of limbs will be incorporated with the contraction of the core muscles. Finally, these core muscle activation will be emphasized during the functional activities.
他の名前：
All the participants will receive the following treatments:
他の名前：
|
|
アクティブコンパレータ：UHEP
Unsupervised home exercise program will be prescribed with home exercise leaflet and education leaflet in the form of back book on first treatment session.
|
All the participants will receive the following treatments:
他の名前：
|
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 |
|---|---|---|
|
Disability (Nepali version of Oswestry Disability Index (NODI)
時間枠：2 weeks
|
Nepali version of Oswestry Disability Index (NODI) will be used to measure disability which is a cross culturally adapted and validated tool for measuring disability in low back pain population in Nepal.
The tool has acceptable reliability (Cronbach's Alpha= 0.723, intraclass correlation coefficient= 0.875)
|
2 weeks
|
二次結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
|
Pain intensity (Numerical Pain Rating Scale (NPRS)
時間枠：2 weeks
|
Numerical Pain Rating Scale (NPRS) - An 11-point numeric pain rating scale ranging from 0 (no pain) to 10 (worst imaginable pain) will be used to assess current pain intensity and the best and worst level of pain during the last 24 hours.
|
2 weeks
|
|
Pain intensity (Numerical Pain Rating Scale (NPRS)
時間枠：6 months
|
Numerical Pain Rating Scale (NPRS) - An 11-point numeric pain rating scale ranging from 0 (no pain) to 10 (worst imaginable pain) will be used to assess current pain intensity and the best and worst level of pain during the last 24 hours.
|
6 months
|
|
Disability (Nepali version of Oswestry Disability Index (NODI)
時間枠：6 months
|
Nepali version of Oswestry Disability Index (NODI) will be used to measure disability which is a cross culturally adapted and validated tool for measuring disability in low back pain population in Nepal.
The tool has acceptable reliability (Cronbach's Alpha= 0.723, intraclass correlation coefficient= 0.875)
|
6 months
|
その他の成果指標
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
|
Changes in pain and disability (Global Rating of Change (GROC)
時間枠：2 weeks
|
Global Rating of Change (GROC) - The fifteen-point global rating scale will be used.
The scale ranges from -7 (a very great deal worse) to zero (about the same) to +7 (a very great deal better).
Intermittent descriptors of worsening or improving are assigned values from -1 to -6 and +1 to +6 respectively.
The global rating will be administered at the follow-up examinations only.
|
2 weeks
|
|
Changes in pain and disability (Global Rating of Change (GROC)
時間枠：6 months
|
Using Global rating of change (GROC)
|
6 months
|
|
Need for medication (using frequency and dosage and types of analgesics used)
時間枠：6 months
|
using frequency and dosage and types of analgesics used
|
6 months
|
|
Need for follow up (number of treatment sessions in past six months will be recorded)
時間枠：6 months
|
number of treatment sessions in past six months will be recorded
|
6 months
|
|
Adverse events
時間枠：6 months
|
numbers of adverse events are noted down using a questionnaire
|
6 months
|
|
Fear avoidance (Fear avoidance belief questionnaire (FABQ)
時間枠：6 months
|
Fear avoidance belief questionnaire (FABQ) - The FABQ is a 16-item scale that assesses the influence of fear avoidance behaviors on physical and work activities.
Each item is scored from 0-6 with possible scores ranging between 0-42 and higher scores representing increased fear-avoidance beliefs.
|
6 months
|
|
Pain Catastrophizing (Pain catastrophizing Scale (PCS)
時間枠：6 months
|
Pain catastrophizing Scale (PCS) - Nepali translation of PCS is a 13-item scale that assesses the pain catastrophizing.
Pain catastrophizing is an exaggerated, negative focus on pain and is related to psychological distress, pain severity, and other negative outcomes in pain population.
Participants responded to each item using a Likert-type scale from 0 ('not at all') to 4 ('all the time').
|
6 months
|
協力者と研究者
ここでは、この調査に関係する人々や組織を見つけることができます。
捜査官
- 主任研究者：Saurab Sharma, MPT、Kathmandu University School of Medical Sciences, Nepal
研究記録日
これらの日付は、ClinicalTrials.gov への研究記録と要約結果の提出の進捗状況を追跡します。研究記録と報告された結果は、国立医学図書館 (NLM) によって審査され、公開 Web サイトに掲載される前に、特定の品質管理基準を満たしていることが確認されます。
主要日程の研究
研究開始 (予想される)
2019年8月1日
一次修了 (予想される)
2020年9月1日
研究の完了 (予想される)
2020年12月1日
試験登録日
最初に提出
2015年1月15日
QC基準を満たした最初の提出物
2015年1月21日
最初の投稿 (見積もり)
2015年1月22日
学習記録の更新
投稿された最後の更新 (実際)
2022年4月6日
QC基準を満たした最後の更新が送信されました
2022年3月28日
最終確認日
2022年3月1日
詳しくは
本研究に関する用語
その他の研究ID番号
- KUSMS107/14
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