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Devorski L, Suppiah A, Fukuda DH, Stout J, Ingersoll CD, Mangum LC. Gamified delivery of at-home rehabilitation for individuals with nonspecific low back pain: a randomized controlled trial. Disabil Rehabil 2024:1-7. [PMID: 38899776 DOI: 10.1080/09638288.2024.2368694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 06/09/2024] [Indexed: 06/21/2024]
Abstract
PURPOSE To measure the change in pain and disability during and after a 6-week gamified delivery of home exercise compared to a take-home packet. MATERIALS AND METHODS A 6-week at-home exercise protocol included participants randomly allocated to a gamified delivery group or packet group. The exercise protocol included the plank, side plank, foot elevated side plank, dead bug, and bird dog completed until discontinuation. The gamified delivery group received on-demand exercise videos and weekly exercise duration leaderboards. The packet group received a take-home packet. RESULTS Forty participants were randomized into a packet group and leaderboard group, and 30 participants completed the study. Disability was significantly lower at 6-weeks (11.29 ± 9.81%) compared to baseline (15.93 ± 11.65%) in the packet group (χ2(2) =10.89, Z= -3.163, p=.002, r=.708). Percent disability was significantly lower at 6-weeks (8.00 ± 5.91%) compared to baseline (13.01 ± 7.17%) in the gamified delivery group (χ2(2) =13.235, Z= -3.399, p= <.001, r= -0.760). Worst pain was higher at baseline (7.05 ± 1.61%) than at 6-weeks (5.75 ± 1.68%) in the packet group (χ2(2) =8.067, Z = 2.760, p=.006, r= -0.617). Worst pain was higher at baseline (6.90 ± 1.33%) than at 6-weeks (5.24 ± 2.38%) in the gamified delivery group (χ2(2) =6.250, Z= -2.810, p=.005, r= -0.628). No significant difference in the change of disability from baseline to 6 weeks was found between groups (p=.483). CONCLUSIONS Core exercises completed until failure may improve disability and pain at 6-weeks and positively influence perceived patient improvement.Registry: Clinicaltrials.gov; Registration number: NCT05573932.
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Affiliation(s)
- Luk Devorski
- Sport, Wellness, Exercise Physiology and Athletic Training (SWEAT) Laboratory, Department of Health Sciences, Saint Joseph's University, Lower Merion, PA, USA
| | - Aravinthan Suppiah
- College of Medicine, University of Central FL, Orlando, FL, USA
- Functional Sports Medicine TM Institute, Orlando, FL, USA
| | - David H Fukuda
- College of Health Professions and Sciences, University of Central Florida, Orlando, FL, USA
- Physiology of Work & Exercise Response (POWER) Laboratory, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, FL, USA
| | - Jeffrey Stout
- College of Health Professions and Sciences, University of Central Florida, Orlando, FL, USA
- Physiology of Work & Exercise Response (POWER) Laboratory, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, FL, USA
| | | | - L Colby Mangum
- College of Health Professions and Sciences, University of Central Florida, Orlando, FL, USA
- Rehabilitation, Athletic assessment, & Dynamic Imaging (READY) Laboratory, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, FL, USA
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Arensman RM, Heymans MW, Kloek CJJ, Ostelo RJWG, Veenhof C, Koppenaal T, Pisters MF. Trajectories of Adherence to Home-Based Exercise Recommendations Among People With Low Back Pain: A Longitudinal Analysis. Phys Ther 2023; 103:pzad091. [PMID: 37669137 PMCID: PMC10740005 DOI: 10.1093/ptj/pzad091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 05/04/2023] [Accepted: 06/12/2023] [Indexed: 09/07/2023]
Abstract
OBJECTIVE This study aimed to examine the presence of distinct trajectories of adherence to home-based exercise recommendations among people with low back pain (LBP). This study also aimed to identify differences in baseline characteristics among groups. METHODS This study was a secondary analysis of a prospective, multicenter cluster randomized controlled trial investigating the cost-effectiveness of a stratified blended physical therapist intervention compared to usual care physical therapy in patients with LBP. The intervention group received usual care with integrated support via a smartphone app. A total of 208 patients were recruited from 58 primary care physical therapist practices. Baseline data included patient characteristics, physical functioning, pain intensity, physical activity, fear avoidance, pain catastrophizing, self-efficacy, self-management ability, and health-related quality of life. The Exercise Adherence Scale (score range = 0-100) was used to measure adherence during each treatment session. Latent class growth analysis was used to estimate trajectories of adherence. RESULTS Adherence data were available from 173 out of 208 patients (83%). Data were collected during an average of 5.1 (standard deviation [SD] = 2.5) treatment sessions, with total treatment duration of 51 (SD = 41.7) days. Three trajectory classes were identified: "declining adherence" (12%), "stable adherence" (45%), and "increasing adherence" (43%). No differences in baseline characteristic were found between groups. CONCLUSION Three adherence trajectories to exercise recommendations were identified in patients with LBP. However, baseline characteristics cannot identify a patient's trajectory group. IMPACT Despite the presence of distinct trajectories of adherence in patients with LBP, physical therapists should not attempt to place a patient in a trajectory group at the start of treatment. Instead, adherence should be closely monitored as treatment progresses and supported when required as part of an ongoing process.
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Affiliation(s)
- Remco M Arensman
- Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, The Netherlands
- Physical Therapy Research, Department of Rehabilitation, Physiotherapy Science and Sport, Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Martijn W Heymans
- Department of Data Science and Bio-Statistics, Amsterdam Public Health Research Institute, Amsterdam University Medical Centre, Location VUmc, North-Holland, Amsterdam, The Netherlands
| | - Corelien J J Kloek
- Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, The Netherlands
- Expertise Center Healthy Urban Living, Research Group Innovation of Human Movement Care, HU University of Applied Sciences, Utrecht, The Netherlands
| | - Raymond J W G Ostelo
- Department of Health Sciences, Faculty of Science, VU University Amsterdam, Amsterdam Movement Sciences Research Institute Amsterdam, North-Holland, Amsterdam, The Netherlands
- Department of Epidemiology and Data Science, Amsterdam University Medical Centre, Location VUmc, North-Holland, Amsterdam, The Netherlands
| | - Cindy Veenhof
- Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, The Netherlands
- Physical Therapy Research, Department of Rehabilitation, Physiotherapy Science and Sport, Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Expertise Center Healthy Urban Living, Research Group Innovation of Human Movement Care, HU University of Applied Sciences, Utrecht, The Netherlands
| | - Tjarco Koppenaal
- Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, The Netherlands
- Physical Therapy Research, Department of Rehabilitation, Physiotherapy Science and Sport, Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Research Group Empowering Healthy Behaviour, Department of Health Innovations and Technology, Fontys University of Applied Sciences, North-Brabant, Eindhoven, The Netherlands
| | - Martijn F Pisters
- Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, The Netherlands
- Physical Therapy Research, Department of Rehabilitation, Physiotherapy Science and Sport, Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Research Group Empowering Healthy Behaviour, Department of Health Innovations and Technology, Fontys University of Applied Sciences, North-Brabant, Eindhoven, The Netherlands
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Vlazna D, Krkoska P, Sladeckova M, Parmova O, Barusova T, Hrabcova K, Vohanka S, Matulova K, Adamova B. Trunk muscle dysfunction in patients with myotonic dystrophy type 2 and its contribution to chronic low back pain. Front Neurol 2023; 14:1258342. [PMID: 37954643 PMCID: PMC10637363 DOI: 10.3389/fneur.2023.1258342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/11/2023] [Indexed: 11/14/2023] Open
Abstract
Introduction Myotonic dystrophy type 2 (MD2) presents with a varied manifestation. Even though the myopathy in these patients is more widespread, axial musculature involvement is one of the most prominent conditions. MD2 patients also often report chronic low back pain (CLBP). The purpose of this study was to evaluate trunk muscle function, including respiratory muscles, in patients with MD2 and to compare it with healthy controls, to determine the occurrence of CLBP in patients with MD2, and to assess whether trunk muscle dysfunction increases the risk of CLBP in these patients. Methods We enrolled 40 MD2 patients (age range 23 to 76 years, 26 women). A comprehensive battery of tests was used to evaluate trunk muscle function. The tests consisted of quantitative muscle strength testing of low back extensor muscles and respiratory muscles and the assessment of trunk muscle endurance. A neurological evaluation contained procedures assessing the distribution of muscle weakness, myotonia, and pain, and used questionnaires focused on these items and on disability, depression, and physical activity. Results The results of this study suggest that patients with MD2 show significant dysfunction of the trunk muscles, including the respiratory muscles, expressed by decreased muscle strength and endurance. The prevalence of CLBP in patients with MD2 was 52.5%. Based on our analysis, the only independent significant risk factor for CLBP in these patients was maximal isometric lower back extensor strength in a prone position ≤ 15.8 kg (OR = 37.3). Other possible risk factors were severity of myotonia and reduced physical activity. Conclusion Outcomes of this study highlighted the presence of axial muscle dysfunction, respiratory muscle weakness, and frequent occurrence of CLBP together with its risk factors in patients with MD2. We believe that the findings of this study may help in management and prevention programs for patients with MD2.
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Affiliation(s)
- Daniela Vlazna
- Department of Neurology, Center for Neuromuscular Diseases (Associated National Center in the European Reference Network ERN EURO-NMD), University Hospital Brno, Brno, Czechia
- Faculty of Medicine, Masaryk University, Brno, Czechia
- Department of Rehabilitation, University Hospital Brno, Brno, Czechia
| | - Peter Krkoska
- Department of Neurology, Center for Neuromuscular Diseases (Associated National Center in the European Reference Network ERN EURO-NMD), University Hospital Brno, Brno, Czechia
- Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Michaela Sladeckova
- Department of Neurology, Center for Neuromuscular Diseases (Associated National Center in the European Reference Network ERN EURO-NMD), University Hospital Brno, Brno, Czechia
- Faculty of Medicine, Masaryk University, Brno, Czechia
- Department of Rehabilitation, University Hospital Brno, Brno, Czechia
- Department of Public Health, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Olesja Parmova
- Department of Neurology, Center for Neuromuscular Diseases (Associated National Center in the European Reference Network ERN EURO-NMD), University Hospital Brno, Brno, Czechia
| | | | | | - Stanislav Vohanka
- Department of Neurology, Center for Neuromuscular Diseases (Associated National Center in the European Reference Network ERN EURO-NMD), University Hospital Brno, Brno, Czechia
- Faculty of Medicine, Masaryk University, Brno, Czechia
| | | | - Blanka Adamova
- Department of Neurology, Center for Neuromuscular Diseases (Associated National Center in the European Reference Network ERN EURO-NMD), University Hospital Brno, Brno, Czechia
- Faculty of Medicine, Masaryk University, Brno, Czechia
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