Managing chronic nonspecific low back pain with a sensorimotor retraining approach
1
Background and aims: Chronic nonspecific low back pain (CNSLBP) is a common healthcare problem for which current interventions are only moderately successful [1]. There is growing evidence of extensive cortical reorganisation and perceptual disturbances which may contribute to the condition [2]. The aim of this study was to test whether a graded sensorimotor retraining program, aimed at influencing cortical representation, would reduce pain intensity, interference of pain on daily life and self reported disability. We also investigated the safety of this intervention by recording any adverse reactions to the program. Managing chronic nonspecific low back pain with a sensorimotor retraining approach: exploratory multiple-baseline study of 3 participants Benedict M. Wand 1 , Neil E. O’Connell 2 , Flavia Di Pietro 3 , Max Bulsara 4 1 School of Physiotherapy, University of Notre Dame Australia, 2 Department of Health Sciences and Social Care, Brunel University, UK, 3 Neuroscience Research Australia, 4 Institute of Health and Rehabilitation Research, University of Notre Dame Australia. Methods: Participants were recruited on the basis of disabling CNSLBP for at least 12 months. The Brief Pain Inventory was used to measure pain intensity and pain’s interference with daily life. Disability was measured via the Roland-Morris Disability Questionnaire. Participants were assessed weekly throughout three phases: a no- treatment baseline phase, a ten week graded sensorimotor retraining phase performed both in the clinic and at home, and finally for a one-month follow up phase. A multiple- baseline A 1 -B-A 2 design was used. Results: All participants showed reduction in pain, pain’s interference with daily life and disability. Improvements were maintained during the post-treatment period. No participant recorded any adverse reaction to treatment. Changes in interference of pain on daily life . Regression coefficient for trend between phases: -2.25 (p < 0.001). Changes in disability . Regression coefficient for trend between phases: -4.86 (p <0.001). Changes in pain intensity . Regression coefficient for trend between phases among all three participants combined: -2.02 (p = 0.001). Where to from here? Further investigation of a sensorimotor retraining program for CNSLBP with more robust experimental designs is warranted. Refinement of the approach is also needed, particularly with respect to which components of the program might offer patients the most benefit. Finally, exploration of the relationship between training strategies and neuroimaging in this group may offer very useful data. [1] van Tulder MW, et al. 2006. Eur Spine J. 15: S64-S81. [2] Lotze M, et al. 2007. Curr Rheumatol Rep. 9: 488-496. Summary of main findings: The three participants showed persistent decreases in pain intensity, interference of pain with daily life, and self-reported disability during the treatment phase as well as maintenance of improvements during the one-month follow-up phase. Trends observed in individual data were confirmed with the mixed-model analysis. This is the first report of a comprehensive graded sensorimotor program for CNSLBP. Summary of the retraining program Changes in the three primary outcomes over time. The dashed vertical lines represent the changes in experimental phase. Data analysis: A combined person-period data set was constructed to evaluate outcomes over time. A parametric linear mixed-model quantified the relationship between pain intensity, the interference of pain on daily life, and disability with phase of the program (fixed-effect parameter).
-
Upload
bodyin-mind -
Category
Health & Medicine
-
view
1.666 -
download
1
description
Managing chronic nonspecific low back pain with a sensorimotor retraining approach.
Transcript of Managing chronic nonspecific low back pain with a sensorimotor retraining approach
Background and aims: Chronic nonspecific low back pain (CNSLBP) is a common
healthcare problem for which current interventions are only moderately successful [1].There is growing evidence of extensive cortical reorganisation and perceptualdisturbances which may contribute to the condition [2]. The aim of this study was to testwhether a graded sensorimotor retraining program, aimed at influencing corticalrepresentation, would reduce pain intensity, interference of pain on daily life and selfreported disability. We also investigated the safety of this intervention by recording anyadverse reactions to the program.
Managing chronic nonspecific low back pain with a sensorimotor retraining approach: exploratory multiple-baseline study of 3 participants
Benedict M. Wand1, Neil E. O’Connell2, Flavia Di Pietro3, Max Bulsara4
1School of Physiotherapy, University of Notre Dame Australia, 2 Department of Health Sciences and Social Care, Brunel University, UK, 3Neuroscience Research Australia, 4Institute of Health and Rehabilitation Research, University of Notre Dame Australia.
Methods: Participants were recruited on the basis of disabling CNSLBP for at least 12
months. The Brief Pain Inventory was used to measure pain intensity and pain’sinterference with daily life. Disability was measured via the Roland-Morris DisabilityQuestionnaire. Participants were assessed weekly throughout three phases: a no-treatment baseline phase, a ten week graded sensorimotor retraining phase performedboth in the clinic and at home, and finally for a one-month follow up phase. A multiple-baseline A1-B-A2 design was used.
Results: All participants showed reduction in pain, pain’s
interference with daily life and disability. Improvements weremaintained during the post-treatment period. No participantrecorded any adverse reaction to treatment.
Changes in interference of pain on daily life.
Regression coefficient for trend between phases: -2.25 (p < 0.001).
Changes in disability.
Regression coefficient for trend between phases: -4.86 (p <0.001).
Changes in pain intensity.
Regression coefficient for trend between phases among all three participants combined: -2.02 (p = 0.001).
Where to from here?
Further investigation of a sensorimotor retrainingprogram for CNSLBP with more robust experimentaldesigns is warranted. Refinement of the approach isalso needed, particularly with respect to whichcomponents of the program might offer patients themost benefit. Finally, exploration of the relationshipbetween training strategies and neuroimaging in thisgroup may offer very useful data.
[1] van Tulder MW, et al. 2006. Eur Spine J. 15: S64-S81.[2] Lotze M, et al. 2007. Curr Rheumatol Rep. 9: 488-496.
Summary of main findings: The three participants
showed persistent decreases in pain intensity, interference ofpain with daily life, and self-reported disability during thetreatment phase as well as maintenance of improvements duringthe one-month follow-up phase. Trends observed in individualdata were confirmed with the mixed-model analysis. This is thefirst report of a comprehensive graded sensorimotor program forCNSLBP.
Summary of the retraining program
Changes in the three primary outcomes over time.
The dashed vertical lines represent the changes in
experimental phase.
Data analysis: A combined person-period data set was
constructed to evaluate outcomes over time. A parametriclinear mixed-model quantified the relationship between painintensity, the interference of pain on daily life, and disability withphase of the program (fixed-effect parameter).
