- Researchers have found the benefits of graded sensorimotor retraining for people with chronic low back pain are likely to be similar across a range of people, rather than being limited to specific subgroups.
- Low back pain affected 619 million people worldwide in 2020 and contributes the largest share of the disability burden.
- The research investigated whether eight clinical and psychological variables modify the effect of treatment on pain intensity and disability levels.
New research has found that the benefits of graded sensorimotor retraining are likely to be similar for all patients with chronic low back pain.
Low back pain is a leading cause of disability burden worldwide, and the treatment was developed to retrain the brain and nervous system to improve movement and pain by restoring confident, coordinated movement through progressive, precise exercises, education and movement relearning.
Research led by NeuRA (Neuroscience Research Australia) PhD student, Martjie Venter, investigated whether eight different variables modified the treatment’s effect on pain and function.
“We know that graded sensorimotor retraining has shown improvements in pain and function, but we needed to understand whether there are groups of people that benefit more or less than others,” she said.
“Our research found that the benefits of graded sensorimotor retraining are likely to be similar for all people presenting with chronic low back pain.”
The study used data from the RESOLVE trial, a two-group sham-controlled randomised clinical trial and included 276 patients. Those in the treatment group received 12 weekly sessions of graded sensorimotor retraining, including pain science education, premovement training and graded movement and loading. Those in the sham control group completed 12 weekly sessions, without advice or education, of sham electrotherapy to the back and sham non-invasive brain stimulation.
The variables investigated included psychoactive medication use, pain intensity, disability level, beliefs about back pain consequences, kinesiophobia, pain catastrophising, pain self-efficacy and back perception.
“We performed a formal moderation analysis by assessing statistical interactions at the 18 week- and 52- week follow up time points,” Ms Venter said.
“While we found no strong evidence of subgroups of people that responded differently to the treatment, we did find that back perception was a potential treatment effect modifier of pain intensity at the 52-week follow-up point.”
Assessing back perception may assist with targeting this treatment
Assessing the back perception of patients using tools like the Fremantle Back Awareness Questionnaire may help identify those who may not experience as great a benefit and for guiding treatment decisions. Back perception refers to how people perceive and feel about their back.
“Using validated tools to assess patient’s back perception may help clinicians identify people who require extra support during the intervention,” Ms Venter said.
“This may include things like slowing task progression, augmenting sensory feedback or increasing premovement training.
“Back perception could also be considered in future trial design, particularly when making decisions about participant selection criteria, and for inclusion in future clinical prediction tools.”
Move to clinical implementation
This secondary analysis provides evidence to inform the translation of graded sensorimotor retraining from a research setting to clinical practice.
“The treatment has had positive results in a high-quality randomised trial and appears to be suitable for people with chronic non-specific low back pain,” said Professor James McAuley, NeuRA Senior Research Scientist .
“This is positive news for the millions of people experiencing back pain each year and looking for effective and cost-effective treatments.
“We are now working to refine the intervention to be a better fit for routine physiotherapy practice and will then undertake a larger clinical trial in primary care settings to assess its effectiveness and readiness for widespread clinical use.”
The study was published on JAMA Network Open and can be read at https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2843802
Clinicians and patients interested in the intervention can reach out to the research team at [email protected] to stay informed.
About us:
Neuroscience Research Australia (NeuRA) is an independent, not-for-profit research institute based in Sydney aiming to prevent, treat and cure brain and nervous system diseases, disorders and injuries through medical research. To learn more about NeuRA: www.neura.edu.au
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