Projects / Programmes
Evaluation of neuro-muscular trunk stabilization functions and development of exercise programs for lower back pain prevention
| Code |
Science |
Field |
Subfield |
| 5.10.02 |
Social sciences |
Sport |
Kinesiology - medical aspect (orthopedy, physiatry etc.) |
| Code |
Science |
Field |
| S273 |
Social sciences |
Physical training, motorial learning, sport |
| Code |
Science |
Field |
| 3.03 |
Medical and Health Sciences |
Health sciences |
low back pain, neuromuscular control, training, testing
Researchers (11)
Organisations (5)
Abstract
Low back pain (LBP) is the most common health problem associated with the locomotor system in the developed world, affecting 70-85% of people at least once in a lifetime. LBP reduces the quality of life, being the second most common reason for absence from work and as such it is a major socio-economic problem in most developed countries (in the EU - billions €/year). The purpose of our project is to upgrade objective evaluation and preventive measures for LBP. This will be done through comprehensive investigation of alterations of neuromuscular functions (NMF) in LBP. In addition to standard statistics, we will use the methods of artificial intelligence, so as to construct predictive, expert and descriptive models for LBP. The project will be implemented over the period of three years and will be divided into three thematic sections of 12 months.
The first thematic section will consist of two studies in which we will verify the objectivity, reliability and validity of tests for the evaluation of NMF of the lumbar body region. The subjects will be healthy young adults of both sexes (n = 30). The aim of the first study is to develop comprehensive protocols for reliable evaluation of all key aspects of NMF of the trunk: maximal voluntary force, endurance in sustained force, automatic pre-programmed and reactive stabilizing muscle actions, kinaesthesia and balance. The aim of the second study is to investigate the existence of synergistic muscle activation patterns and develop valid methods of non-invasive monitoring/forecasting of deep muscle activations in the tasks of dynamic stabilization of the lumbopelvic region. On the basis of the results of these studies, we will determine the testing protocols for subsequent stages of the project.
The second thematic section will comprise two studies, the aim of which will be to find the parameters of NMF of the trunk that are presumably altered in subjects (n = 120-150) of the two groups of workplaces with an increased risk of LBP (i.e., sedentary and physically demanding occupations). At the same time, our aim is to identify the parameters of the NMF of the trunk in which people with chronic LBP differ from those of similar occupations without chronic LBP. The objective of this thematic section is to develop models based on the data related to NMF of the trunk and on an objectified ergonomic assessment of the workplace that will enable us to predict the probability of LBP in various occupations. This would allow for an early detection of irregularities and risk factors for LBP as well as for early preventive measures.
In the third thematic section, a study will be carried out on subjects suffering from chronic LBP (n = 80-90). We will investigate the efficiency of two types of exercise programmes aimed at alleviating chronic LBP. Both exercise programmes will take into account the importance of a proper selection of the contents, quality and quantity of exercise as well as the principle of gradual progression in exercise difficulty. The ultimate goal of this thematic section is to create a set of models to aid in the selection, planning and implementation of the most effective exercise methods in chronic LBP.
Work on the project will be divided into five work packages aimed at organization, data acquisition, implementation of the exercise programme, data processing, and dissemination. The studies will be conducted in accordance with ethical principles and legislation on personal data protection.
In consistence with the directions for modern scientific research, the project will aim to transfer new scientific findings, modern measurement and intervention/training technologies and services into practice. The numerous applied results of our project will be developed into widely accessible products that will contribute to a more effective treatment of LBP as a problem of exceptional proportions. Scientific findings will be published at the international level.
Significance for science
The project has been divided into two thematic subsections. The first methodological subsection of the research has served as a background for the second more applied subsection of the project. Researches in both subsections provided several globally unique findings and outcomes. Assessment of different areas of neuromuscular functions of the trunk in relation to low back pain (LBP) has been receiving extensive research attention over recent decades. Nevertheless, the effective battery of tests that would comprehensively evaluate stabilising functions of the lumbo-pelvic area has not been established. In the first subsection of the project measurement characteristics such as validity and reliability have been determined for wide variety of the tests that have been related with LBP in previous studies. Several research papers have been published on these topics in peer review international journals with impact factor. The results of those studies and comparison of different testing procedures has served for modifications of several measurement protocols. Finally, we have compared the results of different tests and developed the battery of tests that enables differentiation between subgroups of specific neuromuscular functions often changed in LBP and have shown good validity and reliability. With goal of efficient implementation of those tests the mobile measuring system has been developed that enables comprehensive evaluation of neuromuscular functions of the trunk. Such system is international novelty with extensive research and clinical potential. In the second subsection of the project the system has been used for assessment of neuromuscular functions of the trunk in three distinct areas: (1) in the area of work related LBP, (2) for the assessment of the effects of specific sports activities and (3) in the field of pathologies that typically affect trunk stability. Gained experiences and research outcomes will affect future research and improve understanding of processes related with onset of LBP. In the field of work related LBP several neuromuscular changes have been related with specific demands of the work. Considerable attention has been given to the occupations that require sustained adjusted/awkward body positions (especially bent postures) and the sedentary occupations. Therefore the foundations for in-depth analysis of preventive measures has ben made presenting important background for further research. Short and long term effects of specific sports that require precise sensory-motor control has also been investigated. Results confirmed the assumption that specific exercises have the potential to improve neuromuscular functions of the trunk important for competent movement and well being of lumbo-pelvic region. The results are of great importance for improvement of future preventive and curative measures in clinical practice and research. To assess pathological changes of the neuromuscular functions of the trunk, patients with Parkinson disease have been studied. Several changes related to the specific pathology have been identified and individualized exercise programs aimed to preserve those functions have been administered. Research performed in the second subsection of the project further confirmed the validity of the measurement system and revealed some potentials for its upgrades. The measuring system for objective evaluation of neuromuscular functions of the trunk, developed in this project, is already implemented in research an clinical use in some institution in Slovenia and abroad.
Significance for the country
The main effects of this applied project on the development of Slovenia can be divided in three main fields: • Improvements in the prevention and management of low back pain (LBP): LBP is one of the most frequent health issues and as such produces significant financial burden for the society. Objective evaluation of the patients (before and during the therapy and as a follow-up) is one of the most important contributions of this project. Currently, majority of physiotherapeutic practice rely on the range of motion measurement as sole objective measure that as such poorly describes functional performance level of the patients with LBP. This can be effectively achieved with the developed innovative measuring system that further allows formulation of personalized exercise program. This approach to rehabilitation has been also selected for public presentation at 8th national Forum of innovations. The method has been further presented to several rehabilitation institutions that collaborated in the project and has been therefore directly integrated into clinical practice. The method is also appropriate for improvements of preventive measures in the field of work related LBP. Epidemiologic studies imply that between 80 and 85% of the costs related with LBP are indirect costs arising predominantly from reduced working capacity, sick leaves and permanent inability to perform a work. Identifying the risk factors for work related LBP was therefore one of the main goals of the second part of the project. Similar preventive measures based on exercise interventions have been shown to be one of the few effective approaches succeeding in reverting the trend in the direction of reduced incidence of LBP (Maher, 2000). Identifying the risk factors the measuring system further provides background for individualized and targeted preventive approaches therefore improving effectives of the interventions. Applying effective preventive measures the reduction of sick leaves and improve working ability can be expected. Improvements in rehabilitation and prevention of LBP will facilitate progress in physiotherapeutic practice and improved efficacy of LBP management. • System for objective evaluation of neuromuscular functions of the trunk as a product: Currently the system is used only to offer the service but in the future the commercial manufacturing of the measuring system is foreseen. For this purpose some adjustments are planned in order to improve its practical use. The improvements are needed in the field of the data analysis, which is currently time consuming and requires an experienced investigator. The production and marketing of the system is foreseen as a spin-off company. Consequently, wider utilization of the measurement system in daily practice is expected therefore facilitating the aforementioned advances in management and prevention of LBP. The system for objective evaluation of neuromuscular functions of the trunk as a tool for future research: Further research in the field of LBP are necessary to reduce high costs for the society predominantly emerging from lack of understanding of mechanisms related with onset of LBP. One of the main focusses of the research in Slovenia and abroad is to subdivide the population with LBP into subgroups, based on the underlying mechanisms of the pathological change. Such subgrouping would be necessary for the research purposes and even more importantly to introduce more focused rehabilitation approaches in clinical practice. The system for comprehensive assessment of neuromuscular functions of the trunk is unique in the global view and therefore represents a solid basis for future research.
Most important scientific results
Annual report
2011,
2012,
2013,
final report,
complete report on dLib.si
Most important socioeconomically and culturally relevant results
Annual report
2011,
2012,
2013,
final report,
complete report on dLib.si
