Thursday, April 3, 2025
4/3/2025
Significance of Spinal Movement Impairments in Acute Low Back Pain - Project Summary Non-specific low back pain (LBP) is a highly prevalent and costly health condition characterized for many by recurrent, fluctuating or persistent pain and limitations in function over time. The overall objective of this project is to curtail the costly long-term course of LBP. The goal of the current project is to understand the role of specific spinal movement impairments to the course of recovery of people presenting with acute LBP, and to examine the immediate and short-term effects of treating the impairments in people with acute LBP. Spinal movement impairments in people with acute LBP are of particular interest because the impairments have been found to be highly relevant to the clinical course in people with chronic LBP. Our central hypothesis is that the spinal movement impairments will 1) be prevalent in patients with acute LBP, 2) persist to varying degrees over time, 3) be related to the course of recovery of acute LBP and function, and 4) be a viable target for treatment in the acute stage. We will conduct a prospective, observational cohort study of 212 people (ages 18-60) who have acute LBP but do not have a history of chronic LBP. We will collect 1) measures of spinal movement impairments, 2) self-report surveys of patient characteristics, LBP history, psychosocial behavior, comorbidities, treatment use, imaging, LBP intensity and functional limitations, and 3) findings from our clinical exam. The measures of movement, self-report surveys and exam data will be collected at baseline of the acute episode, and at 2 and 6 months thereafter. We will collect a subset of the self-report surveys electronically weekly from baseline-to-8 weeks and monthly from 3-12 months. At baseline and 2 and 6 months after the acute episode we will 1) examine the prevalence of the impairments, 2) test if the degree of the impairments at baseline, as well as change over time in the degree is related to LBP and functional limitations, and 3) test if the degree of impairments at baseline and change in impairments over the 6 months after the acute episode will predict transition to chronic LBP. To test the effect of treating the impairments in the acute stage, we will conduct an early phase learning trial (Phase 2A) in a 2nd sample of people (n=68) who present to an Emergency Department (ED). We will randomize people to 1) motor skill training in functional activities (MST) + usual care (UC) or 2) UC. MST will be provided in the ED and twice in the following 2 weeks. In the ED and 2 weeks after the ED visit we will collect self-report surveys and movement data. Then for each of 10 weeks, we will collect a subset of the self-report surveys electronically. We will test the immediate (within-session) and short-term (2 and 12 week) effect of MST+UC to UC. Expected outcomes will be specific information about the 1) change in prevalence of the impairments over the course of recovery, 2) relevance of change in the impairments to change in the person’s pain and function over time, including the transition to chronicity, and 3) effects of treating the impairments. Successful completion of this project will have an immediate, high impact on research and evaluation and treatment of people with acute LBP that could improve the costly course of LBP for people who have incomplete recovery from an acute episode.
HHS’ Tracking Accountability in Government Grants System (TAGGS) website provides access to detailed descriptions of grants, loans, aggregated direct payments and other types of financial assistance awarded by the HHS Operating Divisions (OPDIVs) and the Office of the Secretary Staff Divisions (STAFFDIVs).