Embodiment- and distraction-based approaches to immersive virtual reality (IVR) show promise in treating persistent low back pain (PLBP). However, which approach is more effective is unclear. This study aims to evaluate the impact of distraction- and embodiment-based IVR on pain processing and patient-reported outcome measures in PLBP. Individuals with PLBP were randomised to receive eight sessions of either distraction- or embodiment-based IVR over two weeks. Outcome measures were evaluated at baseline and after the eighth session. Pain processing was evaluated using conditioned pain modulation (CPM) and temporal summation (TS).Background
Method
Chronic low back pain (CLBP) is the leading cause of disability worldwide. Immersive virtual reality (IVR) can be delivered using head mounted display (HMD) to interact with 3D virtual environment (VE). IVR has shown promising results in management of chronic pain conditions, using different mechanisms (e.g., exposure to movement and distraction). However, it has not been widely tested for CLBP. Future development of IVR intervention needs inputs from gatekeepers to determine key considerations, facilitators and barriers. This qualitative study aimed to explore views and opinions of physiotherapists about IVR intervention for adults with CLBP. Four focus groups were conducted online, with 16 physiotherapists. A demonstration of existing IVR mechanisms was presented. The data were transcribed and analysed through descriptive thematic analysis.Background
Methods
Patients with low back pain are increasing globally. Physical dysfunction and psychosocial factors such as stress, anxiety, and fear of movement, often referred to as yellow flags, play a role in the persistence of low back pain. What is not known is the extent to which yellow flags are screened for and treatment adjusted accordingly by Physiotherapists in India. The aim was to determine the current knowledge and awareness of physiotherapists in India regarding psychosocial factors for managing patients with low back pain. Semi-structured interviews gathered data from of six physiotherapists, The interviews were conducted online. The data was transcribed and analysed using thematic analysis.Purpose and Background
Methods
Patients’ engagement with self-management strategies (SMS) is key when managing low back pain (LBP) and relies on appropriate information being delivered by the treating Clinician. However, patients have differing coping mechanisms which may affect success with SMS. This study aimed to determine Patient and Physiotherapist's perceptions of coping responses and SMS in patients with LBP. Patient completed a Pain Coping strategies questionnaire, before and after LBP treatment. Semi-structured interviews gathered data from of 10 patients (6 males; and 6 physiotherapists. Questionnaire data was described descriptively, and qualitative data was transcribed/analysed thematically.Purpose and Background
Methods
Trunk muscle activity and thoraco-lumbar kinematics have been shown to discriminate non-specific chronic low back pain (NSCLBP) subgroups from healthy controls. Thoracic spine kinematics and muscle activity whilst intuitively associated with NSCLBP, has received less attention and the possibility of intra-regional interactions remains an area for exploration. Determine relationships between muscle activation and kinematics in active extension pattern (AEP) and flexion pattern (FP) subgroups and no-low back pain controls during a sagittal bending task.Background
Purpose
The preliminary study aimed to establish clinical and research expert opinion with regards to the key components of an assessment of a person with Mechanical Low Back Pain (MLBP). We aimed to identify the key subjective questions and objective tests which would be helpful for clinicians to develop the most appropriate self-management exercise programme. This is the first part of the study to develop the ‘Back-to-Fit’ digital tool offering personalised self-management exercise solutions for people with MLBP. Summary of the methods A Bristol online survey which included a questionnaire with a series of open and closed questions was developed using the literature and was distributed among clinicians/researchers with a background in the clinical management of MLBP. The questionnaire included 6 demographic questions followed by sections related to subjective questions and objective tests of the MLBP assessment. 71 participants responded to the survey. In the subjective assessment component, ≥80% level of agreement was obtained for 17 of 26 proposed subjective questions and 05 of the 21 suggested objective tests. Two more questions and two objective tests to be included in the assessment had been suggested by the partcipants.Purpose of the study and background
Results
To assess the test-retest reliability, construct validity and determine the cut-off scoret of BACKonLINE™ for people with LBP. Appropriate treatment for Low back pain (LBP) is vital, however patients can wait for 14–24 weeks on NHS Physiotherapy lists. Many factors contribute to LBP and initially can be due to peripheral tissue damage. However, persistent LBP is associated with amplification in pain processing in the central nervous system (central sensitisation-CS). CS often results in poorer outcomes and often requires longer management making timely assessment and appropriate management crucial. An online self-assessment and self-management tool (BACKonLINE™) for discerning between characteristics of predominantly centrally (CD) or peripherally (PD) driven LBP was developed using a Delphi study.Purpose of the Study
Background
Back and lower limb injuries are prevalent in athletes who perform novel weight-lifting techniques with inappropriate kinematics. Visual-auditory instructions and knowledge of performance (KP) verbal instructions are utilised to help novices execute novel skills. Effectiveness of these methods on executing appropriate front-squat lifting kinematics is limited. Aim: to investigate the effects of visual-auditory instructions compared to KP verbal instructions on front-squat kinematics at sticking point in novice lifters, with improvement determined by proximity to the kinematics of an expert lifter at sticking point when performing optimal front-squat lift. Twenty-four novices were randomised into two groups and performed front-squat lift. The novices in visual-auditory group (n = 12, age = 24.33 ± 2.93 years) received videoaudio instructions, verbal group (n = 12, Age= 22.66 ± 2.34 years) received KP verbal instructions. MATLAB software measured kinematic lumbar angles, Kinovea software measured hip, knee, ankle angles at sticking point of front-squat. Data were collected from video recordings of novices and an expert pre-and post-instructions in one session and expert data were used as reference values of proximity for both groups.Purpose & Background
Methods
The ability to jump higher is a key factor for athletic performance and relies on many factors including spinal movement and trunk muscle activity. Manual therapy including Mulligan' Sustained Natural Apophyseal Glide (SNAG) techniques are proposed to increase spinal movement and thus function. The evidence pf the effect of manual therapy on muscle activity is limited. We aimed to determine the immediate effects of an extension SNAG on the lower lumbar spine on jump height and rectus abdominis (RA), external oblique (EO), multifidus (M) and iliocostalis Lumborum (IL) muscle activity during the flight phase of vertical jump compared to a placebo intervention (flat hand pressure). Eighteen healthy participants (16 males, age 28.11±5.01 years, weight 70.58±11.9 kg, height 1.70±0.07m, body mass index 24.28±3.30)from Cardiff University were randomly allocated to either an extension SNAG or placebo intervention. Surface Electromyography was normalised to maximum voluntary contraction and was collected during the flight phase of the jump and jump height was measured using jump and reach test.Purpose & Background
Method
To develop an online self-assessment and self-management tool (BACKonLINE™) for discerning between people with characteristics of predominantly centrally (CD) or peripherally (PD) driven LBP. Low back pain (LBP) may worsen with time, making appropriate treatment important. In the NHS Physiotherapy services LBP patients may wait for 14–24 weeks for treatments. Many factors contribute to LBP, but it is predominantly initially viewed as a result of peripheral tissue damage. However, evidence show that persistent LBP is associated with amplification in pain processing in the central nervous system (central sensitisation). Sometimes, this may drive symptoms, resulting in poorer outcomes and requiring longer management. Timely assessment and appropriate management is therefore paramount.Purpose of the Study
Background
Differences in regional lumbar angles in sitting have been observed between subgroups of NSCLBP patients exhibiting motor control impairments (MCI) (O'Sullivan, 2005; Dankaerts et al, 2006). However, differences in standing posture and other spinal regions are unknown. This study aimed to compare regional spinal angles in healthy and MCI subgroups in sitting and standing. An observational, cross-sectional study investigated spinal kinematics of 28 Flexion Pattern (FP), 23 Active Extension Pattern (AEP) (O'Sullivan, 2005) and 28 healthy controls using 3D motion analysis (Vicon) during usual sitting and standing. Mean sagittal angle for Total Lumbar (TotLx), Total Thoracic (TotTx), Upper Thoracic (UTx), Lower Thoracic (LTx), Upper Lumbar (ULx) and Lower Lumbar (LLx) regions between groups were compared using one-way ANOVA.Background and Purpose of Study:
Methods:
CB-CFT targeting specific pain provoking posture/movements in NSCLBP patients was shown more beneficial than current best practice. Resources for such interventions are substantial and so modifications for today's NHS are warranted. This study investigated feasibility and effect of CB-CFT delivered in a group setting (CB-CFT/G). Twenty three patients referred to Physiotherapy with NSCLBP undertook (i) 6 week CB-CFT/G(n=13) or (ii) current best practice (C)(n=10). Outcomes: Oswestry Disability Questionnaire (ODQ), pain (VAS), fear avoidance (Tampa Scale of Kinaesiophobia;TSK), physical activity (International Physical Activity Questionnaire;IPAQ), distress&risk assessment (DRAM), StarTBack and satisfaction. Unpaired t-tests assessed between-group difference in mean change of each outcome (p<0.05).Background
Methods
To determine the effect of leg dominance on trunk muscle activity during bridging exercises on the floor and a gym ball. Perturbation training including bridging exercises and unstable surfaces have been shown to increase trunk activity. Trunk muscle activity increases on the contralateral side to the stabilising leg during bridging, however, no studies exist on the effect of leg dominance on trunk muscle activity during bridging exercises. This study will investigate whether trunk muscle activity differs when stabilising on the dominant versus non-dominant leg.Purpose
Background
To compare the effectiveness of the Aspen, Aspen Vista, Philadelphia, Miami-J and Miami-J Advanced collars at restricting cervical spine movement in the sagittal, coronal and axial planes. Nineteen healthy volunteers (12 female, 7 male) were recruited to the study. Collars were fitted by an approved physiotherapist. Eight ProReflex (Qualisys, Sweden) infra-red cameras were used to track the movement of retro reflective marker clusters placed in predetermined positions on the head and trunk. 3D kinematic data was collected during forward flexion, extension, lateral bending and axial rotation from uncollared and collared subjects. The physiological range of motion in the three planes was analysed using the Qualisys Track Manager system.Objective
Methods
Staying active, including walking is promoted as being beneficial for patients with low back pain (LBP). The abdominal muscles appear to influence the stability of the spine and their activity has been shown to change when patients have LBP. Walking with Nordic walking poles has been shown to influence forces on the lower limbs, but little research has investigated the effect on the trunk muscles. Aim: to study the effect of walking using Nordic walking poles on abdominal muscle activity and lower limb forces. Method 15 healthy subjects gave informed consent (5 males. 10 females, age 21.06 yrs.(±88), height 174.45cms (±11.1), weight 71.44 kg (±15.2)). Following a period of walking training with Nordic walking poles data was obtained during a period of walking for internal IO) and external oblique (EO) using surface electromyography activity and vertical lower limb forces (Newtons, (N)) with (WP) and without Nordic walking poles (NP). SEMG data was normalised to maximum voluntary contraction. There were significant increases in IO (p=0.02, NP 31.94 (±39.9) WP 53.05 (±40.61)), EO (p=0.02, NP 46.45, (±30.9), WP 87.93 ± (±60.5)) and vertical forces with poles (p=0.008, NP871.6 (±237.00)N, WP 968.33, (±210.8) N). Using Nordic walking poles significantly increases activity of IO and EO, which may be of value in the rehabilitation of some patients with LBP. Vertical forces increased when walking with poles which is contrary to previous research. This may be due to the data collection setting of a research laboratory or the subjects being novice walkers.Results
Discussion
Some studies report greater repositioning error in LBP patients compared to healthy subjects with other studies showing no differences. This conflicting evidence may be due to different methodologies. A new tool, the Flexchair¯Back Balance Trainer measures consistency of lumbo-pelvic movement during visual tracking tasks which challenge the lumbo-pelvic region. This study aimed to establish the within day (WD) and between day (BD) reliability of a lumbo-pelvic tracking task using the Flexchair in healthy subjects, 22 subjects gave informed consent (10 females, 12 males (age 38.40(±9.29) Height 171.35cms (±8.07) weight 76.21kg (±18.55) Subjects completed six different tracking tasks on the Flexchair, 3 times in the first day with 2 hour of intervals between each test and once on a second and third visit with 2 days in between. Tests 1-6 are of increasing difficulty.Background
Method
