Advice of Staying Active for Sub Acute Low Back Pain
Will Patients With Low Back Pain Benefit From the Advice of Staying Active
The variabilities in the management approaches for patients with LBP reflect uncertainty about the optimal approach. Therefore, there is a need for the implementation of early treatment strategies relying on an evidence-based knowledge to treat the problems and reduce the risk for recurrence and chronicity of LBP.
Advice is considered as the 'first in line' for the treatment of patients with LBP and is recommended in all international guidelines, yet it is under-utilized by the general practitioners. The current evidence in favor for the advice of staying active for patients with LBP is limited, with small or no benefits in pain relief, functional improvement or sick leave compared to rest in bed. Consequently, there is a huge gap between the evidence and practice.
So, the current study aimed at filling this gap and expanding the previous findings by investigating the effect of the advice of staying active on the level of perceived pain, physical activity level, postural control and functional disability in patients with low risk LBP (with a total score of three or less based on the STarT Back Tool score).
研究概览
详细说明
In spite of the great effort, LBP remains a significant burden on the society and can cause a disturbing impact on the functional ability during the productive years of the individuals. It is important to find pragmatic treatments that not only reduce the pain, but also decrease the disability. Activity monitoring in real life has the potential to change our concept of outcomes, and as a result, expand our ideas about the appropriateness of the interventions in rehabilitation.
The international guidelines vary but agree on advising patients with LBP to remain physically active. The National Institute for Clinical Excellence (NICE)'s updated guideline on the LBP recommends encouraging people to continue with their normal activities as far as possible. NICE found that there were no randomized controlled trials (RCTs) (which are the best way of investigating the efficacy of a treatment) that compared the effect of the advice of staying active with no advice or the advice to rest.
Despite the guidelines, it was reported that many health care providers are still too restrictive and believe that LBP requires some avoidance of activities and to remain off- work. Many general practitioners do not give advice on daily activities to patients with back pain and there is confusion about what constitutes an effective advice. Only 12% of the physiotherapists identify correctly the guidelines, and most of them do not agree with these guidelines regarding the return to work or activity. Investigating the benefit of the advice of staying active and different active intervention programs in patients with low risk NSLBP may help in developing recommendations for the physiotherapists responsible for reviewing exercise protocols for patients with LBP.
Therefore, the improvement of the primary care management of patients with LBP has the potential to reduce the long-term effects of back pain, including persistent disabling symptoms, low quality of life, and reduced capacity to work. The advice of staying active may not only be a treatment to improve the recovery from LBP, but also an opportunity to promote physical activity for other health benefits, such as improved cardio-metabolic function, blood pressure, and reduced body fatness.
研究类型
注册 (预期的)
阶段
- 不适用
参与标准
资格标准
适合学习的年龄
接受健康志愿者
有资格学习的性别
描述
Inclusion Criteria:
- Patients will be included if they are between 18 - 65 years of age
- able to stand and walk without assistance.
- Patients will also be included if they have a history of non specific low back pain classified as low risk of poor outcome with a total score of three or less based on the STarT Back Tool score (Hill et al., 2008).
- The back-pain episode is subacute
Exclusion Criteria:
- Patients will be excluded if they have any neurological disease or balance deficits due to vestibular disorders, such as vertebrobasilar insufficiency and visual disorders,
- systemic infection,
- current pregnancy,
- severe musculoskeletal deformity (scoliosis or kyphosis),
- injury to the lower extremity that would interfere with testing or a history of any surgery in the three months prior to testing.
- Patients will also be excluded if they have pain below the knee consistent with a disc herniation, presence of neurological signs, serious spinal complications (e.g., vertebral fracture, tumor or infection),
- spinal stenosis,
- confounding conditions such as extreme obesity, severe scoliosis, significant anatomical leg length inequality, previous spinal surgery.
学习计划
研究是如何设计的？
设计细节
- 主要用途：治疗
- 分配：随机化
- 介入模型：并行分配
- 屏蔽：单身的
武器和干预
参与者组/臂 |
干预/治疗 |
|---|---|
|
实验性的：advice of staying active
The patients will be advised to stay as physically active as possible and continue their everyday activities as normally as possible.
|
The aim of this intervention is to increase patients average daily step count.
The walking program is a behavior change intervention in which the pedometer will be used as a tool to help the patients monitor their activity levels.
|
|
实验性的：walking program
Patients will be encouraged to go about their normal daily activities.
At week one, patients will be asked to familiarize themselves with wearing the pedometer and recording their daily steps in a walking diary for the subsequent 7 days.
The patients will return to see the physiotherapist at the end of week one to discuss any issues with the program, pedometer or recording of desired information.
A step target for week two will be agreed between the physiotherapist and the patient by referring to the mean daily step count recorded at baseline, and the average step count calculated from the walking diary
|
The aim of this intervention is to increase patients average daily step count.
The walking program is a behavior change intervention in which the pedometer will be used as a tool to help the patients monitor their activity levels.
|
|
实验性的：Backward walking
All patients will be instructed to walk at their desired pace 3 days per week with a steady rhythm.
The duration of each training session will initially be 15 minutes and will gradually increase, and finally reach 25 minutes, for every session (Hao Chen, 2011).
There will be no constraint or indication about head and trunk position during backward training
|
The aim of this intervention is to increase patients average daily step count.
The walking program is a behavior change intervention in which the pedometer will be used as a tool to help the patients monitor their activity levels.
|
|
实验性的：Targeted home-based hip exercise
Patients who will be assigned in this group will perform a hip exercise program for six weeks, three times / week to ensure an adequate recovery between exercise sessions (appendix V).
The strengthening exercises will focus on strengthening the gluteus maximus (GMax), gluteus medius (GMed), gluteus minimus (GMin) and short hip external rotator muscles (Distefano et al., 2009).
|
The aim of this intervention is to increase patients average daily step count.
The walking program is a behavior change intervention in which the pedometer will be used as a tool to help the patients monitor their activity levels.
|
|
无干预：control group
The patients will not be given any intervention and will be asked to come after 6 weeks for re-assessment
|
研究衡量的是什么？
主要结果指标
结果测量 |
措施说明 |
大体时间 |
|---|---|---|
|
level of perceived pain by Visual analogue scale
大体时间：six weeks
|
The Visual analogue scale will be used for measuring the pain intensity the scale ranges from 0 to 10 where 0 means no pain and 10 means severe intolerable pain.
|
six weeks
|
次要结果测量
结果测量 |
措施说明 |
大体时间 |
|---|---|---|
|
number of steps
大体时间：six weeks
|
A spring-leverd pedometer (Yamax Digiwalker CW-701, Yamax, Japan) will be used to assess the number of steps.
The number of steps will be used as an indicator for the level of physical activity
|
six weeks
|
合作者和调查者
研究记录日期
研究主要日期
学习开始 (预期的)
初级完成 (预期的)
研究完成 (预期的)
研究注册日期
首次提交
首先提交符合 QC 标准的
首次发布 (实际的)
研究记录更新
最后更新发布 (实际的)
上次提交的符合 QC 标准的更新
最后验证
更多信息
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腰背疼痛的临床试验
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Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University尚未招聘
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Daiichi Sankyo招聘中
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Université Victor Segalen Bordeaux 2Nanox International Laboratory (Belgique)完全的
exercise的临床试验
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University of Maryland, BaltimoreNational Institute on Aging (NIA)完全的