Effect of Motor Skill Training in Functional Activities vs Strength and Flexibility Exercise on Function in People With Chronic Low Back Pain

Abstract

IMPORTANCE Chronic low back pain (LBP) is the most prevalent chronic pain in adults, and there is no optimal nonpharmacologic management. Exercise is recommended, but no specific exercise-based treatment has been found to be most effective.OBJECTIVE To determine whether an exercise-based treatment of person-specific motor skill training (MST) in performance of functional activities is more effective in improving function than strength and flexibility exercise (SFE) immediately, 6 months, and 12 months following treatment. The effect of booster treatments 6 months following treatment also was examined. DESIGN, SETTING, AND PARTICIPANTSIn this single-blind, randomized clinical trial of people with chronic, nonspecific LBP with 12-month follow-up, recruitment spanned December 2013 to August 2016 (final follow-up, November 2017), and testing and treatment were performed at an academic medical center. Recruitment was conducted by way of flyers, physician and physical therapy offices, advertisements, and media interviews at Washington University in St Louis, Missouri. Of 1595 adults screened for eligibility, 1301 did not meet the inclusion criteria and 140 could not be scheduled for the first visit. A total of 154 people with at least 12 months of chronic, nonspecific LBP, aged 18 to 60 years, with modified Oswestry Disability Questionnaire (MODQ) score of at least 20% were randomized to either MST or SFE. Data were analyzed between December 1, 2017, and October 6, 2020.INTERVENTIONS Participants received 6 weekly 1-hour sessions of MST in functional activity performance or SFE of the trunk and lower limbs. Half of the participants in each group received up to 3 booster treatments 6 months following treatment. MAIN OUTCOMES AND MEASURESThe primary outcome was the modified Oswestry Disability Questionnaire (MODQ) score (0%-100%) evaluated immediately, 6 months, and 12 months following treatment.RESULTS A total of 149 participants (91 women; mean [SD] age, 42.5 [11.7] years) received some treatment and were included in the intention-to-treat analysis. Following treatment, MODQ scores were lower for MST than SFE by 7.9 (95% CI, 4.7 to 11.0; P < .001). During the follow-up phase, the MST group maintained lower MODQ scores than the SFE group, 5.6 lower at 6 months (95% CI, 2.1 to 9.1) and 5.7 lower at 12 months (95% CI, 2.2 to 9.1). Booster sessions did not change MODQ scores in either treatment.CONCLUSIONS AND RELEVANCE People with chronic LBP who received MST had greater short-term and long-term improvements in function than those who received SFE. Person-specific MST in functional activities limited owing to LBP should be considered in the treatment of people with chronic LBP.

Clinical outcomes one year after a digital musculoskeletal (MSK) program: an observational, longitudinal study with nonparticipant comparison group

“…To continue to show improvements over time, the digital MSK program may need to include more motor skill training in addition to strength and flexibility exercises. For example, van Dillen et al successfully used motor skill training to target how people performed functional activities, and this approach resulted in functional improvements that endured [42].…”

Person-specific Characteristics of People with Low Back Pain Moderate the Preferred Movement Pattern within Motor Skill Training and Strength and Flexibility Exercise

“…14 Furthermore, the improved movement pattern in MST corresponded with greater improvements in pain and function compared to SFE. 13 Although on average MST improved the altered movement pattern and SFE did not, there was substantial variability in the baseline and the change over time in the pattern within both treatment groups. This variability suggests that some people with LBP improved the pattern to a greater extent than others.…”

“…[11][12][13] The primary goal of MST during LBP-limited functional activities is to replace the long-standing, pain-provoking, altered movement pattern with a pain-free pattern. 10,12,13 One study documented that one session of MST immediately improved the altered movement pattern during a functional activity test of picking up an object (PUO), and the improved pattern was associated with an immediate reduction in LBP symptoms. 10 More recently, the short-and long-term effects of MST were compared to strength and flexibility exercise (SFE).…”

“…10 For example, motor skill training (MST) uses personspecific, challenging practice to drive learning of new motor skills. [11][12][13] The primary goal of MST during LBP-limited functional activities is to replace the long-standing, pain-provoking, altered movement pattern with a pain-free pattern. 10,12,13 One study documented that one session of MST immediately improved the altered movement pattern during a functional activity test of picking up an object (PUO), and the improved pattern was associated with an immediate reduction in LBP symptoms.…”

Participants with mildly-disabling chronic neck pain perform differently during explicit compared to implicit motor learning of a reaching task

“…However, the magnitude of the benefits for pain management, are smaller than desired and commonly short-term [ 14 ]. More recently, using motor skill training, which incorporates learning or relearning functional tasks to improve pain and reduce disability in a group of patients with chronic low back pain led to long-term improvements [ 15 – 17 ]. Integrating motor learning principles into rehabilitation programs could lead to better outcomes, since individuals with CMSK pain may need to acquire/re-acquire movements, motor skills and/or behaviors and then retain for daily use following rehabilitation [ 18 , 19 ].…”