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Sensor-based postural feedback is more effective than conventional feedback to improve lumbopelvic movement control in patients with chronic low back pain: a randomised controlled trial.

ABSTRACT: BACKGROUND:Improving movement control can be an important treatment goal for patients with chronic low back pain (CLBP). Although external feedback is essential when learning new movement skills, many aspects of feedback provision in patients with CLBP remain currently unexplored. New rehabilitation technologies, such as movement sensors, are able to provide reliable and accurate feedback. As such, they might be more effective than conventional feedback for improving movement control. The aims of this study were (1) to assess whether sensor-based feedback is more effective to improve lumbopelvic movement control compared to feedback from a mirror or no feedback in patients with chronic low back pain (CLBP), and (2) to evaluate whether patients with CLBP are equally capable of improving lumbopelvic movement control compared to healthy persons. METHODS:Fifty-four healthy participants and 54 patients with chronic non-specific LBP were recruited. Both participant groups were randomised into three subgroups. During a single exercise session, subgroups practised a lumbopelvic movement control task while receiving a different type of feedback, i.e. feedback from movement sensors, from a mirror or no feedback (=control group). Kinematic measurements of the lumbar spine and hip were obtained at baseline, during and immediately after the intervention to evaluate the improvements in movement control on the practised task (assessment of performance) and on a transfer task (assessment of motor learning). RESULTS:Sensor-based feedback was more effective than feedback from a mirror (p?

SUBMITTER: Matheve T

PROVIDER: S-EPMC6156867 | biostudies-literature | 2018 Sep

REPOSITORIES: biostudies-literature

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Sensor-based postural feedback is more effective than conventional feedback to improve lumbopelvic movement control in patients with chronic low back pain: a randomised controlled trial.

Matheve Thomas T Brumagne Simon S Demoulin Christophe C Timmermans Annick A

Journal of neuroengineering and rehabilitation 20180926 1

<h4>Background</h4>Improving movement control can be an important treatment goal for patients with chronic low back pain (CLBP). Although external feedback is essential when learning new movement skills, many aspects of feedback provision in patients with CLBP remain currently unexplored. New rehabilitation technologies, such as movement sensors, are able to provide reliable and accurate feedback. As such, they might be more effective than conventional feedback for improving movement control. Th ...[more]

PMID: 30253807

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Project description:BackgroundPhysical exercise is a common treatment for people with low back pain (LBP). Wearable sensors that provide feedback on body movements and posture during exercise may enhance postural balance and motor control in people with LBP.ObjectiveThis study aims to investigate whether physical exercising with postural feedback (EPF) improves postural balance, motor control, and patient-reported outcomes in people with LBP.MethodsThe study was an assessor-blinded 2×2 factorial trial. We planned to recruit 80 participants with nonspecific LBP who did not receive treatment for LBP. In addition, we aimed to recruit 40 patients with chronic, nonspecific LBP who were receiving exercise therapy (ET) at the University Hospital Zurich. Both ET patients and participants without treatment were randomized to receive either an additional EPF intervention or no additional intervention. This resulted in four different combinations of interventions: ET+EPF, ET, EPF, and no intervention. The participants underwent outcome assessments at inclusion (T1); 3 weeks later, at randomization (T2); after an intervention period of 3 weeks with a predefined exercise schedule for participants receiving EPF (T3); and after an additional 6 weeks, during which participants assigned to the EPF groups could exercise as much as they wished (T4). Patients receiving ET completed their regularly prescribed therapies during the study period. Balance was assessed during quiet standing on a force platform, and motor control was assessed during a lifting task and a waiter's bow task. Physical activity was recorded using an activity tracker and the participants' mobile phones during the study. The predefined EPF schedule consisted of nine sessions of 20 minutes of exercise with a tablet and inertial measurement unit sensors at home. Participants performed a series of trunk and hip movements and received feedback on their movements in a gamified environment displayed on the tablet.ResultsThe first participant was recruited in May 2019. Data collection was completed in October 2020, with 3 patients and 32 eligible people without therapy who passed the eligibility check.ConclusionsAlthough it will not be possible to investigate differences in patients and people without other therapies, we expect this pilot study to provide insights into the potential of EPF to improve balance in people with LBP and adherence to such interventions.International registered report identifier (irrid)DERR1-10.2196/26982.

Project description:BackgroundPostural balance is compromised in people with low back pain, possibly by changes in motor control of the trunk. Augmenting exercising interventions with sensor-based feedback on trunk posture and movements might improve postural balance in people with low back pain.ObjectiveWe hypothesized that exercising with feedback on trunk movements reduces sway in anterior-posterior direction during quiet standing in people with low back pain. Secondary outcomes were lumbar spine and hip movement assessed during box lift and waiter bow tasks, as well as participant-reported outcomes. Adherence to the exercising intervention was also examined.MethodsA randomized controlled trial was conducted with the intervention group receiving unsupervised home exercises with visual feedback using the Valedo Home, an exergame based on 2 inertial measurement units. The control group received no intervention. Outcomes were recorded by blinded staff during 4 visits (T1-T4) at University Hospital Zurich. The intervention group performed 9 sessions of 20 minutes in the 3 weeks between T2 and T3 and were instructed to exercise at their own convenience between T3 and T4. Postural balance was assessed on a force platform. Lumbar spine and hip angles were obtained from 3 inertial measurement units. The assessments included pain intensity, disability, quality of life, and fear of movement questionnaires.ResultsA total of 32 participants with nonspecific low back pain completed the first assessment T1, and 27 (84%) participants were randomized at T2 (n=14, 52% control and n=13, 48% intervention). Intention-to-treat analysis revealed no significant difference in change in anterior-posterior sway direction during the intervention period with a specified schedule (T2-T3) between the groups (W=99; P=.36; r=0.07). None of the outcomes showed significant change in accordance with our hypotheses. The intervention group completed a median of 61% (55/90; range 2%-99%) of the exercises in the predefined training program. Adherence was higher in the first intervention period with a specified schedule.ConclusionsThe intervention had no significant effect on postural balance or other outcomes, but the wide range of adherence and a limited sample size challenged the robustness of these conclusions. Future work should increase focus on improving adherence to digital interventions.Trial registrationClinicalTrials.gov NCT04364243; https://clinicaltrials.gov/ct2/show/NCT04364243.International registered report identifier (irrid)RR2-10.2196/26982.

Project description:BackgroundPeople with low back pain (LBP) exhibit impaired anticipatory postural adjustments (APAs).ObjectiveTo evaluate whether current motor retraining treatments address LBP-associated changes in movement coordination during tasks that do and do not require APAs.DesignProspectively registered randomized controlled trial with a blinded assessor.SettingOutcome evaluations occurred in a university laboratory; treatments were carried out in outpatient physical therapy clinics.PatientsFifteen subjects without LBP and 33 subjects with chronic, recurrent, and nonspecific LBP.InterventionTwelve subjects with LBP received stabilization treatment, 21 received movement system impairment-based treatment, for more than 6 weekly 1-hour sessions plus home exercises.MeasurementsPre- and post-treatment, surface electromyography (EMG) was recorded bilaterally from trunk and leg muscles during unsupported and supported leg-lifting tasks, which did and did not require an APA, respectively. Vertical reaction forces under the contralateral leg were recorded to characterize the APA. Oswestry disability scores and numeric pain ratings were also recorded.ResultsPersons with LBP demonstrated an impaired APA compared with persons without LBP, characterized by increased premovement contralateral force application and increased postmovement trunk EMG amplitude, regardless of the task. After treatments, both groups similarly improved in disability and function; however, APA characteristics did not change (ie, force application or EMG amplitude) in either task.LimitationsTreating clinicians were not blinded to treatment allocation, only short-term outcomes were assessed, and main effects of treatment do not rule out nonspecific effects of time or repeated exposure.ConclusionsMovement impairments in persons with LBP are not limited to tasks requiring an APA. Stabilization and movement system impairment-based treatments for LBP do not ameliorate and may exacerbate APA impairments (ie, excessive force application and increased post-movement trunk muscle activation).

Project description:Agricultural practices to improve yields in small-scale farms in Africa usually focus on improving growing conditions for the crops by applying fertilizers, irrigation, and/or pesticides. This may, however, have limited effect on yield if the availability of effective pollinators is too low. In this study, we established an experiment to test whether soil fertility, soil moisture, and/or pollination was limiting watermelon (Citrullus lanatus) yields in Northern Tanzania. We subjected the experimental field to common farming practices while we treated selected plants with extrafertilizer applications, increased irrigation and/or extra pollination in a three-way factorial experiment. One week before harvest, we assessed yield from each plant, quantified as the number of mature fruits and their weights. We also assessed fruit shape since this may affect the market price. For the first fruit ripening on each plant, we also assessed sugar content (brix) and flesh color as measures of fruit quality for human consumption. Extra pollination significantly increased the probability of a plant producing a second fruit of a size the farmer could sell at the market, and also the fruit sugar content, whereas additional fertilizer applications or increased irrigation did not improve yields. In addition, we did not find significant effects of increased fertilizer or watering on fruit sugar, weight, or color. We concluded that, insufficient pollination is limiting watermelon yields in our experiment and we suggest that this may be a common situation in sub-Saharan Africa. It is therefore critically important that small-scale farmers understand the role of pollinators and understand their importance for agricultural production. Agricultural policies to improve yields in developing countries should therefore also include measures to improve pollination services by giving education and advisory services to farmers on how to develop pollinator-friendly habitats in agricultural landscapes.

Project description:Wearable sensor technology can accurately measure body motion and provide incentive feedback during exercising. The aim of this pilot study was to evaluate the effectiveness and user experience of a balance training program in older adults integrating data from wearable sensors into a human-computer interface designed for interactive training.Senior living community residents (mean age 84.6) with confirmed fall risk were randomized to an intervention (IG, n?=?17) or control group (CG, n?=?16). The IG underwent 4 weeks (twice a week) of balance training including weight shifting and virtual obstacle crossing tasks with visual/auditory real-time joint movement feedback using wearable sensors. The CG received no intervention. Outcome measures included changes in center of mass (CoM) sway, ankle and hip joint sway measured during eyes open (EO) and eyes closed (EC) balance test at baseline and post-intervention. Ankle-hip postural coordination was quantified by a reciprocal compensatory index (RCI). Physical performance was quantified by the Alternate-Step-Test (AST), Timed-up-and-go (TUG), and gait assessment. User experience was measured by a standardized questionnaire.After the intervention sway of CoM, hip, and ankle were reduced in the IG compared to the CG during both EO and EC condition (p?=?.007-.042). Improvement was obtained for AST (p?=?.037), TUG (p?=?.024), fast gait speed (p?=?. 010), but not normal gait speed (p?=?.264). Effect sizes were moderate for all outcomes. RCI did not change significantly. Users expressed a positive training experience including fun, safety, and helpfulness of sensor-feedback.Results of this proof-of-concept study suggest that older adults at risk of falling can benefit from the balance training program. Study findings may help to inform future exercise interventions integrating wearable sensors for guided game-based training in home- and community environments. Future studies should evaluate the added value of the proposed sensor-based training paradigm compared to traditional balance training programs and commercial exergames.http://www.clinicaltrials.govNCT02043834.

Dataset Information

Sensor-based postural feedback is more effective than conventional feedback to improve lumbopelvic movement control in patients with chronic low back pain: a randomised controlled trial.

Publications

Sensor-based postural feedback is more effective than conventional feedback to improve lumbopelvic movement control in patients with chronic low back pain: a randomised controlled trial.

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