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Background: Improving movement control might be a promising treatment goal during chronic non-specific low back pain (CLBP) rehabilitation. The objective of the study is to evaluate the effect of a single bout of game-based real-time feedback intervention on trunk movement in patients with CLBP.
Methods: Thirteen CLBP patients (8female;41 ± 16 years;173 ± 10 cm;78 ± 22 kg) were included in this randomized cross-over pilot trial. During one laboratory session (2 h), participants performed three identical measurements on trunk movement all including: first, maximum angle of lateral flexion was assessed. Secondly, a target trunk lateral flexion (angle: 20°) was performed. Main outcome was maximum angle ([°]; MA). Secondary outcomes were deviation [°] from the target angle (angle reproduction; AR) and MA of the secondary movement planes (rotation; extension/flexion) during lateral flexion. The outcomes were assessed by an optical 3D-motion-capture-system (2-segment-trunk-model). The measurements were separated by 12-min of intervention and/or resting (randomly). The intervention involved a sensor-based trunk exergame (guiding an avatar through virtual worlds). After carryover effect-analysis, pre-to-post intervention data were pooled between the two sequences followed by analyses of variances (paired t-test).
Results: No significant change from pre to post intervention for MA or AR for any segment occurred for the main movement plane, lateral flexion (p > .05). The upper trunk segment showed a significant decrease of the MA for trunk extension/flexion from pre to post intervention ((4.4° ± 4.4° (95% CI 7.06–1.75)/3.5° ± 1.29° (95% CI 6.22–0.80); p = 0.02, d = 0.20).
Conclusions: A single bout of game-based real-time feedback intervention lead to changes in the secondary movement planes indicating reduced evasive motion during trunk movement.
Intervention in the form of core-specific stability exercises is evident to improve trunk stability. The purpose was to assess the effect of an additional 6 weeks sensorimotor or resistance training on maximum isokinetic trunk strength and response to sudden dynamic trunk loading (STL) in highly trained adolescent athletes. The study was conducted as a single-blind, 3-armed randomized controlled trial. Twenty-four adolescent athletes (14f/10 m, 16 ± 1 yrs.;178 ± 10 cm; 67 ± 11 kg; training sessions/week 15±5; training h/week 22±8) were randomized into resistance training (RT; n=7), sensorimotor training (SMT; n = 10), and control group (CG; n = 7). Athletes were instructed to perform standardized, center-based training for 6 weeks, two times per week, with a duration of 1 h each session. SMT consisted of four different core-specific sensorimotor exercises using instable surfaces. RT consisted of four trunk strength exercises using strength training machines, as well as an isokinetic dynamometer. All participants in the CG received an unspecific heart frequency controlled, ergometer-based endurance training (50 min at max. heart frequency of 130HF). For each athlete, each training session was documented in an individual training diary (e.g., level of SMT exercise; 1RM for strength exercise, pain). At baseline (M1) and after 6 weeks of intervention (M2), participants’ maximum strength in trunk rotation (ROM:63°) and flexion/extension (ROM:55°) was tested on an isokinetic dynamometer (concentric/eccentric 30°/s). STL was assessed in eccentric (30°/s) mode with additional dynamometer-induced perturbation as a marker of core stability. Peak torque [Nm] was calculated as the main outcome. The primary outcome measurements (trunk rotation/extension peak torque: con, ecc, STL) were statistically analyzed by means of the two-factor repeated measures analysis of variance (α = 0.05). Out of 12 possible sessions, athletes participated between 8 and 9 sessions (SMT: 9 ± 3; RT: 8 ± 3; CG: 8 ± 4). Regarding main outcomes of trunk performance, experimental groups showed no significant pre–post difference for maximum trunk strength testing as well as for perturbation compensation (p > 0.05). It is concluded, that future interventions should exceed 6 weeks duration with at least 2 sessions per week to induce enhanced trunk strength or compensatory response to sudden, high-intensity trunk loading in already highly trained adolescent athletes, regardless of training regime.
Background: Core-specific sensorimotor exercises are proven to enhance neuromuscular activity of the trunk, improve athletic performance and prevent back pain. However, the dose-response relationship and, therefore, the dose required to improve trunk function is still under debate. The purpose of the present trial will be to compare four different intervention strategies of sensorimotor exercises that will result in improved trunk function.
Methods/design: A single-blind, four-armed, randomized controlled trial with a 3-week (home-based) intervention phase and two measurement days pre and post intervention (M1/M2) is designed. Experimental procedures on both measurement days will include evaluation of maximum isokinetic and isometric trunk strength (extension/flexion, rotation) including perturbations, as well as neuromuscular trunk activity while performing strength testing. The primary outcome is trunk strength (peak torque). Neuromuscular activity (amplitude, latencies as a response to perturbation) serves as secondary outcome.
The control group will perform a standardized exercise program of four sensorimotor exercises (three sets of 10 repetitions) in each of six training sessions (30 min duration) over 3 weeks. The intervention groups’ programs differ in the number of exercises, sets per exercise and, therefore, overall training amount (group I: six sessions, three exercises, two sets; group II: six sessions, two exercises, two sets; group III: six sessions, one exercise, three sets). The intervention programs of groups I, II and III include additional perturbations for all exercises to increase both the difficulty and the efficacy of the exercises performed. Statistical analysis will be performed after examining the underlying assumptions for parametric and non-parametric testing.
Discussion: The results of the study will be clinically relevant, not only for researchers but also for (sports) therapists, physicians, coaches, athletes and the general population who have the aim of improving trunk function.
Background: Backpacks are essential in the daily lives of children. Carrying a heavy backpack affects trunk posture during standing. It remains unclear, whether this effect is also observed during gait.
Research question: How do different backpack weights affect trunk kinematics during walking in children?
Methods: Sixteen children stood and walked on a 5 m walkway with a custom load-carrying-system simulating unloaded and loaded backpacks (10 %;20 %;30 % of body mass (BM). A marker-based 3D motion analysis system captured whole-body kinematics (Rizzoli model). During walking, the primary outcomes were the maximum ranges of motion (RoM;[°]) of thoracic and lumbar trunk segmental angles in three planes. During standing, the average angles over 5 s were measured in three planes. Secondary measures included stride length, stride time, and velocity during walking. The children's own backpacks' weights were measured and expressed as a percentage of body mass. Statistical analysis was performed using repeated-measures ANOVA (α=0.05) and Tukey-Kramer post hoc test.
Results: The average weight of the children’s own backpack was 15.4 ± 7.4 %BM. For the experimental conditions, the average weights added to the load-carrying system were 3.3 ± 0.8 kg (10 %BM), 6.5 ± 1.7 kg (20 %BM), and 9.8 ± 2.5 kg (30 %BM). During standing, the average trunk flexion angles (sagittal plane) of the lumbar trunk segment significantly increased with increased backpack weight (p = 0.002). During walking, no changes in sagittal plane RoM but significant decreases in lumbar and thoracic transversal and frontal plane RoM (p < 0.001), stride length (p = 0.047) and velocity (p = 0.041) were observed with additional weight. No significant differences were observed for stride time between the conditions.
Significance: Added backpack weight led to a more flexed trunk posture during standing and reduced transversal and frontal plane trunk movement, stride length, and gait velocity during walking. These adjustments likely compensate for the dorsally displaced center of mass and minimize energy expenditure by reducing trunk-backpack-angular momentum during walking.
Widespread insect losses are a critical global problem. Mitigating this problem requires identifying the principal drivers across different taxa and determining which insects are covered by protected areas. However, doing so is hindered by missing information on most species owing to extremely high insect diversity and difficulties in morphological identification. To address this knowledge gap, we used one of the most comprehensive insect DNA metabarcoding data sets assembled (encompassing 31,846 flying insect species) in which data were collected from a network of 75 Malaise traps distributed across Germany. Collection sites encompass gradients of land cover, weather, and climate, along with differences in site protection status, which allowed us to gain broader insights into how insects respond to these factors. We examined changes in total insect biomass, species richness, temporal turnover, and shifts in the composition of taxa, key functional groups (pollinators, threatened species, and invasive species), and feeding traits. Lower insect biomass generally equated to lower richness of all insects and higher temporal turnover, suggesting that biomass loss translates to biodiversity loss and less stable communities. Spatial variability in insect biomass and composition was primarily driven by land cover, rather than weather or climate change. As vegetation and land-cover heterogeneity increased, insect biomass increased by 50% in 2019 and 56% in 2020 and total species richness by 58% and 33%, respectively. Similarly, areas with low-vegetation habitats exhibited the highest richness of key taxa, including pollinators and threatened species, and the widest variety of feeding traits. However, these habitats tended to be less protected despite their higher diversity. Our results highlight the value of heterogeneous low vegetation for promoting overall insect biomass and diversity and that better protection of insects requires improved protection and management of unforested areas, where many biodiversity hotspots and key taxa occur.
Mitigating ongoing losses of insects and their key functions (e.g. pollination) requires tracking large-scale and long-term community changes. However, doing so has been hindered by the high diversity of insect species that requires prohibitively high investments of time, funding and taxonomic expertise when addressed with conventional tools. Here, we show that these concerns can be addressed through a comprehensive, scalable and cost-efficient DNA metabarcoding workflow. We use 1815 samples from 75 Malaise traps across Germany from 2019 and 2020 to demonstrate how metabarcoding can be incorporated into large-scale insect monitoring networks for less than 50 € per sample, including supplies, labour and maintenance. We validated the detected species using two publicly available databases (GBOL and GBIF) and the judgement of taxonomic experts. With an average of 1.4 M sequence reads per sample we uncovered 10,803 validated insect species, of which 83.9% were represented by a single Operational Taxonomic Unit (OTU). We estimated another 21,043 plausible species, which we argue either lack a reference barcode or are undescribed. The total of 31,846 species is similar to the number of insect species known for Germany (~35,500). Because Malaise traps capture only a subset of insects, our approach identified many species likely unknown from Germany or new to science. Our reproducible workflow (~80% OTU-similarity among years) provides a blueprint for large-scale biodiversity monitoring of insects and other biodiversity components in near real time.
Background: Psychoeducation positively influences the psychological components of chronic low back pain (CLBP) in conventional treatments. The digitalization of health care has led to the discussion of virtual reality (VR) interventions. However, CLBP treatments in VR have some limitations due to full immersion. In comparison, augmented reality (AR) supplements the real world with virtual elements involving one’s own body sensory perception and can combine conventional and VR approaches.
Objective: The aim of this study was to review the state of research on the treatment of CLBP through psychoeducation, including immersive technologies, and to formulate suggestions for psychoeducation in AR for CLBP.
Methods: A scoping review following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was performed in August 2024 by using Livivo ZB MED, PubMed, Web of Science, American Psychological Association PsycINFO (PsycArticle), and PsyArXiv Preprints databases. A qualitative content analysis of the included studies was conducted based on 4 deductively extracted categories.
Results: We included 12 studies published between 2019 and 2024 referring to conventional and VR-based psychoeducation for CLBP treatment, but no study referred to AR. In these studies, educational programs were combined with physiotherapy, encompassing content on pain biology, psychological education, coping strategies, and relaxation techniques. The key outcomes were pain intensity, kinesiophobia, pain catastrophizing, degree of disability, quality of life, well-being, self-efficacy, depression, attrition rate, and user experience. Passive, active, and gamified strategies were used to promote intrinsic motivation from a psychological point of view. Regarding user experience from a software development perspective, user friendliness, operational support, and application challenges were recommended.
Conclusions: For the development of a framework for an AR-based psychoeducational intervention for CLBP, the combination of theories of acceptance and use of technologies with insights from health psychological behavior change theories appears to be of great importance. An example of a theory-based design of a psychoeducation intervention in AR for CLBP is proposed and discussed.
Objectives: To investigate the feasibility and effects of a sensorimotor stabilization exercise intervention with and without behavioral treatment in nonspecific low back pain.
Design: A three-armed multicenter randomized controlled trial.
Setting: Five study sites across Germany (3 orthopedic university outpatient clinics, 1 university sports medicine department, and 1 clinical institution).
Participants: Six hundred and sixty-two volunteers (N=662) (59% females, age 39±13y) with low back pain.
Interventions: Sensorimotor training (SMT), sensorimotor training with behavioral therapy (SMT+BT), and usual care group (UCG; continuation of the already ongoing individual treatment regime). Intervention groups performed a 12-week (3wk center-based, 9wk home-based) program.
Main Outcome Measures: Adherence, dropout rates, adverse events, and intervention effects on pain intensity, disability, and trunk torque (gain scores, repeated measures analysis of variance, α-level<0.05).
Results: In total, 220 participants received SMT, 222 received SMT+BT, and 170 were analyzed as UCG. Dropout rates were 10% for SMT and SMT+BT at week 3, 31% and 30% at week 4, and 49% and 50% at week 12. Adherence rates above 80% were reached in both interventions; 134 adverse events occurred. Intervention effects compared to UCG were found for pain intensity (SMT, P=.011, effect size d=0.41), disability (SMT+BT, P=.020, d=0.41), and peak torque (SMT, P=.045, d=0.38; SMT+BT, P=.019, d=0.44), with overall small effect sizes.
Conclusions: Participants were highly adherent to the sensorimotor exercise, but showed increased dropout rates, particularly during home-based training. Both interventions proved to be feasible, and although only SMT showed an increased effect on pain intensity compared to UCG, the SMT+BT showed positive effects on disability. Both interventions led to increases in strength, indicative of a neuromuscular adaptation.
Background: Telerehabilitation can contribute to the maintenance of successful rehabilitation regardless of location and time. The aim of this study was to investigate a specific three-month interactive telerehabilitation routine regarding its effectiveness in assisting patients with physical functionality and with returning to work compared to typical aftercare.
Objective: The aim of the study was to investigate a specific three-month interactive telerehabilitation with regard to effectiveness in functioning and return to work compared to usual aftercare.
Methods: From August 2016 to December 2017, 111 patients (mean 54.9 years old; SD 6.8; 54.3% female) with hip or knee replacement were enrolled in the randomized controlled trial. At discharge from inpatient rehabilitation and after three months, their distance in the 6-minute walk test was assessed as the primary endpoint. Other functional parameters, including health related quality of life, pain, and time to return to work, were secondary endpoints.
Results: Patients in the intervention group performed telerehabilitation for an average of 55.0 minutes (SD 9.2) per week. Adherence was high, at over 75%, until the 7th week of the three-month intervention phase. Almost all the patients and therapists used the communication options. Both the intervention group (average difference 88.3 m; SD 57.7; P=.95) and the control group (average difference 79.6 m; SD 48.7; P=.95) increased their distance in the 6-minute-walk-test. Improvements in other functional parameters, as well as in quality of life and pain, were achieved in both groups. The higher proportion of working patients in the intervention group (64.6%; P=.01) versus the control group (46.2%) is of note.
Conclusions: The effect of the investigated telerehabilitation therapy in patients following knee or hip replacement was equivalent to the usual aftercare in terms of functional testing, quality of life, and pain. Since a significantly higher return-to-work rate could be achieved, this therapy might be a promising supplement to established aftercare.
Global change effects on biodiversity and human wellbeing call for improved long-term environmental data as a basis for science, policy and decision making, including increased interoperability, multifunctionality, and harmonization. Based on the example of two global initiatives, the International Long-Term Ecological Research (ILTER) network and the Group on Earth Observations Biodiversity Observation Network (GEO BON), we propose merging the frameworks behind these initiatives, namely ecosystem integrity and essential biodiversity variables, to serve as an improved guideline for future site-based long-term research and monitoring in terrestrial, freshwater and coastal ecosystems. We derive a list of specific recommendations of what and how to measure at a monitoring site and call for an integration of sites into co-located site networks across individual monitoring initiatives, and centered on ecosystems. This facilitates the generation of linked comprehensive ecosystem monitoring data, supports synergies in the use of costly infrastructures, fosters cross-initiative research and provides a template for collaboration beyond the ILTER and GEO BON communities.