Instruction Modes for Motor Control Skills Acquisition: A Randomized Controlled Trial

2019 ◽  
Vol 52 (4) ◽  
pp. 444-455 ◽  
Author(s):  
Roy La Touche ◽  
Macarena Sánchez-Vázquez ◽  
Ferran Cuenca-Martínez ◽  
María Prieto-Aldana ◽  
Alba Paris-Alemany ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Motor Control ◽  
Controlled Trial ◽  
Skills Acquisition ◽  
Randomized Controlled

scholarly journals Predicting Response to Motor Control Exercises and Graded Activity for Patients With Low Back Pain: Preplanned Secondary Analysis of a Randomized Controlled Trial

2014 ◽  
Vol 94 (11) ◽  
pp. 1543-1554 ◽  
Author(s):  
Luciana Gazzi Macedo ◽  
Christopher G. Maher ◽  
Mark J. Hancock ◽  
Steve J. Kamper ◽  
James H. McAuley ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Low Back Pain ◽  
Motor Control ◽  
Back Pain ◽  
Controlled Trial ◽  
Secondary Analysis ◽  
Low Back ◽  
Randomized Controlled ◽  
Clinical Instability ◽  
Graded Activity

Background Current treatments for low back pain have small effects. A research priority is to identify patient characteristics associated with larger effects for specific interventions. Objective The aim of this study was to identify simple clinical characteristics of patients with chronic low back pain who would benefit more from either motor control exercises or graded activity. Design This study was a secondary analysis of the results of a randomized controlled trial. Methods One hundred seventy-two patients with chronic low back pain were enrolled in the trial, which was conducted in Australian physical therapy clinics. The treatment consisted of 12 initial exercise sessions over an 8-week period and booster sessions at 4 and 10 months following randomization. The putative effect modifiers (psychosocial features, physical activity level, walking tolerance, and self-reported signs of clinical instability) were measured at baseline. Measures of pain and function (both measured on a 0–10 scale) were taken at baseline and at 2, 6, and 12 months by a blinded assessor. Results Self-reported clinical instability was a statistically significant and clinically important modifier of treatment response for 12-month function (interaction: 2.72; 95% confidence interval=1.39 to 4.06). Participants with high scores on the clinical instability questionnaire (≥9) did 0.76 points better with motor control exercises, whereas those who had low scores (<9) did 1.93 points better with graded activity. Most other effect modifiers investigated did not appear to be useful in identifying preferential response to exercise type. Limitations The psychometric properties of the instability questionnaire have not been fully tested. Conclusions A simple 15-item questionnaire of features considered indicative of clinical instability can identify patients who respond best to either motor control exercises or graded activity.

scholarly journals Treadmill integrated robot-assisted ankle dorsiflexion training for stroke rehabilitation: A randomized controlled trial

2020 ◽  
Author(s):  
Susan Conroy ◽  
Anindo Roy ◽  
Laurence Magder ◽  
Derek Eversley ◽  
Kate Flores ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Motor Control ◽  
Negative Impact ◽  
Controlled Trial ◽  
Ankle Dorsiflexion ◽  
Treadmill Training ◽  
Foot Drop ◽  
Gait Velocity ◽  
Randomized Controlled ◽  
Foot Strike

Abstract Background: Stroke-related ankle dysfunction due to hemiparesis has a profound negative impact on gait biomechanics and walking. Task-oriented treadmill training improves gait velocity but does not lead to restitution of ankle function. Advances in robotic technology have led to the development of an adaptive ankle robot that can be integrated into treadmill walking and provide precisely timed graded assistance consistent with motor learning approaches. The aim of this study was to compare the effectiveness of a 6-week treadmill-integrated adaptive ankle robot (TMR) training to 6-weeks of treadmill training (TM) alone on improved paretic ankle motor control and gait performance. Methods: This was a single-blind (evaluator-blinded) randomized controlled trial. 45 participants received either TMR or TM training 3 times per week for 6 weeks. Primary outcomes were improved peak paretic ankle dorsiflexion (DF) angle at swing, improved DF angle at foot strike (weight acceptance), and increased gait velocity during self-selected over-ground walking. The primary analysis was based on intention-to-treat using a longitudinal regression model. An additional sub-set analysis of subjects with biomechanically defined foot drop was performed. Results: There were no significant post-training ankle dorsiflexion or gait velocity differences between groups. Six-week post-training mean peak paretic DF swing angle was (4.84 ± 6.83; 4.2 ± 6.83 p=0.63) and DF angle at foot strike was (-0.70 ± 6.55; -0.46 ± 5.70 p=0.84) respectively for TMR and TM. Gait velocity gains were similar and TMR had a mean increase of 0.54 m/s ± 0.24 and TM increased 0.56 m/s ±0.32. p=0.48 post-training.Conclusion: Integrating adaptive ankle robotics into task-specific locomotor training was not significantly better than treadmill training alone. Both interventions improved gait velocity. Promising results in ankle motor control were seen in a subset of subjects with biomechanically defined foot drop that warrants further investigation. Clinical Trial Registration: Clinical trials.gov id: NCT02483676. Registered June 29, 2015, https://clinicaltrials.gov/ct2/show/NCT02483676

scholarly journals Motor Control Exercises, Sling Exercises, and General Exercises for Patients With Chronic Low Back Pain: A Randomized Controlled Trial With 1-Year Follow-up

2010 ◽  
Vol 90 (10) ◽  
pp. 1426-1440 ◽  
Author(s):  
Monica Unsgaard-Tøndel ◽  
Anne Margrethe Fladmark ◽  
Øyvind Salvesen ◽  
Ottar Vasseljen
Keyword(s):  
Randomized Controlled Trial ◽  
Low Back Pain ◽  
Motor Control ◽  
Back Pain ◽  
Outcome Measures ◽  
Chronic Low Back Pain ◽  
Controlled Trial ◽  
Low Back ◽  
Randomized Controlled

BackgroundExercise benefits patients with chronic nonspecific low back pain; however, the most effective type of exercise remains unknown.ObjectiveThis study compared outcomes after motor control exercises, sling exercises, and general exercises for low back pain.DesignThis was a randomized controlled trial with a 1-year follow-up.SettingThe study was conducted in a primary care setting in Norway.PatientsThe participants were patients with chronic nonspecific low back pain (n=109).InterventionsThe interventions in this study were low-load motor control exercises, high-load sling exercises, or general exercises, all delivered by experienced physical therapists, once a week for 8 weeks.MeasurementsThe primary outcome measure was pain reported on the Numeric Pain Rating Scale after treatment and at a 1-year follow-up. Secondary outcome measures were self-reported activity limitation (assessed with the Oswestry Disability Index), clinically examined function (assessed with the Fingertip-to-Floor Test), and fear-avoidance beliefs after intervention.ResultsThe postintervention assessment showed no significant differences among groups with respect to pain (overall group difference) or any of the outcome measures. Mean (95% confidence interval) group differences for pain reduction after treatment and after 1 year were 0.3 (−0.7 to 1.3) and 0.4 (−0.7 to 1.4) for motor control exercises versus sling exercises, 0.7 (−0.6 to 2.0) and 0.3 (−0.8 to 1.4) for sling exercises versus general exercises, and 1.0 (−0.1 to 2.0) and 0.7 (−0.3 to 1.7) for motor control exercises versus general exercises.LimitationsThe nature of the interventions made blinding impossible.ConclusionsThis study gave no evidence that 8 treatments with individually instructed motor control exercises or sling exercises were superior to general exercises for chronic low back pain.

scholarly journals In-Person Versus eHealth Mindfulness-Based Intervention for Adolescents With Chronic Illness: Protocol for a Randomized Controlled Trial (Preprint)

2017 ◽  
Author(s):  
Nicholas Chadi ◽  
Miriam Kaufman ◽  
Elli Weisbaum ◽  
Catherine Malboeuf-Hurtubise ◽  
Sara Ahola Kohut ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Salivary Cortisol ◽  
Qualitative Data ◽  
Controlled Trial ◽  
Illness Perception ◽  
Self Esteem ◽  
Skills Acquisition ◽  
Home Practice ◽  
Mindfulness Skills ◽  
Randomized Controlled

BACKGROUND Eight-week mindfulness-based interventions (MBIs) have a beneficial impact on mental health and well-being in adolescents with chronic health conditions. Usually delivered in person in a group setting, these programs are difficult to access for teens with disabilities or who do not have in-person MBIs available in their communities. OBJECTIVE This paper outlines the rationale, development, and design of a randomized controlled trial comparing the effects of an MBI delivered in person or via eHealth in adolescents with a chronic illness. Quantitative outcomes will include mindfulness skills acquisition (primary outcome), effects of the MBI on self-reported mood, anxiety, self-esteem, illness perception, and physiological stress (via salivary cortisol), and qualitative outcomes will include individual practice, participant appreciation, and adaptation of the MBI for eHealth. METHODS This is a randomized noninferiority mixed methods study comparing 2 MBI arms: in-person and eHealth. Participants are eligible to participate if they are aged 13 to 18 years, have a diagnosis of chronic medical condition, live close enough to the recruitment hospital to participate in the in-person arm of the study, and are currently followed by a health care provider. Each participant will receive an adapted 8-week MBI delivered either in person at a tertiary pediatric hospital or via a secure audio-visual platform allowing group interactions in real time. Groups will be facilitated by 2 experienced mindfulness providers. Quantitative and qualitative data will be collected through standardized research questionnaires administered via a secure, youth-friendly online platform and through semistructured interviews, participant log books, facilitator log books, and salivary cortisol analysis. Qualitative data will be analyzed using a grounded theory model. RESULTS Data collection is currently underway. Data analysis, manuscript writing, and additional publications are expected to be completed in the winter and spring of 2018. CONCLUSIONS Based on previous results from in-person trials conducted in adolescents and eHealth trials conducted in adults, we anticipate that both modes of delivery will significantly improve mindfulness skills acquisition, mood, anxiety, self-esteem, illness perception, and stress and that the magnitude of the effects will be correlated to the level of home practice. We predict that participants in both arms will show similar levels of home practice and that both modes of delivery will have high levels of feasibility and acceptability. If successful, this study could provide evidence for the use of eHealth in the delivery of 8-week MBIs in clinical adolescent populations, potentially increasing availability to MBIs for a large group of youth with mobility issues or living away from large urban centers. CLINICALTRIAL ClinicalTrials.org NCT03067207; https://clinicaltrials.gov/ct2/show/NCT03067207 (archived by WebCite at http://www.webcitation.org/6v4ZK8RBH)

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