A Treatment Outcome Study on the Efficacy of Two Therapy Interventions on the Treatment of Chronic

Low-Back Pain in an Elderly Population

Julia Goodkin

Introduction Review of Literature Research Question Methods Results Discussion Conclusion

Pain• Pain is defined as an unpleasant

sensory and emotional experience associated with actual or potential tissue damage

• Generally classified in three main typesoAcuteoCancer-relatedoChronic (Ashburn, 2010)

https://www.painmanagementlosangeles.com/a-detailed-information-about-acute-pain-management.html

Introduction Review of Literature Research Question Methods Results Discussion Conclusion

Chronic Low-Back Pain (CLBP)

• Persistent pain that lasts weeks to years• Most common cause of job-related disability• Affects about 100 million adults per year and has an

estimated annual cost of $635 billion (Institute of Medicine, 2011)

https://painconsortium.nih.gov/NIH_Pain_Programs/Task_Force/cLBP_RTF_MinimalDataset.pdf

Introduction Review of Literature Research Question Methods Results Discussion Conclusion

CLBP and Cognitive Function

• Persistent pain leads to higher rates of anxiety disorders (Taylor, 2001)

• CLBP patients had over 9 times the risk of developing major depression (Atkinson et al., 1991)

• More than 6 million elderly persons per year that experience at least one episode of LBP also report decline in their quality of life and life satisfaction (Weiner, 2006)

Introduction Review of Literature Research Question Methods Results Discussion Conclusion

Common Treatments of CLBP• NSAIDs• Exercise• Yoga• Massage

http://thecompleteherbalguide.com/tai-chi/#.WD8CRXeZORshttp://www.hemophiliafed.org/uploads/FDA-Shifts-Focus-to-Abuse-Deterrent-Generic-Opioid-Development_strict_xxl.jpg

http://www.johnsonmedicalassociates.com/massage-therapy/

Introduction Review of Literature Research Question Methods Results Discussion Conclusion

http://previews.123rf.com/images/andreypopov/andreypopov1211/andreypopov121100186/16406148-Large-group-of-diverse-people-

Functional Restoration

• Multidimensional pain management program (Chan, 2016)

• Three particular aspectsoMyofascial Release Techniques (MFRT)oNeural Flossing (NF)o Proprioceptive Neuromuscular

Facilitation (PNF)

https://www.youtube.com/watch?v=Gko8IVDoNx4

https://www.youtube.com/watch?v=HkXkUjffCYw

Introduction Review of Literature Research Question Methods Results Discussion Conclusion

Research Question and Hypothesis• Purpose: Compare changes in pain and function achieved in a

standard fitness program versus an individualized therapy program consisting of multi-dimensional exercises.

• H1: The application of an individualized multidimensional exercise therapy treatment will result in positive changes in physical function, walking pattern and brain processing as measured by subjective questionnaires.

• H0: The application of an individualized multidimensional exercise therapy treatment will not result in positive changes in physical function, walking pattern and brain processing as measured by subjective questionnaires.

Introduction Review of Literature Research Question Methods Results Discussion Conclusion

Methods1. Allocation of participants through Center of Healthy Living and

Longevity (CHLL)2. Distribution of participants into Multidimensional Exercise

Therapy (MET) or Traditional Senior Exercise Therapy (TET) groups

3. Collection of pre-test measurements 4. Execution of therapeutic interventions5. Collection of post-test measurements6. Administration of 6 month post-test assessment

Introduction Review of Literature Research Question Methods Results Discussion Conclusion

Participants

• Center of Healthy Living and Longevity (CHLL)

• Reported CLBP• Aged 65 or older

Introduction Review of Literature Research Question Methods Results Discussion Conclusion

Traditional Senior Exercise Therapy (TET)

• Performed 3 times a per week for 45 minutes per session• Guided by an instructor• Focus on practicing activities of daily living (ADL) and

improving strength and increasing muscle– Chair stands–Walking– Chair supported squats

Introduction Review of Literature Research Question Methods Results Discussion Conclusion

Multi-dimensional Exercise Therapy (MET)• Participants receive an individualized treatment program

addressing specific functional disabilities• Movements designed to improve range of motion, flexibility

and strength of hip and low-back• Common intervention will include–MFRT–NF– PNF

• Therapy occurs twice a week on campus and once a week in home

Introduction Review of Literature Research Question Methods Results Discussion Conclusion

PROMIS-29• Measures psychosocial

outcomes• Focus on the previous seven

days• Scored on a 5-point likert

scale• Questions focused on ADLs

Introduction Review of Literature Research Question Methods Results Discussion Conclusion

NeuroCom SOT• Identifies abnormalities in

the patients use of the three balance systems– Somatosensory–Visual–Vestibular

Introduction Review of Literature Research Question Methods Results Discussion Conclusion

Senior Fitness Test• A series of tests that assess

the major components of fitness for older adults– Body strength –Agility–Aerobic endurance– Flexbility

Introduction Review of Literature Research Question Methods Results Discussion Conclusion

I-Gait Assessment

• Record tridimensional full body motion during walking gait for subjects

• No sensors or special clothing required

Introduction Review of Literature Research Question Methods Results Discussion Conclusion

ResultsTable 1: PROMIS measures after MET and TET treatments were administered

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Introduction Review of Literature Research Question Methods Results Discussion Conclusion

Results cont.Table 2: NeuroCom measures after both MET and TET treatments were administered.

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Introduction Review of Literature Research Question Methods Results Discussion Conclusion

Results cont.• MET results in positive changes in brain processes and physical

functioning

• Walking patterns were not affectedTable 3: iGait measures after MET and TET treatments were administered

Introduction Review of Literature Research Question Methods Results Discussion Conclusion

Discussion

• Prior research examining TET and MET interventions is scarce• Study provided the first comprehensive biopsychosocial results in

scientific literature• Massage has been shown to produce positive treatment outcomes

(Cherkin et al, 2010)• Massage treatment in conjunction with exercise improved physical

condition (Furlan et al, 2014)

Introduction Review of Literature Research Question Methods Results Discussion Conclusion

Conclusion

• 8 out of 10 individuals experience some form of LBP at some point in their lives (Weiner, 2010)

• Treatments of CLBP can be expensive or addictive• Exercise in addition to an FR program has proven to be an

effective treatment option for CLBP in an elderly population

Introduction Review of Literature Research Question Methods Results Discussion Conclusion

Bibliography• A.Tanvi, A. (2013). Effect of Proprioceptive Neuromuscular Facilitation Program on Muscle Endurance, Strength, Pain, and Functional Performance in Women with Post-Partum

Lumbo-Pelvic Pain. IOSR-JDMS, 7(3), 58-65. doi:10.9790/0853-0735865• Adams, M. A., Stefanakis, M., & Dolan, P. (2010). Healing of a painful intervertebral disc should not be confused with reversing disc degeneration: Implications for physical

therapies for discogenic back pain. Clinical Biomechanics, 25(10), 961-971. doi:10.1016/j.clinbiomech.2010.07.016• Anderson, R., Wise, D., Sawyer, T., & Chan, C. (2005). Integration of Myofascial Trigger Point Release and Paradoxial Relaxation Training Treatment of Chronic Pelvic Pain in

Men. The Journal of Urology, 174(1), 155-160. doi:10.1097/01.ju.0000161609.31185.d5• Bressler, H. B., Keyes, W. J., Rochon, P. A., & Badley, E. (1999). The Prevalence of Low Back Pain in the Elderly. Spine, 24(17), 1813. doi:10.1097/00007632-199909010-00011• Budhrani-Shani, P., Berry, D. L., Arcari, P., Langevin, H., & Wayne, P. M. (2016). Mind-Body Exercises for Nurses with Chronic Low Back Pain: An Evidence-Based Review.

Nursing Research and Practice, 2016, 1-10. doi:10.1155/2016/9018036• Castro-Sánchez, A. M., Matarán-Peñarrocha, G. A., Granero-Molina, J., Aguilera-Manrique, G., Quesada-Rubio, J. M., & Moreno-Lorenzo, C. (2011). Benefits of Massage-

Myofascial Release Therapy on Pain, Anxiety, Quality of Sleep, Depression, and Quality of Life in Patients with Fibromyalgia. Evidence-Based Complementary and Alternative Medicine, 2011, 1-9. doi:10.1155/2011/561753• Chan, A. Y., Ford, J. J., Surkitt, L. D., Richards, M. C., Slater, S. L., Davidson, M., & Hahne, A. J. (2016). Individualised functional restoration plus guideline-based advice versus advice alone for non-reducible discogenic low back pain: a randomised controlled trial. Physiotherapy. doi:10.1016/j.physio.2016.08.001• Gatchel, R. J., Peng, Y. B., Peters, M. L., Fuchs, P. N., & Turk, D. C. (2007). The biopsychosocial approach to chronic pain: Scientific advances and future directions.

Psychological Bulletin, 133(4), 581-624. doi:10.1037/0033-2909.133.4.581• Haldeman, S., & Dagenais, S. (2008). A supermarket approach to the evidence-informed management of chronic low back pain. The Spine Journal, 8(1), 1-7.

doi:10.1016/j.spinee.2007.10.009• Institute of Medicine (U.S.). (2011). Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: National Academies

Press. • Jaiswal, A., Scherrer, J., Salas, J., Van den Berk-Clark, C., Fernando, S., & Herndon, C. (2016). Differences in the Association between Depression and Opioid Misuse in Chronic

Low Back Pain versus Chronic Pain at Other Locations. Healthcare, 4(2), 34. doi:10.3390/healthcare4020034• Johannes, C. B., Le, T. K., Zhou, X., Johnston, J. A., & Dworkin, R. H. (2010). The Prevalence of Chronic Pain in United States Adults: Results of an Internet-Based Survey. The

Journal of Pain, 11(11), 1230-1239. doi:10.1016/j.jpain.2010.07.002• Kanekar, N., & Aruin, A. S. (2014). The effect of aging on anticipatory postural control. Exp Brain Res, 232(4), 1127-1136. doi:10.1007/s00221-014-3822-3• Kim, S. (2015). Efficacy of tendon and nerve gliding exercises for carpal tunnel syndrome: a systematic review of randomized controlled trials. J Phys Ther Sci, 27(8), 2645-2648.

doi:10.1589/jpts.27.2645• Loeser, J. D., & Melzack, R. (1999). Pain: an overview. The Lancet, 353, 1607-1609. • Van der Kolk, N. M., & King, L. A. (2013). Effects of exercise on mobility in people with Parkinson's disease. Movement Disorders, 28(11), 1587-1596. doi:10.1002/mds.25658• Van Hooff, M. L., Van der Merwe, J. D., O’Dowd, J., Pavlov, P. W., Spruit, M., De Kleuver, M., & Van Limbeek, J. (2010). Daily functioning and self-management in patients with

chronic low back pain after an intensive cognitive behavioral programme for pain management. European Spine Journal, 19(9), 1517-1526. doi:10.1007/s00586-010-1435-5• Vibe Fersum, K., O'Sullivan, P., Skouen, J., Smith, A., & Kvåle, A. (2012). Efficacy of classification-based cognitive functional therapy in patients with non-specific chronic low

back pain: A randomized controlled trial. EJP, 17(6), 916-928. doi:10.1002/j.1532-2149.2012.00252.x• Weiner, D. K., Haggerty, C. L., Kritchevsky, S. B., Harris, T., Simonsick, E. M., Nevitt, M., & Newman, A. (2003). How Does Low Back Pain Impact Physical Function in

Independent, Well-Functioning Older Adults? Evidence from the Health ABC Cohort and Implications for the Future. Pain Med, 4(4), 311-320. doi:10.1111/j.1526-4637.2003.03042.x

• Weiner, D. K., Rudy, T. E., Morrow, L., Slaboda, J., & Lieber, S. (2006). The Relationship Between Pain, Neuropsychological Performance, and Physical Function in Community-Dwelling Older Adults with Chronic Low Back Pain. Pain Med, 7(1), 60-70. doi:10.1111/j.1526-4637.2006.00091.x