Low Back Pain Patients Research Articles

The effect of cognitive functional therapy on the plantar pressure distribution symmetry in patients with chronic non-specific low back pain: A randomized controlled trial

ObjectiveThis study aimed to evaluate the effect of Cognitive functional therapy (CFT) on plantar pressure distribution symmetry in chronic non-specific low back pain (CNSLBP) patients. Methodforty females with NSCLBP (age range 30–50 years) were recruited for clinical trials. They were randomly divided into experimental and control groups (Each group had 20 patients). The patients in the experimental group received CFT for 8 weeks. The primary outcome was psychological variables inclusive of pain, kinesiophobia and disability. The secondary outcome was plantar pressure distribution symmetry which assessment in standing condition. The Covariance statistical method was used for data analysis. ResultsThe results of covariance analysis for primary outcome showed a significant difference (p < 0.05) with a reduction of 52 % in pain (p = 0.001), 12 % in kinesiophobia (p = 0.001) and 41% in disability (p = 0.001). Also, the results of covariance analysis for secondary outcome showed a significant difference in plantar pressure distribution symmetry of inter-limbs foot (p = 0.007), forward and backward in the right foot (p = 0.002) and forward and backward in the left foot (p = 0.001). ConclusionCFT reduces of pain, kinesiophobia and disability. In addition significant difference in the plantar pressure distribution symmetry was observed, which it is argued the plantar pressure asymmetric can be influenced by psychological factors.

Minimal-invasive pain procedures are effective in different degenerative pain generators in CLBP: A prospective cohort study.

It is estimated that a significant number of spinal surgeries are performed, but many patients do not often benefit. Our aim was to determine how effective minimally invasive pain procedures (MIP) are in chronic low back pain (CLBP) patients with proven degenerative causes (specific low back pain). 386 eligible patients with CLBP/sciatica resistant to conservative therapy and scheduled for open surgery were screened, and 167 could be enrolled in this study. Indications for MIP in the remaining 150 individuals were made by one experienced spinal surgeon. Before and 6 months after the intervention, the numeric rating scale (NRS) and Oswestry Disability Index (ODI) were recorded. MIP was performed, such as radiofrequency of the facet and SI-joint, intradiscal electrothermal therapy in case of discogenic pain, as well as epidural neuroplasty in patients with disc herniation/epidural fibrosis. There was a statistically significant decrease in NRS (p< 0.05), as well as a significant increase in ODI (p< 0.001) 6 months after the procedures. This was also true for the results of all different pain generators and subsequent performed procedures alone. The indication of MIP should be routinely reviewed in patients with CLBP to avoid potentially open surgery and a burden on healthcare costs.

Serious treatment-emergent adverse events in chronic low back pain patients treated with buprenorphine or oral opioids: a retrospective commercial claims analysis.

Aim: Explore the safety of Belbuca® (buprenorphine buccal film), buprenorphine transdermal patches and oral opioids for chronic low back pain (cLBP) treatment. Methods: The retrospective analysis of the MarketScan Commercial database (2018-2021) included treatment-naive cLBP adults. The first date of buprenorphine (Belbuca and transdermal patch) or opioid prescription was index date. Cohorts were defined based on the index medication. Observation included a 6-month pre-index period, while post-index lasted until the end of continuous insurance coverage. There were 44 relevant treatment-emergent adverse events (TEAEs) identified in the literature. Incidence rate ratio (IRR) and incidence rate difference (IRD) were used to compare serious TEAE rates (in 1000 person-years) between cohorts. Propensity-score matching minimized the selection bias. Results: Buprenorphine had lower rates of 15 serious TEAEs than oral opioids (all p≤0.037), while higher rates only for serious dizziness (IRR 2.44, p=0.011; driven by Belbuca), opioid abuse/dependence (IRR 3.13, p=0.004; driven by patches) and cholecystitis (IRD 20.25, p=0.044; an outlier). Additionally, a comparison between Belbuca and oral opioids showed lower rates of 13 serious TEAEs (all p≤0.024) and a higher serious dizziness rate (IRR 3.17, p=0.024). Although the rates of serious opioid abuse/dependence were similar (24.60 vs 26.93, p=0.921), all Belbuca patients and none of the opioid patients had a positive history of these events. Belbuca also had lower rates of five serious TEAEs than transdermal patches (all p≤0.018), including a serious opioid abuse/dependence (IRR 0.04, p<0.001), but higher rates of serious cholecystitis (IRD 52.17, p=0.035; an outlier) and suicidal ideation (IRD 156.50, p<0.001; an outlier). Conclusion: Buprenorphine had a better safety profile than oral opioids in cLBP treatment. Belbuca showed a more favorable TEAE profile than buprenorphine transdermal patches and oral opioids.

Characteristics and outcomes of patients with low back pain with and without radiating leg pain following the GLA:D back program

BackgroundSome patients with low back pain (LBP) also report radiating leg pain which is a prognostic factor for poorer clinical outcomes. We aimed: 1) to compare the baseline characteristics of patients with LBP with - (LBP + leg pain) and without radiating leg pain (LBP - alone); 2) to investigate whether patients with LBP + leg pain show similar post-treatment outcomes as compared to LBP – alone, after participation in an exercise and patient education program, i.e. the GLA:D Back program. MethodsThe patient sample included 3508 patients in the GLA:D Back program between March 2018 and August 2022. The outcomes were mean changes in LBP intensity, back-related activity limitation, self-efficacy and fear of movement measured from baseline to 3, 6 and 12 months. Baseline characteristics were compared with descriptive statistics, and linear mixed models were used to estimate group differences in changes from baseline to 3-, 6- and 12 months. Results1915 (55%) of the patients were in the group LBP- alone and 1593 (45%) in the LBP + leg pain. The LBP + leg pain group displayed higher STarT back classification (greater risk of chronicity) compared to the LBP–alone. The LBP + leg pain group showed almost similar improvements in all outcomes compared to LBP – alone after the GLA:D Back program. ConclusionIn long-lasting (chronic) LBP patients, the LBP + leg pain group improved to the same extent as LBP - alone regarding LBP intensity, disability, and fear of movement following an exercise and patient education program, GLA:D Back.

Understanding the flexion-relaxation phenomenon in non-specific chronic low back pain patients throught immersive virtual reality feedback approach

The flexion-relaxation phenomenon (FRP) is frequently absent among non-specific chronic low back pain (NSCLBP) patients. However, it is unknown whether this absence is intrinsic to their pathology or merely a consequence of reduced trunk flexion. Immersive virtual reality (IVR) can create a patient avatar whose range of motion can be modulated to differ from the real movement. The present study enrolled 15 NSCLBP patients and 15 asymptomatic participants with similar characteristics to disentangle the relationship between range of motion and the FRP in NSCLBP using IVR. Trunk kinematics and lumbar muscle electromyography were assessed. The IVR environment was combined with a motion capture system to create avatars that moved like each participant. The IVR display showed a closed room and a mirror reflecting the subject’s avatar with a target line to be reached by trunk flexion. The avatar’s trunk movements were modulated from reality, leading the participants to flex their trunk more than their voluntary maximum trunk flexion. Under IVR conditions, NSCLBP patients significantly increased their trunk flexion angle, which was coupled with a significant improvement in the FRP. The absence of the FRP among the NSCLBP population appeared to be primarily related to reduced trunk flexion.

Analysis of Influencing Factors for Chronic Low Back Pain with Cognitive Impairment

Background: Cognitive impairment (CI) is a common complication in chronic low back pain (CLBP) patients, and its progression increases the risk of dementia. However, there is currently a lack of predictive indicators for CLBP-CI. Previous studies have shown that routine blood indexes have predictive value for Alzheimer’s disease, but their relationship with CLBP-CI remains unclear. This study aims to explore the correlation between routine blood indexes and provide evidence of disparities in chronic pain and cognitive impairment between two groups of individuals with low back pain, as well as establish the foundation for longitudinal experimental studies aimed at developing effective interventions for cognitive impairment in individuals with chronic low back pain. Methods: This cross-sectional study was conducted at West China Hospital, Sichuan University. The Montreal Cognitive Assessment (MoCA) was conducted to divide patients into the CLBP-CI or CLBP-nCI group. Statistical analysis was performed to examine the differences between chronic low back pain patients with cognitive impairment and those without cognitive impairment. All statistical tests were conducted at a significance level of α=0.05 for two-sided testing. Results: The prevalence of chronic low back pain with cognitive impairment in this study demonstrates age-related disparities, with a higher prevalence observed among older individuals (P=0.009). A statistically significant difference in white blood cell count was observed between individuals with chronic low back pain and cognitive impairment (P=0.004). Conclusion: Age and white blood cell count may serve as influential factors in the development of chronic low back pain with cognitive impairment. This finding can aid healthcare professionals in implementing early intervention and treatment for individuals experiencing this condition.

The role of melatonergic system in intervertebral disc degeneration and its association with low back pain: a clinical study.

The mechanisms of intervertebral disc degeneration (IVDD) in low back pain (LBP) patients are multiples. In this study, we attempt to investigate whether melatonergic system plays a potential role in IVDD patients with LBP by analyzing their clinical specimens. The fucus will be given to the correlation between the melatonin receptor expression and intervertebral disc tissue apoptosis. In this clinical study, 107 lumbar intervertebral disc nucleus pulposus (NP) specimens from patients with LBP were collected with patients' consents. The disc height (DH) discrepancy ratio, range of motion and sagittal parameters of the pathological plane were measured and Pfirrmann grade was used to classified the grades of IVDD level. Discs at grades 1-3 were served as normal control and grades 4-5 were considered as IVDD. The expression levels of melatonin receptor 1A (MT1) and 1B (MT2) were measured by immunohistochemistry. The apoptosis of NP was assessed using TUNEL staining. Their potential associations among MT1/2, DH, apoptosis, sagittal parameters with IVDD and LBP were evaluated with statistical analysis. The incidence of IVDD was positively associated with age and negatively related to VAS scores for LBP (p<0.001). Patients with higher degree of IVDD also have higher DH discrepancy ratio (p<0.001), higher prevalence of lumbar instability (p=0.003) and higher cell apoptosis compared to the control. Nevertheless, no statistically significant correlation was identified between Pfirrmann grade and lumbar sagittal parameters. MT1 and MT2 both were highly expressed in the NP tissues. Importantly, MT1 expression but not MT2 was significantly increased in the intervertebral disc tissue of patients with IVDD and its level correlated well with cell apoptosis level and the severity of IVDD as well as lower VAS scores for LBP. The highly elevated MT1 expression was found in NP tissues of patients with IVDD and LBP compared to the control. This phenomenon probably reflects the compensating response of the body to the pathological alteration of the IVDD and LBP. Therefore, these findings provide the novel information to use selective agonists of MT1 to target IVDD and LBP clinically.

Predictors of response in PROMIS-global in a chronic low back pain specialty clinic: STarTBack and chronic overlapping pain conditions.

Tools, such as the STarTBack Screening Tool (SBT), have been developed to identify risks of progressing to chronic disability in low back pain (LBP) patients in the primary care population. However, less is known about predictors of change in function after treatment in the specialty care population. We pursued a retrospective observational cohort study involving LBP patients seen in a multidisciplinary specialty clinic to assess which features can predict change in function at follow-up. The SBT was administered at initial visit, and a variety of patient characteristics were available in the chart including the presence of chronic overlapping pain conditions (COPCs). Patient Reported Outcomes Measurement Information System-10 (PROMIS-10) global physical health (PH) and global mental health (MH) were measured at baseline and at pragmatic time points during follow-up. Linear regression was used to estimate adjusted associations between available features and changes in PROMIS scores. 241patients were followed for a mean of 17.0 ± 7.5months. Mean baseline pain was 6.7 (SD 2.1), PROMIS-10 global MH score was 44.8 (SD 9.3), and PH score was 39.4 (SD 8.6). 29.7% were low-risk on the SBT, 41.8% were medium-risk, and 28.5% were high-risk. Mean change in MH and PH scores from baseline to the follow-up questionnaire were 0.86 (SD 8.11) and 2.39 (SD 7.52), respectively. Compared to low-risk patients, high-risk patients had a mean 4.35points greater improvement in their MH score (p= 0.004) and a mean 3.54points greater improvement in PH score (p= 0.006). Fewer COPCs also predicted greater improvement in MH and PH. SBT and the presence of COPC, which can be assessed at initial presentation to a specialty clinic, can predict change in PROMIS following treatment. Effort is needed to identify other factors that can help predict change in function after treatment in the specialty care setting.

Comparing the Scores of The Functional Movement Screen™ in Individuals with Low Back Pain versus Healthy Individuals: A Systematic Review and Meta-Analysis.

The Functional Movement Screen™ (FMS™) is widely used to assess functional movement patterns and illuminate movement dysfunctions that may have a role in injury risk. However, the association between FMS™ scores and LBP remains uncertain. The purpose of this systematic review and meta-analysis was to examine functional movement scores among patients with low back pain (LBP) and healthy subjects with no LBP and review the validity of the FMS™ tool for screening functional movement among LBP patients. The systematic review and meta-analysis included papers assessing functional movement among adult patients with LBP using the FMS™ through a literature review of five databases. The search strategy focused used relevant keywords: Functional movement screen AND low back pain. The review included all papers assessing functional movement among LBP adult patients (>18 years old) using the FMS™ published between 2003 to 2023. The risk of bias in the involved studies was evaluated using the updated Cochrane ROB 2 tool. Statistical analysis was conducted using Review Manager software, version 5.4. The meta-analysis included the total FMS™ score and the scores of the seven FMS™ movement patterns. Seven studies were included in this systematic review were considered to have low to unclear risk of bias. The meta-analysis revealed that the LBP group had a significantly lower total FMS™ score than the control group by 1.81 points (95% CI (-3.02, -0.59), p= 0.004). Patients with LBP had a significantly lower score than the control group regarding FMS™ movement patterns, the deep squat (p <0.01), the hurdle step (p <0.01), the inline lunge (P value <0.01), the active straight leg raise (p <0.01), the trunk stability push-up (p=0.02), and the rotational stability screens (p <0.01). Lower scores on the FMS™ are associated with impaired functional movement. Identifying the specific functional movement impairments linked to LBP can assist in the creation of personalized treatment plans and interventions. Further research is needed to assess the association of cofounders, such as age, gender, and body mass index, with the FMS™ score among LBP patients and controls. 1.

An Observational Study of Various Risk Factors and Etiological Profile in Patients with Lower Back Pain at Tertiary Care Center.

The study aimed to analyze the risk factors and etiological profile of lower back pain (LBP) among patients attending a neurology outpatient department at a tertiary care center. A cross-sectional observational study was conducted, involving 170 patients, aged over 18, presenting with LBP between March and August 2023. Sociodemographic and lifestyle data were collected, and diagnostic investigations, including X-ray and magnetic resonance imaging (MRI), were performed. Patients were categorized into acute and chronic LBP groups for analysis. Age-acute LBP was more prevalent in younger patients (<35 years), while chronic LBP was predominant in older age-groups (≥55 years). Gender-females showed a higher prevalence of LBP compared to males, with chronic LBP more common among females. Triggering events-heavy weightlifting was a significant trigger for chronic LBP, while coughing/sneezing was common in acute LBP. Occupation-patients with physically exerting jobs were more prone to acute LBP, while chronic LBP was prevalent among homemakers and those with no work. Body mass index (BMI)-obesity and overweight were associated with chronic LBP. Medication-chronic LBP patients were more likely to be on medication compared to acute LBP patients. MRI findings-prolapsed intervertebral disk (PIVD) was the most prevalent etiology, more common in chronic LBP patients. Other etiologies included vertebral fracture, tumor, tuberculosis, and various spinal conditions. Lower back pain is a multifaceted condition influenced by age, gender, BMI, and lifestyle factors. Effective management and prevention strategies should consider these risk factors to improve patients' quality of life. A comprehensive approach is essential to address the complex etiology of LBP.

Effectiveness of Virtual Reality on Rehabilitation of Chronic Non-Specific Low Back Pain Patients.

Virtual reality (VR) is used extensively for musculoskeletal conditions, but its efficacy in chronic low back pain still needs more investigation. To discuss the effectiveness of VR on selected outcomes in Chronic Non-Specific Low Back Pain (CNSLBP). Thirty-five patients with CNSLBP joined this study. Postural correction exercises using the TBed VR gaming system in addition to hamstring stretching were employed, and moist heat on the low back was applied. Pre- and post-intervention values of pain, ROM, function, and balance (overall stability index) were obtained using the numerical rating pain scale (NPRS), Oswestry Disability Index, back range of motion (BROM), and Biodex system. Satisfaction level on a 1-10 scale and the degree of commitment to the exercise sessions were assessed after the intervention. The patients completed the intervention period and outcome measures sessions. Paired t-tests reported statistically significant improvements and high effect size in pain, ROM, function, and balance after the end of the treatment (p < 0.001, Cohen's d > 0.69). The level of satisfaction was 9.25 ± 0.766, and the commitment to exercise sessions was high (98.75% attendance rate). Applying postural correction using TBed VR gaming in addition to heat and stretching may improve pain, range of motion, function, and balance in patients with chronic low back pain.

The efficacy of core stability exercises versus conventional physiotherapy in lower back pain

Context: Practice guidelines recommend various types of general exercise and core stability exercises with electrotherapeutic modalities for chronic back pain but it remains the primary cause of absenteeism and disability. Chronic low back pain causes activity limitation in persons younger than 45 years. Core stability exercise is becoming increasingly popular for low back pain. Aims: To find out the effectiveness of core stability exercises on Pain and Disability in patients with chronic low back pain Settings and Design: A comparative study was done in the Physiotherapy OPD of Mahatma Gandhi Medical College &amp; Hospital Jaipur. Methods and Material: 40 subjects suffering from low back pain as per the inclusion and exclusion criteria were enrolled. The subjects were divided into two Group A (core stability) and Group B (General exercises). Before the treatment session, the pain and disability of the patients in each group were assessed with the help of the VAS scale and ODI scale respectively. After 15 days they were again assessed and the improvement levels were calculated. Statistical analysis used: Paired t-test was used to analyze significant changes between pre-test &amp; post-test measurements. Results: Statistical analysis made with the quantitative data revealed a statistically significant difference between the Core stability group &amp; General exercises group on pain &amp; disability level. Group A (core stability) improved in VAS and ODI compared to Group B (General exercises) with P values of 0.018 and 0.021 respectively. Conclusions: The findings reveal that core stability exercises are more effective than General exercises in chronic low back pain patients.

Maitland Mobilization versus Core Stability Exercises in Management Chronic Nonspecific LBP

Background: Low back pain (LBP) is one of the main causes that affect mechanical function in human bodies worldwide, 90% of the cases with non-specific LBP. Different options are available for the management of non-specific LBP. While Maitland mobilization and core stability exercises are usually utilized in clinical practice for managing Chronic Nonspecific Low Back Pain, there is now a lack of research examining their comparative effectiveness. Objective: The objective of this study is to assess and compare the efficiency of Maitland mobilization and core stability exercise as treatment modalities for adults suffering from chronic non-specific low back pain. Methods: A total of 36 Non-specific low back pain (NSLBP) patients with ages 18 to 45 years were inducted and given their Informed consent. Subjects were allocated into two groups through simple random sampling. Group A (N=18) received central posterior-anterior vertebral mobilization while group B (N=18) received core stability exercises. Pain and functional disability were assessed using the Visual Analogue scale (VAS) and Oswestry Disability Index (ODI) respectively. Pre &amp; post-treatment scores were documented and compared to achieve the aim of this study. Results: T-test indicated that the results pre- and post-treatment were showed a statistically positive significant difference by applying Maitland mobilization technique with non-specific LBP to improve functional disability (ODI) and reduce pain intensity (VAS) with (p = 0.001), respectively. On the other hand, results for the application of core stability exercises in management NSLBP also showed positive signs in reducing VAS and improving ODI with (p= 0.001) respectively. The findings suggest that there was no statistically significant difference between the Maitland mobilization technique and core stability exercises in treating NSLBP for pain reduction with (p = 0.312) and improvement in ODI with (p = 0.055). For applying Maitland mobilization in NSLBP, Pearson correlation results indicated that there was no relationship between body mass index (KG/M2) and functional disability (ODI) with (p = 0.034) and pain severity (VAS) with (p = 0.808). For core stability exercises, the results of Pearson's correlation indicated that there was no relationship between body mass index (KG/M2) and functional disability (ODI) with (p = 0.959) and pain intensity (VAS) with (p = 0.987). By gender, the results showed there were no statistically significant role for Maitland mobilization and core stability exercises in improving function and reducing pain among patients with chronic non-specific low back pain. Conclusion: Both core stability exercises and Maitland method have demonstrated effectiveness in reducing pain and improving functional disability in patients with chronic nonspecific low back pain.

Using continuous relative phase and modified vector coding analyses to quantify spinal coordination and coordinative variability for healthy and chronic low back pain patients: An exploratory comparative analysis

Differences in coordination and coordinative variability are common in people with low back pain. While differences may relate to the different analyses used to quantify these metrics, the preferred approach remains unclear. We aimed to compare coordination and coordinative variability, in people with and without low back pain performing a lifting/lowering task, using continuous relative phase and vector coding procedures, and to identify which technique better detects group differences. Upper lumbar (T12-L3), lower lumbar (L3-S1), and hip angular kinematics were measured using electromagnetic motion capture during 10 crate lifting/lowering repetitions from adults with (n = 47) and without (n = 17) low back pain. Coordination and coordinative variability for the Hip-Lower Lumbar and Lower Lumbar-Upper Lumbar joint pairs were quantified using mean absolute relative phase and deviation phase (continuous relative phase), and coupling angle and coupling angle variability (vector coding), respectively. T-tests examined group differences in coordination and variability. Cohen’s d bootstrapping analyses identified the more sensitive technique for detecting group differences. Less in-phase and more variable behavior was observed in the low back pain group, mostly independent of joint pair and analytical technique (P < 0.05, Cohen’s d range = 0.61 to 1.33). Qualitatively, the low back group limited motion at the lower lumbar spine during lifting/lowering. Continuous relative phase was more sensitive in detecting group differences in coordinative variability, while vector coding was more sensitive towards differences in coordination. These procedures convey distinct information and have their respective merits. Researchers should consider the choice of analytical techniques based on their study objectives.

Surgical treatment of refractory low back pain using implanted BurstDR spinal cord stimulation (SCS) in a cohort of patients without options for corrective surgery: Findings and results from the DISTINCT study, a prospective randomized multi-center-controlled trial

Background: Low back pain (LBP) is a highly prevalent, disabling condition affecting millions of people. Patients with an identifiable anatomic pain generator and resulting neuropathic lower extremity symptoms often undergo spine surgery, but many patients lack identifiable and/or surgically corrective pathology. Nonoperative treatment options often fail to provide sustained relief. Spinal cord stimulation (SCS) is sometimes used to treat these patients, but the lack of level 1 evidence limits its widespread use and insurance coverage. The DISTINCT RCT study evaluates the efficacy of passive recharge burst SCS compared to conventional medical treatment (CMM) in alleviating chronic, refractory axial low back pain. MethodsThis prospective, multicenter, randomized, study with an optional 6-month crossover involved patients who were not candidates for lumbar spine surgery. The primary and secondary endpoints evaluated improvements in low back pain intensity (NRS), back pain-related disability (ODI), pain catastrophizing (PCS), and healthcare utilization. Patients were randomized to SCS therapy or CMM at 30 US study sites. ResultsThe SCS arm reported a 85.3% NRS responder rate (≥ 50% reduction) compared to 6.2% (5/81) in the CMM arm. After the 6M primary endpoint, SCS patients elected to remain on assigned therapy and 66.2% (49/74) of CMM patients chose to trial SCS (crossover). At the 12M follow-up, SCS and crossover patients reported 78.6% and 71.4% NRS responder rates. Secondary outcomes indicated significant improvements in ODI, PCS, and reduced healthcare utilization. Six serious adverse events were reported and resolved without sequelae. ConclusionDISTINCT chronic low back pain patients with no indication for corrective surgery experienced a significant and sustained response to burst SCS therapy for up to 12 months. CMM patients who crossed over to the SCS arm reported profound improvements after 6 months. This data advocates for a timely consideration of SCS therapy in patients unresponsive to conservative therapy.

Effect of Diaphragm Strengthening Exercise with Incentive Spirometry on Pain and Core Muscle Stability in Low Back Pain Patients at M.Yunus Hospital Bengkulu

This study examined the effect of diaphragm strengthening exercise with incentive spirometry on pain and core muscle stability in patient with LBP (Low Back Pain). Twenty respondents aged 25-60 years participated in this research group. This research using a pre-experimental one-group pretest-posttest design. Incentive spirometry training was given to one group 3 times a week for 4 weeks. Pain level was measured using the numerical rating scale and core muscle stability was measured using a sphygmomanometer which had been modified to function as a tool to measure core muscle stability. There was a decrease in pain levels and an increase in core muscle stability in research subjects. The results of the wilcoxon test and paired t-test obtained a significance value of less than 0.05. There is an effect of diaphragm muscle strengthening exercises using incentive spirometry on improving pain and core muscle stability in patients with LBP (Low Back Pain).

The Efficacy of the Smartphone App for the Self-Management of Low Back Pain: A Systematic Review and Assessment of Their Quality through the Mobile Application Rating Scale (MARS) in Italy.

Smartphone apps for self-management are valuable tools to help manage low back pain (LBP) patients. The purposes of this systematic review were to (a) summarize the available studies on the efficacy of smartphone apps for self-management of LBP and (b) identify free applications available in Italy that offer strategies for LBP self-management and provide a qualitative assessment using the Mobile Application Rating Scale (MARS). According to the Prisma Checklist, six bibliographic databases were searched with the keywords 'low back pain', 'mobile application', 'smartphone', and 'telemedicine'. In total, 852 records were screened, and 16 were included in the systematic review. Of the six RCTs included, four reported a statistically significant decrease in pain in favor of the app group, and two RCTs did not. Only in a non-RCT was there an increase in the disability score. In the application research conducted on mobile stores, we identified and rated 25 applications through MARS. The overall scores ranged from 1.93 to 3.92 for the IOS app and 1.73 to 4.25 for the Play Store app. The findings suggest that few apps meet satisfying quality, content, and functionality criteria for LBP self-management.

Exercise-induced neuroplasticity: a new perspective on rehabilitation for chronic low back pain.

Chronic low back pain patients often experience recurrent episodes due to various peripheral and central factors, leading to physical and mental impairments, affecting their daily life and work, and increasing the healthcare burden. With the continuous advancement of neuropathological research, changes in brain structure and function in chronic low back pain patients have been revealed. Neuroplasticity is an important mechanism of self-regulation in the brain and plays a key role in neural injury repair. Targeting neuroplasticity and regulating the central nervous system to improve functional impairments has become a research focus in rehabilitation medicine. Recent studies have shown that exercise can have beneficial effects on the body, such as improving cognition, combating depression, and enhancing athletic performance. Exercise-induced neuroplasticity may be a potential mechanism through which exercise affects the brain. This article systematically introduces the theory of exercise-induced neuroplasticity, explores the central effects mechanism of exercise on patients with chronic low back pain, and further looks forward to new directions in targeted neuroplasticity-based rehabilitation treatment for chronic low back pain.

Psychometric Properties of Chosen Scales Evaluating Disability in Low Back Pain-Narrative Review.

Low back pain (LBP) is one of the most common disabling conditions. This disability significantly reduces the quality of life of LBP patients. This article reviews the most common and well-known measures currently used to assess disability in LBP, such as the Oswestry Disability Index (ODI), the Roland-Morris Disability Questionnaire (RMDQ), the Quebec Back Pain Disability Scale (QBPDS), the Low Back Outcome Score (LBOS), and the Low Back Pain Rating Scale (LBPRS). To reliably evaluate questionnaires and other measurement methods, there are parameters known as psychometric properties, which consist primarily of the validity, reliability and sensitivity. These methods are based on a multi-item questionnaire assessing physical functioning that is completed independently by the patient. They can be used to assess the disability associated with many conditions. All are specific to LBP, and their psychometric properties have been tested on a relevant population of patients with the condition and published in peer-reviewed publications.

Counting your chickens before they hatch: improvements in an untreated chronic pain population, beyond regression to the mean and the placebo effect.

Isolating the effect of an intervention from the natural course and fluctuations of a condition is a challenge in any clinical trial, particularly in the field of pain. Regression to the mean (RTM) may explain some of these observed fluctuations. In this paper, we describe and quantify the natural trajectory of questionnaire scores over time, based on initial scores. Twenty-seven untreated chronic low back pain patients and 25 healthy controls took part in this observational study, wherein they were asked to complete an array of questionnaires commonly used in pain studies during each of 3 visits (V1, V2, V3) at the 2-month interval. Scores at V1 were classified into 3 subgroups (extremely high, normal, and extremely low), based on z-scores. The average delta (∆ = V2 - V1) was calculated for each subgroup, for each questionnaire, to describe the evolution of scores over time based on initial scores. This analysis was repeated with the data for V2 and V3. Our results show that high initial scores were widely followed by more average scores, while low initial scores tended to be followed by similar (low) scores. These trajectories cannot be attributable to RTM alone because of their asymmetry, nor to the placebo effect as they occurred in the absence of any intervention. However, they could be the result of an Effect of Care, wherein participants had meaningful improvements simply from taking part in a study. The improvement observed in patients with high initial scores should be carefully taken into account when interpreting results from clinical trials.