A Longitudinal Clinical Study of Neurophysiological Responses and Patient-reported Outcomes throughout a Programme of Physiotherapy for Acute & Sub-acute Low Back Pain.

Jo Perry, Ann Green

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Study Design
A pragmatic, prospective, longitudinal, observational study recording sympathetic nervous system (SNS) skin conductance (SC) responses and patient reported outcome measure (PROM) changes to a program of guideline-endorsed physiotherapy treatment for low back pain (NSLBP) symptoms of up to 12 weeks duration.
Objectives
To record SC changes within- and between-treatment episodes at treatment inception, mid-point and discharge and observe correlations between the magnitude of SC responses, pain abatement (narrative pain rating scale - NPRS) and functional restoration (Oswestry Disability Index - ODI).
Background
Despite guideline recommendations for the use of manual and exercise therapies for the early management of LBP, there is little empirical clinical evidence to support the long-term neurophysiological effects of therapy in this clinical group.
Methods
Sixty patients received a guideline-endorsed physiotherapy treatment programme. Continuous neurophysiological recordings of SC activity levels were taken throughout each treatment. PROM data were extracted from inception, mid-point and discharge. Within- and between-treatment analyses determined the nature of SC changes and correlations to longitudinal changes in pain and function.
Results
SC changes were significant during all ‘treatment’ periods (p=0.044) with the greatest magnitude of sympatho-excitatory responses occurring at inception (219%). The treatment modality providing the maximum SNS response was a high velocity lumbar rotation manipulation. Positive correlations were identified between SC responses, ODI improvements (r=0.82, p<0.0005) and pain abatement (r=0.459, p<0.0005).
Conclusions
Patients with LBP exhibit neurophysiological treatment responses indicative of a symptom-related neuroplastic state of dorsal horn sensitisation that is receptive to early manual therapy intervention.
Original languageEnglish
Pages (from-to)456-466
Number of pages11
JournalJournal of Manipulative and Physiological Therapeutics
Volume41
Issue number6
Early online date1 Jul 2018
DOIs
Publication statusPublished - Jul 2018

Fingerprint

Low Back Pain
Longitudinal Studies
Skin
Musculoskeletal Manipulations
Therapeutics
Pain
Sympathetic Nervous System
Guidelines
Clinical Studies
Patient Reported Outcome Measures
Spinal Manipulation
Exercise Therapy
Secondary Prevention
Observational Studies

Keywords

  • Low Back Pain
  • skin conductance
  • Manipulation
  • spinal
  • Patient Reported Outcome Measures
  • Sympathetic nervous system

ASJC Scopus subject areas

  • Health Professions(all)
  • Medicine(all)

Cite this

@article{35e2558a854c4d389b7e8ae2dc5f4e2c,
title = "A Longitudinal Clinical Study of Neurophysiological Responses and Patient-reported Outcomes throughout a Programme of Physiotherapy for Acute & Sub-acute Low Back Pain.",
abstract = "Study DesignA pragmatic, prospective, longitudinal, observational study recording sympathetic nervous system (SNS) skin conductance (SC) responses and patient reported outcome measure (PROM) changes to a program of guideline-endorsed physiotherapy treatment for low back pain (NSLBP) symptoms of up to 12 weeks duration.ObjectivesTo record SC changes within- and between-treatment episodes at treatment inception, mid-point and discharge and observe correlations between the magnitude of SC responses, pain abatement (narrative pain rating scale - NPRS) and functional restoration (Oswestry Disability Index - ODI). BackgroundDespite guideline recommendations for the use of manual and exercise therapies for the early management of LBP, there is little empirical clinical evidence to support the long-term neurophysiological effects of therapy in this clinical group.MethodsSixty patients received a guideline-endorsed physiotherapy treatment programme. Continuous neurophysiological recordings of SC activity levels were taken throughout each treatment. PROM data were extracted from inception, mid-point and discharge. Within- and between-treatment analyses determined the nature of SC changes and correlations to longitudinal changes in pain and function.ResultsSC changes were significant during all ‘treatment’ periods (p=0.044) with the greatest magnitude of sympatho-excitatory responses occurring at inception (219{\%}). The treatment modality providing the maximum SNS response was a high velocity lumbar rotation manipulation. Positive correlations were identified between SC responses, ODI improvements (r=0.82, p<0.0005) and pain abatement (r=0.459, p<0.0005).ConclusionsPatients with LBP exhibit neurophysiological treatment responses indicative of a symptom-related neuroplastic state of dorsal horn sensitisation that is receptive to early manual therapy intervention.",
keywords = "Low Back Pain, skin conductance, Manipulation, spinal, Patient Reported Outcome Measures, Sympathetic nervous system",
author = "Jo Perry and Ann Green",
year = "2018",
month = "7",
doi = "10.1016/j.jmpt.2017.11.003",
language = "English",
volume = "41",
pages = "456--466",
journal = "Journal of Manipulative and Physiological Therapeutics",
issn = "0161-4754",
publisher = "Elsevier",
number = "6",

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T1 - A Longitudinal Clinical Study of Neurophysiological Responses and Patient-reported Outcomes throughout a Programme of Physiotherapy for Acute & Sub-acute Low Back Pain.

AU - Perry, Jo

AU - Green, Ann

PY - 2018/7

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N2 - Study DesignA pragmatic, prospective, longitudinal, observational study recording sympathetic nervous system (SNS) skin conductance (SC) responses and patient reported outcome measure (PROM) changes to a program of guideline-endorsed physiotherapy treatment for low back pain (NSLBP) symptoms of up to 12 weeks duration.ObjectivesTo record SC changes within- and between-treatment episodes at treatment inception, mid-point and discharge and observe correlations between the magnitude of SC responses, pain abatement (narrative pain rating scale - NPRS) and functional restoration (Oswestry Disability Index - ODI). BackgroundDespite guideline recommendations for the use of manual and exercise therapies for the early management of LBP, there is little empirical clinical evidence to support the long-term neurophysiological effects of therapy in this clinical group.MethodsSixty patients received a guideline-endorsed physiotherapy treatment programme. Continuous neurophysiological recordings of SC activity levels were taken throughout each treatment. PROM data were extracted from inception, mid-point and discharge. Within- and between-treatment analyses determined the nature of SC changes and correlations to longitudinal changes in pain and function.ResultsSC changes were significant during all ‘treatment’ periods (p=0.044) with the greatest magnitude of sympatho-excitatory responses occurring at inception (219%). The treatment modality providing the maximum SNS response was a high velocity lumbar rotation manipulation. Positive correlations were identified between SC responses, ODI improvements (r=0.82, p<0.0005) and pain abatement (r=0.459, p<0.0005).ConclusionsPatients with LBP exhibit neurophysiological treatment responses indicative of a symptom-related neuroplastic state of dorsal horn sensitisation that is receptive to early manual therapy intervention.

AB - Study DesignA pragmatic, prospective, longitudinal, observational study recording sympathetic nervous system (SNS) skin conductance (SC) responses and patient reported outcome measure (PROM) changes to a program of guideline-endorsed physiotherapy treatment for low back pain (NSLBP) symptoms of up to 12 weeks duration.ObjectivesTo record SC changes within- and between-treatment episodes at treatment inception, mid-point and discharge and observe correlations between the magnitude of SC responses, pain abatement (narrative pain rating scale - NPRS) and functional restoration (Oswestry Disability Index - ODI). BackgroundDespite guideline recommendations for the use of manual and exercise therapies for the early management of LBP, there is little empirical clinical evidence to support the long-term neurophysiological effects of therapy in this clinical group.MethodsSixty patients received a guideline-endorsed physiotherapy treatment programme. Continuous neurophysiological recordings of SC activity levels were taken throughout each treatment. PROM data were extracted from inception, mid-point and discharge. Within- and between-treatment analyses determined the nature of SC changes and correlations to longitudinal changes in pain and function.ResultsSC changes were significant during all ‘treatment’ periods (p=0.044) with the greatest magnitude of sympatho-excitatory responses occurring at inception (219%). The treatment modality providing the maximum SNS response was a high velocity lumbar rotation manipulation. Positive correlations were identified between SC responses, ODI improvements (r=0.82, p<0.0005) and pain abatement (r=0.459, p<0.0005).ConclusionsPatients with LBP exhibit neurophysiological treatment responses indicative of a symptom-related neuroplastic state of dorsal horn sensitisation that is receptive to early manual therapy intervention.

KW - Low Back Pain

KW - skin conductance

KW - Manipulation

KW - spinal

KW - Patient Reported Outcome Measures

KW - Sympathetic nervous system

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DO - 10.1016/j.jmpt.2017.11.003

M3 - Article

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JO - Journal of Manipulative and Physiological Therapeutics

JF - Journal of Manipulative and Physiological Therapeutics

SN - 0161-4754

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