Are Supervised Exercises and TENS Necessary Along With Prescribed Home Exercises for Chronic Low Back Pain?
28 de março de 2022 atualizado por: 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.
Visão geral do estudo
Status
Retirado
Condições
Intervenção / Tratamento
Descrição detalhada
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.
Tipo de estudo
Intervencional
Estágio
- Não aplicável
Critérios de participação
Os pesquisadores procuram pessoas que se encaixem em uma determinada descrição, chamada de critérios de elegibilidade. Alguns exemplos desses critérios são a condição geral de saúde de uma pessoa ou tratamentos anteriores.
Critérios de elegibilidade
Idades elegíveis para estudo
18 anos a 65 anos (Adulto, Adulto mais velho)
Aceita Voluntários Saudáveis
Não
Gêneros Elegíveis para o Estudo
Tudo
Descrição
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
-
Plano de estudo
Esta seção fornece detalhes do plano de estudo, incluindo como o estudo é projetado e o que o estudo está medindo.
Como o estudo é projetado?
Detalhes do projeto
- Finalidade Principal: Tratamento
- Alocação: Randomizado
- Modelo Intervencional: Atribuição Paralela
- Mascaramento: Solteiro
Armas e Intervenções
Grupo de Participantes / Braço |
Intervenção / Tratamento |
|---|---|
|
Experimental: 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.
Outros nomes:
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.
Outros nomes:
All the participants will receive the following treatments:
Outros nomes:
|
|
Experimental: 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.
Outros nomes:
All the participants will receive the following treatments:
Outros nomes:
|
|
Comparador Ativo: 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:
Outros nomes:
|
O que o estudo está medindo?
Medidas de resultados primários
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
|
Disability (Nepali version of Oswestry Disability Index (NODI)
Prazo: 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
|
Medidas de resultados secundários
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
|
Pain intensity (Numerical Pain Rating Scale (NPRS)
Prazo: 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)
Prazo: 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)
Prazo: 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
|
Outras medidas de resultado
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
|
Changes in pain and disability (Global Rating of Change (GROC)
Prazo: 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)
Prazo: 6 months
|
Using Global rating of change (GROC)
|
6 months
|
|
Need for medication (using frequency and dosage and types of analgesics used)
Prazo: 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)
Prazo: 6 months
|
number of treatment sessions in past six months will be recorded
|
6 months
|
|
Adverse events
Prazo: 6 months
|
numbers of adverse events are noted down using a questionnaire
|
6 months
|
|
Fear avoidance (Fear avoidance belief questionnaire (FABQ)
Prazo: 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)
Prazo: 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
|
Colaboradores e Investigadores
É aqui que você encontrará pessoas e organizações envolvidas com este estudo.
Patrocinador
Investigadores
- Investigador principal: Saurab Sharma, MPT, Kathmandu University School of Medical Sciences, Nepal
Datas de registro do estudo
Essas datas acompanham o progresso do registro do estudo e os envios de resumo dos resultados para ClinicalTrials.gov. Os registros do estudo e os resultados relatados são revisados pela National Library of Medicine (NLM) para garantir que atendam aos padrões específicos de controle de qualidade antes de serem publicados no site público.
Datas Principais do Estudo
Início do estudo (Antecipado)
1 de agosto de 2019
Conclusão Primária (Antecipado)
1 de setembro de 2020
Conclusão do estudo (Antecipado)
1 de dezembro de 2020
Datas de inscrição no estudo
Enviado pela primeira vez
15 de janeiro de 2015
Enviado pela primeira vez que atendeu aos critérios de CQ
21 de janeiro de 2015
Primeira postagem (Estimativa)
22 de janeiro de 2015
Atualizações de registro de estudo
Última Atualização Postada (Real)
6 de abril de 2022
Última atualização enviada que atendeu aos critérios de controle de qualidade
28 de março de 2022
Última verificação
1 de março de 2022
Mais Informações
Termos relacionados a este estudo
Palavras-chave
Termos MeSH relevantes adicionais
Outros números de identificação do estudo
- KUSMS107/14
Informações sobre medicamentos e dispositivos, documentos de estudo
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produto fabricado e exportado dos EUA
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