Dataset Information

Predictors for physical activity and its change after active physical therapy in people with spinal pain and insomnia: Secondary analysis of a randomized controlled trial.

ABSTRACT:

Background

In healthy people and people with nonspecific chronic spinal pain (nCSP) and/or insomnia, participation in physical activity on a regular basis has several physical and psychological health benefits. However, people with chronic conditions often tend to reduce physical activity participation which can lead to deconditioning over time. Currently, there are no known predictors for an (in)active lifestyle (before and after physical therapy treatment) in people with chronic spinal pain and comorbid insomnia.

Objective

To examine predictors of pre-treatment moderate-to-vigorous physical activity (MVPA) and to examine determinants for a change in MVPA in response to 14-weeks of active physical therapy treatment in people with nonspecific chronic spinal pain (nCSP) and comorbid insomnia.

Methods

Baseline data and post-treatment data were analyzed for 66 participants. A linear multiple regression analysis was conducted to examine which factors predict MVPA at baseline. Linear mixed-effects modeling was used to identify determinants for change in MVPA in response to an active physical therapy treatment.

Results

Physical fatigue (b = -0.9; 95%CI: -1.59, -0.15), less limitations in functioning as a result of emotional problems (b = 0.1; 95%CI: 0.03, 0.10), mental fatigue (b = -1.0; 95%CI: -1.67, -0.43), lower general sleep quality (b= 0.7; 95%CI: 0.22, 1.17), and body mass index (b = -0.5; 95%CI: -0.93, -0.16) were significant predictors of baseline MVPA. The regression model explained 33.3% of the total variance in baseline MVPA. The change of MVPA in response to the treatment ranged from a decrease of 17.5 to an increase of 16.6 hours per week. No determinants for change in MVPA after treatment could be identified.

Conclusion

People with nCSP and comorbid insomnia are more likely to engage in MVPA if they report, at baseline, lower sleep quality, fewer limitations in functioning resulting from emotional problems, lower body mass index, as well as less physical and mental fatigue.

SUBMITTER: Bilterys T

PROVIDER: S-EPMC9661644 | biostudies-literature | 2022 Nov-Dec

REPOSITORIES: biostudies-literature

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Publications

Predictors for physical activity and its change after active physical therapy in people with spinal pain and insomnia: Secondary analysis of a randomized controlled trial.

Bilterys Thomas T Van Looveren Eveline E Mairesse Olivier O Nijs Jo J Meeus Mira M Ickmans Kelly K Cagnie Barbara B Goubert Dorien D Willaert Ward W De Pauw Robby R Danneels Lieven L Moens Maarten M Malfliet Anneleen A

Brazilian journal of physical therapy 20221031 6

<h4>Background</h4>In healthy people and people with nonspecific chronic spinal pain (nCSP) and/or insomnia, participation in physical activity on a regular basis has several physical and psychological health benefits. However, people with chronic conditions often tend to reduce physical activity participation which can lead to deconditioning over time. Currently, there are no known predictors for an (in)active lifestyle (before and after physical therapy treatment) in people with chronic spinal ...[more]

PMID: 36372043

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Project description:Insomnia is a major problem in the chronic spinal pain (CSP) population and has a negative impact on health and well-being. While insomnia is commonly reported, underlying mechanisms explaining the relation between sleep and pain are still not fully understood. Additionally, no reviews regarding the prevention of insomnia and/or associated factors in people with CSP are currently available. To gain a better understanding of the occurrence of insomnia and associated factors in this population, we conducted a systematic review of the literature exploring associates for insomnia in people with CSP in PubMed, Web of Science and Embase. Three independent reviewers extracted the data and performed the quality assessment. A meta-analysis was conducted for every potential associate presented in at least two studies. A total of 13 studies were found eligible, which together identified 25 different potential associates of insomnia in 24,817 people with CSP. Twelve studies had a cross-sectional design. Moderate-quality evidence showed a significantly higher rate for insomnia when one of the following factors was present: high pain intensity, anxiety and depression. Low-quality evidence showed increased odds for insomnia when one of the following factors was present: female sex, performing no professional activities and physical/musculoskeletal comorbidities. Higher healthcare use was also significantly related to the presence of insomnia. One study showed a strong association between high levels of pain catastrophizing and insomnia in people with chronic neck pain. Last, reduced odds for insomnia were found in physically active people with chronic low back pain compared to inactive people with chronic low back pain. This review provides an overview of the available literature regarding potential associates of insomnia in people with CSP. Several significant associates of insomnia were identified. These findings can be helpful to gain a better understanding of the characteristics and potential origin of insomnia in people witch CSP, to identify people with CSP who are (less) likely to have insomnia and to determine directions of future research in this area.

Project description:Background/Objectives: White matter (WM) structural changes have been found in patients with chronic spinal pain (CSP). In these patients, pain neuroscience education followed by cognition-targeted exercise therapy (i.e., the Modern Pain Neuroscience Approach (MPNA)) was shown to be more effective than biomedically-focused education followed by symptom-contingent exercise therapy for improving clinical outcomes. The present study examined whether an MPNA, compared to biomedically-focused treatment, can change WM structure in regions of interest and whether potential WM structural changes are associated with clinical improvements in patients with CSP. Methods: Patients with CSP were randomized into an experimental (MPNA) or control (biomedically-focused) treatment group. Diffusion-weighted Magnetic Resonance Images were acquired pre-treatment, post-treatment, and at 1-year follow-up. WM structure was assessed using diffusion tensor imaging in 8 WM regions of interest, and linear mixed models assessed differences between groups in response to treatment. Results: No significant treatment x time interaction effects were found; however, significant main effects of time were found in 7 WM tracts. Significant main effects of time revealed increased fractional anisotropy (FA), decreased mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) in the cingulum hippocampus, and decreased RD and MD in the superior cerebellar peduncle at 1-year follow-up compared to baseline. In contrast, decreased FA and/or increased MD, AD, or RD values were found in other WM tracts (e.g., anterior corona radiata) from pre-treatment to 1-year follow-up. Greater reduction in kinesiophobia was moderately correlated with a smaller decrease in RD in the superior cerebellar peduncle at 1-year follow-up compared to baseline. No other significant associations were found between WM structural changes and clinical improvements. Conclusions: In conclusion, in patients with CSP, regional WM structure changed over time irrespective of prescribed treatment (timespan of 12 months). Further research, including Neurite Orientation Dispersion and Density Imaging and a healthy control group, allowing for a more specific examination of WM microstructural changes in response to multimodal treatment in patients with CSP, is warranted.

Project description:BackgroundInsomnia is a highly prevalent and debilitating comorbidity that is often not addressed in therapy for chronic spinal pain (CSP). Given the close interaction between insomnia and CSP severity and related disability, targeting sleep problems during therapy could improve treatment outcomes in these patients.ObjectiveCan cognitive behavioral therapy for insomnia (CBT-I) combined with the modern neuroscience approach (i.e. pain neuroscience education and cognition-targeted exercise therapy) reduce pain and improve sleep, physical activity and function in people with CSP and comorbid insomnia?MethodsParticipants: One-hundred-twenty participants with chronic spinal pain and comorbid insomnia Intervention: CBT-I combined with the modern neuroscience approach (experimental) compared to the modern neuroscience approach alone (control). Both interventions start with three sessions of pain neuroscience education, followed by six sessions of CBT-I and nine sessions of cognition-targeted exercise therapy in the experimental group, or 15 sessions of cognition-targeted exercise therapy in the control group.MeasurementsPrimary outcome measure: self-reported pain severity (Brief Pain Inventory).Secondary outcome measurespain sensitivity (pressure pain thresholds, and online questionnaires), sleep-related outcomes (home-based polysomnography and online questionnaires), physical activity (actigraphy), and function (online questionnaires). Online questionnaires will be completed at baseline, directly post-treatment, and at 3, 6 and 12 months post-treatment. Polysomnography, pressure pain thresholds and actigraphy will be carried out at baseline, post-treatment and at 12 months follow-up.DiscussionFindings may provide (1) a novel therapeutic approach for people with CSP and comorbid insomnia to improve pain, sleep, physical activity and function, and (2) new treatment guidelines for professionals.Trial registrationClinicaltrials.gov NCT03482856 (https://clinicaltrials.gov/ct2/show/NCT03482856).

Project description:Study designSecondary analysis of a randomized controlled trial.ObjectiveTo identify preoperative physical variables associated with favorable postoperative outcome in individuals undergoing laminectomy or laminotomy for degenerative central lumbar spinal stenosis.Summary of background dataClinical or condition specific variables have most commonly been studied as predictors of postoperative outcome in lumbar spinal stenosis. If associated to favorable postoperative outcome, modifiable physical variables would inform prehabilitation interventions for patients with degenerative central lumbar spinal stenosis.MethodsPatients awaiting surgery for central lumbar spinal stenosis were recruited to participate in a randomized controlled trial. Following baseline data collection of demographics, clinical portrait and physical testing, participants were randomized to either 6-week active prehabilitation program or hospital standard care. Complete baseline and postoperative data were obtained from 58 participants which were included in the present analysis. Favorable postoperative outcome was determined based on two outcome measures. Favorable outcome was defined as a decrease of ≥30% on the Numerical Rating Scale for leg pain intensity and a decrease of ≥30% on the Oswestry Disability Index for low back disability. Baseline physical variables were used to conduct binary logistic regression.ResultsSixty percent of participants were determined as having a favorable postoperative outcome. None of the included physical variables were found to be predictors of a favorable postoperative outcome based on leg pain intensity and low back pain-associated disability [trunk flexors muscle strength (OR = 0.73; 95%CI (0.02-27.12)] lumbar extensors muscle endurance [OR= 1.09; 95%CI (0.95-1.24)] total ambulation time [OR = 1.00 95%CI (0.99-1.01)] lumbar active range of motion in extension [OR = 1.08; 95%CI (0.95-1.23)] and knee extensors muscle strength [OR=1.02; 95%CI (0.98-1.06)].ConclusionResults show that none of the investigated variables, all related to low back and lower limbs physical capacity, were predictors of postoperative recovery. Further testing in larger cohort is needed to assess the full potential of physical outcome measures as predictors of postoperative recovery.

Project description:BackgroundExercise interventions improve clinical outcomes of pain and function in adults with knee pain due to osteoarthritis and higher levels of physical activity are associated with lower severity of pain and higher levels of physical functioning in older adults with knee osteoarthritis in cross-sectional studies. However, to date no studies have investigated if change in physical activity level during exercise interventions can explain clinical outcomes of pain and function. This study aimed to investigate if change in physical activity during exercise interventions is associated with future pain and physical function in older adults with knee pain.MethodsSecondary longitudinal data analyses of a three armed exercise intervention randomised controlled trial. Participants were adults with knee pain attributed to osteoarthritis, over the age of 45 years old (n = 514) from Primary Care Services in the Midlands and Northwest regions of England. Crude and adjusted associations between absolute change in physical activity from baseline to 3 months (measured by the self-report Physical Activity Scale for the Elderly (PASE)) and i) pain ii) physical function (Western Ontario and McMaster Universities Osteoarthritis Index) and iii) treatment response (OMERACT-OARSI responder criteria) at 3 and 6 months follow-up were investigated using linear and logistic regression.ResultsChange in physical activity level was not associated with future pain, function or treatment response outcomes in crude or adjusted models at 3 or 6 months (P > 0.05). A 10 point increase in PASE was not associated with pain β = - 0.01 (- 0.05, 0.02), physical function β = - 0.09 (- 0.19, 0.02) or likelihood (odds ratio) of treatment response 1.02 (0.99, 1.04) at 3 months adjusting for sociodemographics, clinical covariates and the trial intervention arm. Findings were similar for 6 month outcome models.ConclusionsChange in physical activity did not explain future clinical outcomes of pain and function in this study. Other factors may be responsible for clinical improvements following exercise interventions. However, the PASE may not be sufficiently responsive to measure change in physical activity level. We also recommend further investigation into the responsiveness of commonly used physical activity measures.Trial registration( ISRCTN93634563 ). Registered 29th September 2011.

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Dataset Information

Predictors for physical activity and its change after active physical therapy in people with spinal pain and insomnia: Secondary analysis of a randomized controlled trial.

Background

Objective

Methods

Results

Conclusion

Publications

Predictors for physical activity and its change after active physical therapy in people with spinal pain and insomnia: Secondary analysis of a randomized controlled trial.

Similar Datasets

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