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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: 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.
Vibroarthrography measures joint sounds caused by sliding of the joint surfaces over each other. and can be affected by joint health, load and type of movement. Since both warm-up and muscle fatigue lead to local changes in the knee joint (e.g., temperature increase, lubrication of the joint, muscle activation), these may impact knee joint sounds. Therefore, this study investigates the effects of warm-up and muscle fatiguing exercise on knee joint sounds during an activity of daily living. Seventeen healthy, physically active volunteers (25.7 ± 2 years, 7 males) performed a control and an intervention session with a wash-out phase of one week. The control session consisted of sitting on a chair, while the intervention session contained a warm-up (walking on a treadmill) followed by a fatiguing exercise (modified sit-to-stand) protocol. Knee sounds were recorded by vibroarthrography (at the medial tibia plateau and at the patella) at three time points in each session during a sit-to-stand movement. The primary outcome was the mean signal amplitude (MSA, dB). Differences between sessions were determined by repeated measures ANOVA with intra-individual pre-post differences for the warm-up and for the muscle fatigue effect. We found a significant difference for MSA at the medial tibia plateau (intervention: mean 1.51 dB, standard deviation 2.51 dB; control: mean -1.28 dB, SD 2.61 dB; F = 9.5; p = .007; η2 = .37) during extension (from sit to stand) after the warm-up. There was no significant difference for any parameter after the muscle fatiguing exercise (p > .05). The increase in MSA may mostly be explained by an increase in internal knee load and joint friction. However, neuromuscular changes may also have played a role. It appears that the muscle fatiguing exercise has no impact on knee joint sounds in young, active, symptom-free participants during sit to stand.
Study design: Systematic review with meta-analysis and meta-regression.
Background and objectives: We systematically reviewed and delineated the existing evidence on sustainability effects of motor control exercises on pain intensity and disability in chronic low back pain patients when compared with an inactive or passive control group or with other exercises. Secondary aims were to reveal whether moderating factors like the time after intervention completion, the study quality, and the training characteristics affect the potential sustainability effects.
Methods: Relevant scientific databases (Medline, Web of Knowledge, Cochrane) were screened. Eligibility criteria for selecting studies: All RCTs und CTs on chronic (≥ 12/13 weeks) nonspecific low back pain, written in English or German and adopting a longitudinal core-specific/stabilizing sensorimotor control exercise intervention with at least one pain intensity and disability outcome assessment at a follow-up (sustainability) timepoint of ≥ 4 weeks after exercise intervention completion.
Results and conclusions: From the 3,415 studies that were initially retrieved, 10 (2 CTs & 8 RCTs) on N = 1081 patients were included in the review and analyses. Low to moderate quality evidence shows a sustainable positive effect of motor control exercise on pain (SMD = -.46, Z = 2.9, p < .001) and disability (SMD = -.44, Z = 2.5, p < .001) in low back pain patients when compared to any control. The subgroups’ effects are less conclusive and no clear direction of the sustainability effect at short versus mid versus long-term, of the type of the comparator, or of the dose of the training is given. Low quality studies overestimated the effect of motor control exercises.
Stabilization exercise (SE) is evident for the management of chronic non-specific low back pain (LBP). The optimal dose-response-relationship for the utmost treatment success is, thus, still unknown. The purpose is to systematically review the dose-response-relationship of stabilisation exercises on pain and disability in patients with chronic non-specific LBP. A systematic review with meta-regression was conducted (Pubmed, Web of Knowledge, Cochrane). Eligibility criteria were RCTs on patients with chronic non-specific LBP, written in English/German and adopting a longitudinal core-specific/stabilising/motor control exercise intervention with at least one outcome for pain intensity and/or disability. Meta-regressions (dependent variable = effect sizes (Cohens d) of the interventions (for pain and for disability), independent variable = training characteristics (duration, frequency, time per session)), and controlled for (low) study quality (PEDro) and (low) sample sizes (n) were conducted to reveal the optimal dose required for therapy success. From the 3,415 studies initially selected, 50 studies (n = 2,786 LBP patients) were included. N = 1,239 patients received SE. Training duration was 7.0 ± 3.3 weeks, training frequency was 3.1 ± 1.8 sessions per week with a mean training time of 44.6 ± 18.0 min per session. The meta-regressions’ mean effect size was d = 1.80 (pain) and d = 1.70 (disability). Total R2 was 0.445 and 0.17. Moderate quality evidence (R2 = 0.231) revealed that a training duration of 20 to 30 min elicited the largest effect (both in pain and disability, logarithmic association). Low quality evidence (R2 = 0.125) revealed that training 3 to 5 times per week led to the largest effect of SE in patients with chronic non-specific LBP (inverted U-shaped association). In patients with non-specific chronic LBP, stabilization exercise with a training frequency of 3 to 5 times per week (Grade C) and a training time of 20 to 30 min per session (Grade A) elicited the largest effect on pain and disability.
Background: Electrical stimulation is an effective treatment method for improving motor function after stroke, but the optimal current type for patients with stroke and arm paresis remains unclear.
Objective: To compare the effects of kilohertz frequency with low-frequency current on stimulation efficiency, electrically induced force, discomfort, and muscle fatigue in patients with stroke.
Design: A randomized crossover study.
Setting: Neurological inpatient rehabilitation clinic in Germany.
Participants: A total of 23 patients with arm paresis after stroke within the last 6 months were recruited, 21 were enrolled, and 20 completed the study (7 females; mean ± SD: 66 ± 12 years; 176 ± 11 cm; 90 ± 19 kg; 57 ± 34 days since stroke).
Intervention: All patients underwent both kilohertz and low-frequency stimulation in a randomized order on 2 days (48-hour washout). Each day included a step protocol with a gradual increase in stimulation intensity, starting at the first measurable force (up to 12 steps, 1 mA increments, 8 seconds stimulation, 60 second rest) and a fatigue protocol (30 repetitions, 8 second stimulation, 3 second rest).
Main Outcome Measure: Primary outcome was stimulation efficiency (electrically induced force/stimulation intensity) [N/mA], measured during each step of the stepwise increase in current intensity protocol.
Results: Linear-mixed-effects models showed significantly higher stimulation efficiency for low-frequency stimulation (mean difference 0.14 [95% confidence interval, 0.01–0.27 N/mA], p = .031). However, current type did not significantly affect electrically induced force, level of discomfort, or muscle fatigue (p > .05).
Conclusion: The findings suggest that low-frequency stimulation is more efficient than kilohertz-frequency stimulation. However, both current types yield similar effects on force, discomfort, and fatigue, making them both viable options for wrist extensor stimulation in patients after stroke. Considering the variability among individuals, customizing the current type based on electrically induced force and perceived discomfort may enhance therapeutic outcomes. Further research on the long-term treatment effects of both current types is warranted.
