BELOW (training development study)
Research type
Research Study
Full title
Behaviour change to rEduce LOW back pain: a training development study (BELOW)
IRAS ID
339101
Contact name
Stephen Preece
Contact email
Sponsor organisation
University of Salford
ISRCTN Number
ISRCTN31860277
Duration of Study in the UK
0 years, 9 months, 28 days
Research summary
Summary of Research:
The current NHS treatment for people with low back pain (LBP) who are at high risk of long-term problematic symptoms involves a combination of physical exercises and psychological methods. However, the effectiveness of this combined approach is not very strong, partly because many patients prefer physical treatments and are hesitant to engage with the psychological aspects. Additionally, some musculoskeletal physiotherapists believe that current combined treatments lack sufficient "hands-on" guidance.To address these issues, we have developed a new physiotherapy treatment for LBP called Cognitive Muscular Therapy (CMT). CMT integrates psychological techniques for pain management with training to improve postural control. Unlike traditional strength training, CMT focuses on improving postural control by reducing overactivity of the abdominal and low back muscles, using "hands-on" guidance during treatment. Small sensors are used to visualize muscle activity to facilitate this relearning process. In a small pilot study, 15 people with long-lasting back pain received 7 sessions of CMT and on average, their pain decreased by 77%.
This project, funded by the National Institute for Health Research (NIHR) aims to understand if CMT can be developed to form part of the NHS treatment for LBP. The first part of the project involves developing and testing a training programme for physiotherapists. We will recruit 4 physiotherapists who will complete online and face to face training. They will then deliver 7 sessions of CMT to 2 participants with LBP. All participants will be interviewed to understand their experiences of delivering/receiving CMT. This feedback will be used to develop the training course for physiotherapists. This course will be used to train physiotherapists as part of a future feasibility study. This future feasibility study will evaluate the practicality and acceptability of implementing CMT within the NHS context.
Summary of Findings:
The research focused on low back pain (LBP), which is a leading cause of global disability. LBP causes significant activity limitation and pain, placing an enormous economic burden on individuals, families, communities, and industries. Current physiotherapy approaches primarily use exercise combined with psychological techniques such as education. However, research indicates that people with LBP have altered coordination and overactive trunk muscles during functional tasks, which may contribute to long term LBP. Current physiotherapy approaches don't address this overactivity.What was the aim of the study? To gain insight and map improvements to a physiotherapy training course for a new intervention- Cognitive Muscular Therapy (CMT).
How was the study conducted? The study involved participants with low back pain and 4 NHS physiotherapists. The NHS physiotherapists completed 16 hours of online training and attended one face to face training day. Overall, 16 participants were recruited via social media, with 8 participants receiving the full intervention of 7 sessions of CMT. All participants completed questionnaires about their pain and disability, before their first session and after their final session. All treatment sessions were observed by researchers involved in the development of the training course. Finally, all participants and physiotherapists were offered an interview following their final session.
What were the results? Firstly, the training course was acceptable to physiotherapists and ensured physiotherapists were able to deliver CMT competently. Several improvements were suggested to improve the next version of the training course, for example, including more videos and audio and reducing the text. Secondly, on average, the Roland Morris Disability Questionnaire improved by 57%, the Numerical Rating of Pain Scale improved by 55% and the pain catastrophising (a measure of psychological distress related to pain) improved by 29%. Finally, patients found CMT acceptable and overall felt they had benefited from taking part in the study.
What do these results mean? These findings suggest that the training course was developed to an acceptable standard, allowing physiotherapists to understand the theory behind CMT and how to apply this to patients. This indicates that the training course, developed for physiotherapists, is suitable for use in a planned feasibility study involving 90 participants (IRAS ID: 331773. Moreover, CMT appears to be effective in improving pain, reducing disability and reducing pain catastrophising in patients with long standing LBP.
Why is this important? LBP affects a lot of people worldwide. New interventions are required that can help people to manage their pain and increase their function. This research supports previous research, demonstrating that CMT is effective for people with LBP and is deliverable by NHS physiotherapists. Further work is now required to understand if larger numbers of people with LBP benefit from CMT and compare CMT with gold standard physiotherapy.
REC name
Wales REC 6
REC reference
24/WA/0115
Date of REC Opinion
26 Apr 2024
REC opinion
Favourable Opinion