Chronic Pain, Low Back Pain, Muscle Tightness
Conditions
Keywords
Psychologically informed physiotherapy, Electromyography biofeedback, Cognitive Muscular Therapy
Brief summary
The primary aim of this study is to adapt Cognitive Muscular Therapy so that it can be used to manage chronic low back pain. A secondary aim is to understand the potential therapeutic benefit of this intervention.
Detailed description
There is evidence that people with chronic low back pain (LBP) demonstrate muscle overactivity during functional tasks when compared to healthy controls. Interestingly, this increased activity of the low back and trun, muscles has been associated with increased sensitivity to pain. It has also been shown that people with chronic LBP exhibit alterations in functional movement patterns and postures when compared to healthy people. Such alterations may be a direct result of increased stiffness in the spine which results from muscle overactivity. Psychosocial physiotherapy techniques for LBP are gaining widescale acceptance. However, these approaches are often combined with strengthening exercises, and not specifically aimed at reducing muscle overactivity. Therefore, there is a need for research into interventions for chronic LBP which integrate psychologically informed practice with training to reduce muscle overactivity. The investigators have developed a new treatment for people with knee osteoarthritis, known as Cognitive Muscular Therapy (CMT). CMT is a form of psychologically informed physiotherapy which uses biofeedback training to reduce muscle overactivity and therefore lower the mechanical stress on the knee. CMT is delivered through five sequential intervention components and teaches patients to think and respond differently to pain, to improve postural control and to perform functional movements, such as walking, with less muscle tension. See the dedicated website for further details (https://hub.salford.ac.uk/cognitive-muscular-therapy/). Given the strong focus on postural control, the investigators are confident that CMT can be adapted and used to treat other chronic musculoskeletal conditions, such as LBP. In this project, the investigators will map changes to the five CMT intervention components. The intervention will then be delivered to patients with chronic low back pain, after which the investigators will seek to understand participant perceptions of the new treatment.
Interventions
BEHAVIORALCognitive Muscular Therapy for low back pain
Psychologically informed physiotherapy which used biofeedback training to reduce muscle overactivity and improve postural control
Sponsors
University of Salford
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
The primary aim is to develop the intervention. We will do this through delivery of the intervention to three waves of patients. After each of the first two waves, the intervention will be adapted based on participant feedback
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Above 18 years old 2. Speak and understand English sufficient to read the information sheet and sign the consent form 3. Ability to walk without an assistive device for at least 100m (to ensure patients have sufficient mobility to be able to complete the intervention) 4. Low back pain for at least three months' duration 5. Currently scoring 4 or more on the Roland disability scale
Exclusion criteria
1. Dementia or other major cognitive impairment 2. Red flags (specific causes of LBP, such as acute disc prolapse with radicular pain, or other serious pathology) 3. Pregnancy 4. History of serious spinal injury (fractures, spinal cord injury) 5. BMI \>33 (as EMG measurement is not possible in people with higher BMI) 6. Acute low back pain (Onset less than 3 months) 7. Any systemic inflammatory disorders, such as rheumatoid arthritis 8. Any balance disorders which may increase the risk of a fall
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Rowland Morris Disability questionnaire | Change from baseline to 2 months | Used to capture pain/disability associated with low back pain. Score 0-24 (0=no pain, 24=maximum pain) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in Pain catastrophizing scale | Change from baseline to 2 months | Used to capture pain catastrophizing behaviours. Score 0-52 (0=no pain catastrophizing, 52=maximum pain catastrophizing) |
| Change in Tampa scale of kinesiophobia | Change from baseline to 2 months | Used to capture kinesiophobia behaviours. Score 17-68 (0=no kinesiophobia, 52=maximum kinesiophobia) |
| Change in Oswestry disability scale | Change from baseline to 2 months | Used to capture intensity of low back pain. Score 0-100 (0=no pain) |
Countries
United Kingdom
Outcome results
None listed