Low Back Pain: Unveiling the Contribution of Motor Control Adaption Using Biomechanical Modeling and Neuroimaging
- Conditions
- Low Back Pain
- Interventions
- Other: mechanical stimulationOther: vibrotactile stimulation
- Registration Number
- NCT03255616
- Lead Sponsor
- Balgrist University Hospital
- Brief Summary
This project aims to reveal the potential sensorimotor reorganization of sensory input in low back pain patients and its association with different motor control strategies in LBP.
- Detailed Description
Background: Low back pain (LBP) is a major health issue. Treatment of chronic LBP is still a major challenge due to a lack of pathophysiological understanding. Thus, understanding LBP pathophysiology is a research priority. Adaptions of motor control likely play a significant role in chronic or recurrent LBP because motor control is crucial for spine posture, stability and movement. Different motor adaption strategies exist across individuals with LBP and two phenotypes representing the opposite ends of a spectrum have been suggested; i.e. "tight" control and "loose" control over trunk movement. The former would be associated with reduced trunk motor variability, the later with increased trunk motor variability. This conceptual framework is very useful to explain maintenance and aggravating of LBP because motor control adaptations are expected to have long-term consequences, such as increased spinal tissue loading, associated with degeneration of intervertebral discs and other tissues. Several knowledge gaps need to be addressed to test the validity of this framework: 1) Do loose/tight control phenotypes indeed exist and/or do other motor control adaption strategies exist? 2) Is reduced/altered paraspinal proprioceptive input associated with LBP related to neuroplastic cortical changes, thereby affecting the organizational structure in sensorimotor cortices and top-down trunk motor control? 3) Do psychological factors influence the organizational structure in sensorimotor cortices and motor control strategies? To address these knowledge gaps, the objectives of the current project are: I) To establish motor control phenotypes in LBP. Proprioceptive weighting and biomechanical assessment of dynamic movement tasks, including subject-specific spine kinematic variability and its relationship to pain duration, negative pain-related cognitions, segmental loadings and paraspinal muscle forces, will be performed. II) To test whether cortical proprioceptive maps differ between healthy subjects and patients with LBP. Brain activation in response to thoracolumbar vibrotactile stimulation will be interrogated using functional magnetic resonance imaging data and univariate and multivariate analysis based on machine learning. III) To test whether proprioceptive maps demonstrate a relationship to spine kinematic patterns, pain duration and negative pain-related cognitions in LBP patients.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 80
Not provided
Not provided
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Healthy subjects mechanical stimulation Spine kinematics assessment during daily activities and brain responses to thoracolumbar mechanical and vibrotactile stimulation Healthy subjects vibrotactile stimulation Spine kinematics assessment during daily activities and brain responses to thoracolumbar mechanical and vibrotactile stimulation Low back pain patients mechanical stimulation Spine kinematics assessment during daily activities and brain responses to thoracolumbar mechanical and vibrotactile stimulation Low back pain patients vibrotactile stimulation Spine kinematics assessment during daily activities and brain responses to thoracolumbar mechanical and vibrotactile stimulation
- Primary Outcome Measures
Name Time Method Blood oxygenation level dependent (BOLD) responses MR assessment, 30 minutes supraspinal BOLD responses induced by mechanical and vibrotactile stimulations of the back recorded by means of functional magnetic resonance imaging (fMRI)
Spine biomechanics: muscle forces Spinal kinematics assessment, 120 minutes segmental muscle forces (N/mm) during dynamic tasks
Proprioceptive repositioning errors Proprioceptive assessment, 10 minutes Sagittal plane repositioning errors assessed through lumbar and thoracic spinal curvature angles
Spine biomechanics: segmental loading Spinal kinematics assessment, 120 minutes segmental loading (N) during dynamic tasks
Center of pressure displacements Postural stability assessment, 20 minutes Center of pressure displacements during vibrotactile stimulation while standing on a force plate
Spine kinematics Spinal kinematics assessment, 120 minutes Sagittal and frontal plane lumbar and thoracic spinal curvature angles
- Secondary Outcome Measures
Name Time Method Fear of movement Medical assessment, 5 minutes score of the Tampa Scale of Kinesiphobia (TSK) questionnaire
Fear Avoidance Beliefs Medical assessment, 5 minutes scores of the Fear Aovidance Beliefs questionnaire (FABQ) in low back pain patients
Perception of the back Medical assessment, 2 minutes Assessment of self-perception of the back using the Fremantle Back Awareness Questionnaire
State and Trait anxiety Medical assessment, 2 minutes scores of state and trait anxiety (STAI) questionnaire
Perceived harmfulness of back stressing movements Medical assessment, 15 minutes Assessment of the perceived harmfulness of back stressing movements using the electronic version of the PHODA questionnaire
Pain characteristics Medical assessment, 1 minutes Pain quality assessment using the PainDETECT questionnaire in low back pain patients
Segmental movement MR assessment, 20 minutes Displacement (intervertebral angles) of the stimulated and adjacent spinal segments during mechanical pressure using dynamic T2 scans
Level of disability Medical assessment, 3 minutes scores of the Oswestry Disability Index (ODI) in low back pain patients
Trial Locations
- Locations (1)
Balgrist University Hospital
🇨🇭Zürich, Switzerland