A Systematic Review and Meta-Analysis on the Effectiveness of Graded Activity and Graded Exposure for Chronic Nonspecific Low Back Pain

López‐de‐Uralde‐Villanueva, Ibai; Muñoz-García, Daniel; Gil-Martínez, Alfonso; Pardo-Montero, Joaquín; Muñoz-Plata, Rosa; Angulo‐Díaz‐Parreño, Santiago; Gómez-Martínez, Miguel; Touche, Roy La

doi:10.1111/pme.12882

Cited by 72 publications

(63 citation statements)

References 78 publications

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“…For example, While studies on VRG in chronic LbP are just emerging, available research postulates that the effectiveness of the approach can be attributed to neuromodulatory mechanisms [50]. In explaining the neuromodulatory mechanisms, VRG interventions in chronic LbP are cognitive-behavioural approaches using graded exposure that could encourage movement of the lumbar spine, especially in highly avoidant and fearful patients with chronic LbP [51]. In a fun, motivating, and distracting context, bE-VRG exerts a neuromodulatory effect by stimulating patients to head virtual soccer balls while standing leg wide apart in order to head off the balls and, in the process, causing a sig-nificant amount of spinal extension and side glides.…”

Section: Discussionmentioning

confidence: 99%

Comparative effects of clinic- and virtual reality-based McKenzie extension therapy in chronic non-specific low-back pain

Mbada¹,

Makinde²,

Odole³

et al. 2019

Hum Mov.

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Purpose. The study compared the influence of Clinic-based McKenzie Therapy (CbMT) and a Virtual Reality Game (VRG) version on pain intensity, back extensor muscles endurance, activity limitation, participation restriction, fear avoidance belief, kinesiophobia, and general health status of patients with chronic non-specific low-back pain.Methods. This quasi-experimental study involved 46 patients (CbMT: n = 24; VRG: n = 22) with 'directional preference' for extension, randomized into CbMT or VRG group. Treatment was applied thrice weekly for 8 weeks. Outcomes were assessed at the end of the 4 th and 8 th week. Data analysis employed descriptive and inferential statistics of independent t-test, Mann-Whitney U test, repeated measure ANOVA, Friedman's ANOVA, and ANCOVA. The significance level was set as = 0.05.Results. There were no significant differences in the treatment outcomes (mean change) across the groups (p > 0.05), except for kinesiophobia, where VRG led to a significantly higher decline in mean rank at week 4 (28.3 vs. 19.1; p = 0.018) and 8 (28.7 vs. 18.7; p = 0.009), and vitality (a general health status item) at week 4 (27.6 vs. 19.8; p = 0.042) and 8 (28.1 vs. 19.3; p = 0.042). ANCOVA showed that significant baseline parameters were not significant predictors of vitality (F = 1.986; p = 0.070) or kinesiophobia (F = 0.866; p = 0.563) outcomes. Conclusions. The VRG mode of McKenzie therapy is comparable with the clinic-based approach in most outcomes. VRG has a superior effect on kinesiophobia, but may take a higher toll on vitality/energy. Citation: Mbada CE, Makinde MO, Odole AC, Dada OO, Ayanniyi O, Salami AJ, Gambo IP. Comparative effects of clinicand virtual reality-based McKenzie extension therapy in chronic non-specific low-back pain. Hum Mov. 2019;20(3):66-79; doi: https://doi.org/10.5114/hm.2019.83998.

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Section: Discussionmentioning

confidence: 99%

Comparative effects of clinic- and virtual reality-based McKenzie extension therapy in chronic non-specific low-back pain

Mbada¹,

Makinde²,

Odole³

et al. 2019

Hum Mov.

View full text Add to dashboard Cite

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“…However, when compared against each other and other exercise interventions, the results tend to be equivocal (George, Wittmer, Fillingim, and Robinson, 2010;López-de-Uralde-Villanueva et al, 2015;Macedo, 2010;Rasmussen-Barr, Äng, Arvidsson, and NilssonWikmar, 2009). Graded activity programs work on quota based systems in which a set amount of increase at a predetermined rate is employed in an operant conditioning model, while exposure based models attempt to extinguish the response to feared activities through desensitization under controlled conditions (Lindström et al, 1992;Main et al, 2015;Riecke, Holzapfel, Rief, and Glombiewski, 2013;Vlaeyen et al, 2012) .…”

Section: Introductionmentioning

confidence: 91%

Reconciling movement and exercise with pain neuroscience education: A case for consistent education

Blickenstaff

Pearson

2016

Physiotherapy Theory and Practice

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This article will introduce a conceptual framework of kinesthetic education that is consistent with and reinforces pain neuroscience education. This article will also provide some specific guidance for integrating pain neuroscience education with exercise and movement in a more congruent manner. Our belief is that this will enhance the effectiveness of specific movement approaches such as graded exposure techniques. Over the past decade, a new paradigm of pain education has been explored in an effort to improve patient outcomes. Using advances in pain neuroscience, patients are educated in the biological and physiological processes involved in their pain experience. Growing evidence supports the ability of pain neuroscience education (PNE) to positively impact a person's pain ratings, disability, pain catastrophization, and movement limitations. What is often overlooked, however, is the consistency between the messages of PNE and those of other therapeutic interventions, including movement therapies. This article proposes the following: education provided in isolation will be limited in its impact, the addition of guided purposeful movement performed in a manner consistent with PNE may be vital to the desired behavioral changes, and when inconsistent messages are delivered between education and movement interventions, outcomes may be adversely impacted.

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“…Disrupt adhesions between adjacent tissues that restrict movement or cause pain Graded activity and exposure training: graded activity and exposure to progressively more functional activities and behaviors using a cognitive behavioral approach 63,98,99 Suspected/proposed mechanism(s): Figure 4 displays evidence-based intervention descriptions. Each figure was designed as a single-page summary of results from this study.…”

Section: Other Interventionsmentioning

confidence: 99%

Development of a Clinical Decision Aid for Chiropractic Management of Common Conditions Causing Low Back Pain in Veterans: Results of a Consensus Process

Vining

Shannon

Salsbury

et al. 2019

Journal of Manipulative and Physiological Therapeutics

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Objective: The purpose of this study was to develop a clinical decision aid for chiropractic management of common conditions causing low back pain (LBP) in veterans receiving treatment in US Veterans Affairs (VA) health care facilities. Methods: A consensus study using an online, modified Delphi technique and Research Electronic Data Capture web application was conducted among VA doctors of chiropractic. Investigators reviewed the scientific literature pertaining to diagnosis and treatment of nonsurgical, neuromusculoskeletal LBP. Thirty seed statements summarizing evidence for chiropractic management, a graphical stepped management tool outlining diagnosis-informed treatment approaches, and support materials were then reviewed by an expert advisory committee. Email notifications invited 113 VA chiropractic clinicians to participate as Delphi panelists. Panelists rated the appropriateness of the seed statements and the stepped process on a 1-to-9 scale using the RAND/University of California, Los Angeles methodology. Statements were accepted when both the median rating and 80% of all ratings occurred within the highly appropriate range. Results: Thirty-nine panelists (74% male) with a mean (standard deviation) age of 46 (11) years and clinical experience of 17 (11) years participated in the study. Accepted statements addressed included (1) essential components of chiropractic care, (2) treatments for conditions causing or contributing to LBP, (3) spinal manipulation mechanisms, (4) descriptions and mechanisms of commonly used chiropractic interventions, and (5) a graphical stepped clinical management tool. Conclusion: This study group produced a chiropractic clinical decision aid for LBP management, which can be used to support evidence-based care decisions for veterans with LBP.

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A Systematic Review and Meta-Analysis on the Effectiveness of Graded Activity and Graded Exposure for Chronic Nonspecific Low Back Pain

Cited by 72 publications

References 78 publications

Comparative effects of clinic- and virtual reality-based McKenzie extension therapy in chronic non-specific low-back pain

Comparative effects of clinic- and virtual reality-based McKenzie extension therapy in chronic non-specific low-back pain

Reconciling movement and exercise with pain neuroscience education: A case for consistent education

Development of a Clinical Decision Aid for Chiropractic Management of Common Conditions Causing Low Back Pain in Veterans: Results of a Consensus Process

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