scholarly journals Novel walking pole gait pattern improves activity in an older adult with chronic low back pain

2021 ◽  
Vol 14 (12) ◽  
pp. e245807
Author(s):  
Evan L Prost ◽  
Carmen C Abbott ◽  
Erin A Dannecker ◽  
Brad W Willis
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Chronic Low Back Pain ◽  
Perceived Exertion ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Gait Pattern ◽  
Potential Effect ◽  
Low Back ◽  
Decision Making Model

A 65-year-old woman with chronic low back pain participated in a 1-week community walking poles course. Although the participant received instruction in the standard Nordic walking method, she independently adopted a novel, modified, two-point gait pattern. Subsequently, her pain and activity tolerance using walking poles were monitored at 6 and 12 months. The participant ambulated two times the distance and reported lower ratings of perceived exertion and pain at 6-month and 12month follow-ups when walking with poles compared with walking without poles. This case highlights the potential effect of respecting patient preference within the clinical decision-making model. Doing so empowered a participant with chronic low back pain to adopt a novel, self-selected gait pattern and improve her short-term and long-term outcomes associated with chronic musculoskeletal disease.

scholarly journals Prediction of Treatment Outcomes for Patients with Chronic Low Back Pain: the Development of a Clinical Decision Guideline for Spine Surgeons

2016 ◽  
Vol 6 (1_suppl) ◽  
pp. s-0036-1582716-s-0036-1582716
Author(s):  
Miranda Van Hooff ◽  
Hanneke Van Dongen ◽  
Maarten Spruit ◽  
Raymond Ostelo ◽  
Marinus De Kleuver
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Treatment Outcomes ◽  
Chronic Low Back Pain ◽  
Clinical Decision ◽  
Low Back

scholarly journals A Graded Exposure, Locomotion-Enabled Virtual Reality App During Walking and Reaching for Individuals With Chronic Low Back Pain: Cohort Gaming Design (Preprint)

2020 ◽  
Author(s):  
Rebecca White Hennessy ◽  
Deanna Rumble ◽  
Mike Christian ◽  
David A Brown ◽  
Zina Trost
Keyword(s):  
Virtual Reality ◽  
Low Back Pain ◽  
Back Pain ◽  
Chronic Low Back Pain ◽  
Perceived Exertion ◽  
Rating Of Perceived Exertion ◽  
Low Back ◽  
Progressive Movement ◽  
System Usability Scale ◽  
Graded Exposure

BACKGROUND Chronic low back pain (cLBP) can interfere with daily activities, and individuals with elevated pain-related fear (also known as kinesiophobia or the fear of injury due to movement) can develop worse long-term disability. Graded exposure (GEXP) protocols use successive participation in avoided activities to help individuals overcome fearful movement appraisals and encourage activity. We sought to develop a series of GEXP virtual reality (VR) walking and reaching scenarios to increase the exposure and engagement of people with high kinesiophobia and cLBP. OBJECTIVE This study aims to (1) determine GEXP content validity of the VR application and (2) determine the feasibility of individuals with cLBP performing locomotion-enabled physical activities. METHODS We recruited 13 individuals with cLBP and high pain-related fear to experience six VR modules, which provide progressive movement exposure over three sessions in a 1 week period. At session 1, participants ranked each module by likelihood to avoid and assigned an expected pain and concern for harming their back rating to each module. Participants provided a rating of perceived exertion (RPE) after experiencing each module. To test feasibility, we administered the system usability scale (SUS) and treatment evaluation inventory (TEI) following the final session. In addition, we measured pain and pain-related fear at baseline and follow-up. RESULTS The 12 participants who completed the study period assigned higher avoidance (<i>P</i>=.002), expected pain (<i>P</i>=.002), and expected concern (<i>P</i>=.002) for session 3 modules compared with session 1 modules. RPE significantly increased from session 1 (mean 14.8, SD 2.3) to session 3 (mean 16.8, SD 2.2; <i>P</i>=.009). The VR application showed positive feasibility for individuals with cLBP through acceptable SUS (mean 76.7, SD 13.0) and TEI (mean 32.5, SD 4.9) scores. Neither pain (<i>P</i>=.20) nor pain-related fear (<i>P</i>=.58) changed significantly across sessions. CONCLUSIONS The GEXP VR modules provided progressive exposure to physical challenges, and participants found the VR application acceptable and usable as a potential treatment option. Furthermore, the lack of significant change for pain and pain-related fear reflects that participants were able to complete the modules safely.

scholarly journals The Nijmegen Decision Tool for Chronic Low Back Pain. Development of a Clinical Decision Tool for Secondary or Tertiary Spine Care Specialists

PLoS ONE ◽  
2014 ◽  
Vol 9 (8) ◽  
pp. e104226 ◽  
Author(s):  
Miranda L. van Hooff ◽  
Jan van Loon ◽  
Jacques van Limbeek ◽  
Marinus de Kleuver
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Chronic Low Back Pain ◽  
Clinical Decision ◽  
Low Back ◽  
Decision Tool ◽  
Spine Care

Clinical Assessment of Low-Back-Pain Treatment Outcomes in Athletes

2011 ◽  
Vol 20 (1) ◽  
pp. 74-88 ◽  
Author(s):  
Luzita I. Vela ◽  
Douglas E. Haladay ◽  
Craig Denegar
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Clinical Outcomes ◽  
Clinical Decision Making ◽  
Outcomes Assessment ◽  
Clinical Decision ◽  
Low Back ◽  
Bottom Line ◽  
Patient Scenario ◽  
Clinical Outcomes Assessment

Patient Scenario:A 21-year-old male rodeo athlete complains of acute low back pain (LBP) after a bareback event. The athlete wishes to compete in a rodeo event in 4 d.Clinical Outcomes Assessment:Given the questionable validity and reliability of traditional clinical examination techniques for LBP, a treatment subgroup classification system combined with clinical outcomes assessment provides greater insight into suitable clinical interventions and patient response to treatment. Four LBP treatment subgroups based on the patient’s clinical presentation and symptoms have been established: manipulation, stabilization, specific exercise, and traction. Manipulation subgroup research has produced a valid clinical prediction rule (CPR). The Visual Analog Scale, Numeric Rating Scale (NRS), Oswestry Low Back Pain Disability Index (ODI), Roland Morris Disability Questionnaire, Short Form 36 (SF-36), and Global Rating of Change Scale are valid, reliable, and responsive outcomes instruments with established values for minimum clinically important difference (MCID). These instruments document important changes in disablement and health-related quality of life in patients with low back injury, as well as demonstrate treatment outcomes.Clinical Decision Making:On examination the athlete presents with moderate pain and disability as measured by the NRS, ODI, and SF-36 and meets all 5 criteria for the manipulation subgroup, indicating a high likelihood of success with manipulative therapy when following the guidelines presented in the CPR. Expected outcomes values, based on MCID values, were met after 1 treatment. Preferred outcomes, based on physical activity requirements for sport, were met on day 4.Clinical Bottom Line:LBP generators are difficult to establish using traditional clinical examination techniques. The combined use of clinical criteria, using an LBP subgroup system, and baseline outcomes measures should guide treatment. Benchmarks should be guided by established MCID values for each instrument.

scholarly journals Subgrouping Patients With Low Back Pain

2011 ◽  
Vol 3 (6) ◽  
pp. 534-542 ◽  
Author(s):  
Jeffrey J. Hebert ◽  
Shane L. Koppenhaver ◽  
Bruce F. Walker
Keyword(s):  
Decision Making ◽  
Low Back Pain ◽  
Back Pain ◽  
Spinal Manipulation ◽  
Clinical Decision Making ◽  
Treatment Approach ◽  
Clinical Decision ◽  
Low Back ◽  
Stabilization Exercise ◽  
Socioeconomic Burden

Context: Low back pain (LBP) is a prevalent condition imposing a large socioeconomic burden. Despite intensive research aimed at the efficacy of various therapies for patients with LBP, most evidence has failed to identify a superior treatment approach. One proposed solution to this dilemma is to identify subgroups of patients with LBP and match them with targeted therapies. Among the subgrouping approaches, the system of treatment-based classification (TBC) is promoted as a means of increasing the effectiveness of conservative interventions for patients with LBP. Evidence acquisition: MEDLINE and PubMed databases were searched from 1985 through 2010, along with the references of selected articles. Results: TBC uses a standardized approach to categorize patients into 1 of 4 subgroups: spinal manipulation, stabilization exercise, end-range loading exercise, and traction. Although the TBC subgroups are in various stages of development, recent research lends support to the effectiveness of this approach. Conclusions: While additional research is required to better elucidate this method, the TBC approach enhances clinical decision making, as evidenced by the improved clinical outcomes experienced by patients with LBP.

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