Effects of Bilateral Asymmetrical Limbs Proprioceptive Neuromuscular Facilitation on Multifidus Muscle in CLBP.

NCT04206137 | Completed

• 1 other identifier: University of Karachi
• Study Type: interventional
• Target: 150
• Locations: 1 country
• Sites: 1

Brief Summary

The low back pain is a leading cause to limit individual functional activities worldwide and 60%-80% of adults are probable to get low back pain at least once in life time. Whereas, the chronic low back pain prevalence is 10%.The current literature suggests that any exercise is beneficial for reducing chronic nonspecific low back pain. This limits evidence regarding superiority of specific exercise for low back pain treatment. Therefore, a randomized control trial will be conducted at department of physiotherapy to assess which treatment is more effective in chronic low back pain at department of physiotherapy, institute of physical medicine and rehabilitation, Dow University of Health Sciences after synopsis approval. Overall 150 participants with 18-40 years old having chronic low back pain will be eligible and they will be included through non-probability, purposive sampling technique. The written informed consent will be taken from all the participants. They will be divided through systematic random sampling method into two groups, 75 in each group. Group A (experimental group) will receive Bilateral, asymmetrical limbs PNF pattern exercises and group B (control group) will receive Swiss ball exercises. All participants will be assessed using assessment form. Pain and functional disability will be measured by subjective outcome tools, visual analogue scale with 0-10cm and Oswestry disability index , respectively. Range of movement of lumbar and multifidus muscle activity will be measured by objective outcome tool, modified-modified Schober's test and surface electromyography, respectively. The pre \& post treatment outcomes will be collected and recorded. Treatment sessions will be given thrice a week for 5 weeks. A maximum drop-out rate of 20% is expected. The Mean ± SD will be calculated for quantitative variables and frequencies and percentages for qualitative variables. The recorded outcome variables before and after the five weeks of treatment will be compared and analysed. The p-value of 0.05 will be considered as level of significant.

Conditions

Low Back Pain

Keywords

Muscle pain; Low Back Disorder; Exercise; Physical Therapy; Surface Electromyography

Outcome Measures

Primary Outcomes (3)

• Visual analogue scale

  The visual analogue scale is used for measurement of pain intensity. It is a continuous scale. It comprises a horizontal or vertical 10 centimeters or 100 millimeters line. The participant is asked to indicate a point of pain intensity by placing a line perpendicular to the Visual analogue scale line. The scale is most commonly referred by "no pain" with score of 0 and "worst imaginable pain" with score of 100 on the scale. The higher scores shows higher pain intensity and lower scores shows lower pain intensity.

  Change from baseline pain intensity at 5 weeks.

• Modified Modified Schober's test.

  It is used during physical examination to assess the lumbar range of movement. It is highly co-related with lumbar range of movement measured through radiograph.

  Change from baseline lumbar range of movement at 5 weeks.

• Surface electromyography

  It is a record of the electrical activity associated with muscular contraction. The electromyography is recorded and the peak amplitude \[maximal voluntary isometric contraction\] is selected manually and recorded.

  Change from baseline multifidus muscle activity at 5 weeks

Secondary Outcomes (1)

• Oswestry Disability Index

  Change from baseline functional disability at 5 weeks

Study Arms (2)

Group A (PNF rhythmic initiation group )

EXPERIMENTAL

PNF rhythmic initiation with bilateral asymmetrical upper and lower limb pattern will administered on both sides, there will be 10 repetition and 3 sets for each side, 20 second rest between two sets.

Other: Group A (PNF rhythmic initiation group )

Group B (Swiss ball exercise group)

ACTIVE COMPARATOR

Swiss ball exercises will be administered. There will be 10 repetitions, with 5 sets, taking 15 seconds rest between each set.

Other: Group B (Swiss ball exercises)

Interventions

Group A (PNF rhythmic initiation group ) OTHER

Lifting of arms and push the head back through the pattern of flexion -abduction-external rotation and neck in extension to the left in opposition of therapist hand resistance will be asked to do. At the end range of motion extensor muscles of back will start to contract.Then, reversing of that movement pattern to extension-adduction-internal rotation and neck flexion to right against the therapist resisting hands will be asked. this will be repeated on both sides

Group A (PNF rhythmic initiation group )

Group B (Swiss ball exercises) OTHER

Supine position: A ball will be placed under patient neck, and will be asked to bend hip and knee up to 90°. 5 times, 10 seconds hold Supine position: With a ball below the pelvis, knees bent, the ball press will be done with pelvis. 5 times, for 10 seconds hold. Crawling position: With a ball below one knee while keeping toes away from contact with the floor, the patient will balance first to stabilize the posture and slowly raise the other lower limb. This exercise will be performed in turn for the two lower limbs 10 times, with 10 seconds hold. Prone position: the patient will place a ball in front of pelvis and will repeatedly raise and lowered the two lower limbs alternately. There will be 10 repetitions, with 5 sets, taking 15 seconds rest between each set.

Group B (Swiss ball exercise group)

Eligibility Criteria

• Age: 18 Years - 40 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• Chronic Low back pain (pain for \> 3 month)

You may not qualify if:

• Any history related to spinal surgery
• Previous administration of epidural injections.
• Low Back Pain due to specific pathology,
• Neurological deficits (like stroke)
• Clinical disorder contraindicated to exercise.

Sponsors & Collaborators

• University of Karachi: lead

Study Sites (1)

Aftab Ahmed Mirza Baig

Karachi, Sindh, Pakistan

Location

Related Publications (20)

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  PMID: 37294220 DERIVED

Related Links

• Malla, S., Chahal, A., Tiku, R.K, Kaul B. Effect of motor control exercise on Swiss ball and PNF technique on non-specific low back pain. Health Sci .2018; 7(4):114-24
• Mavromoustakos, S., Beneka, A., Malliou, V., Adamidis, A., Kellis, E., Kagiaoglou, A., et al. Effects of a 6-week Proprioceptive Neuromuscular Facilitation Intervention on pain and disability in individuals with chronic low back pain. J Phys Act N.
• Adler, S. S., Beckers, D., Buck, M. PNF in practice: an illustrated guide. Springer Science \& Business Media. . 2007; https://doi.org/10.1007/978-3-540-73904-3
• Osama, M., Mustafa, M. The prevalence of chronic low back pain and relative disability among farmers of swat. Int J Res Sci. 2017; 5(1), 37-42.

MeSH Terms

Conditions

Low Back Pain; Myalgia; Motor Activity

Condition Hierarchy (Ancestors)

Back Pain; Pain; Neurologic Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms; Muscular Diseases; Musculoskeletal Diseases; Neuromuscular Diseases; Nervous System Diseases; Musculoskeletal Pain; Behavior

Study Officials

• Aftab Ahmed Mirza Baig, MSAPT

  University of Karachi

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal Investigator

Study Record Dates

• First Submitted: December 15, 2019
• First Posted: December 20, 2019
• Study Start: March 3, 2020
• Primary Completion: December 15, 2020
• Study Completion: January 17, 2021
• Last Updated: February 8, 2021

Record last verified: 2021-02

Data Sharing

• IPD Sharing: Will not share

Locations

PA (1)