Introduction

ReviewofLiterature

Discussion

Conclusion

Bibliography

• Painisdefinedasanunpleasantsensoryandemotionalexperienceassociatedwithactualorpotentialtissuedamage(Melzack,2010)

• Acutepainisanormalresponsetotraumaorsurgery• Cancer-relatedpainreferstothepainexperiencedasaresultof

primarytumorgrowth• Chronicpainisapersistentpainthatlastsweekstoyears

• Theeffectsofchronicpainonthepatientsignificantlyaffectsthepatient’smood,personalityandsocialrelationships(Codeerre,1992)

• Chroniclow-backpain(CLBP)resultsfromacertainareaofthebodyafflictedwithextremeamountsofpainpersistingasfrequentlyashalfofthedaysinthepastsixmonthsbeforediagnosis

• CLBPisthesecondmostcommoncauseofdisabilityamongtheelderly• CLBPaffectsabout100millionadultsandhasanestimatedannualcostof$635

billion(InstituteofMedicine,2011)

• LBPnegativelyimpactsthementalfunctioninolderadults(Weiner,2006)• Outoftheapproximate17millionelderlypersonsthatexperienceatleastone

episodeofLBPinafullcalendaryear,morethan6millionoftheseindividualsreportsufferingfromadeclineintheirqualityoflifeandlifesatisfaction

• Anassociationwasrevealedbetweenpainintensityandimpairedqualityoffunctioninyoungerindividualsaged14-16

• Preliminaryevidenceexiststosupportthisrelationshipinolderadults(Weiner,2003)

• Dependingontheseverityoftheinitialpainandextensivenessofitspersistence,differenttreatmentmethodsareemployed

• MedicationsplayanimportantroleinthemanagementofCLBP,howevertheconstantabuseofCLBPtreatmentmedicinessuchasanti-inflammatorydrugs,antidepressants,musclerelaxantsandopioidsisextremelydetrimental(Bokarius,2010)

• Patientsshouldbecarefullyassessedbeforethestartoflong-termopioidtherapy(Chaparro,2015)

• Safertreatmentinterventionsincludetaichi,yoga andotherformsofexercise• Functionalrestoration(FR)hasbeendefinedasa“multimodalpainmanagement

program”• Programemploysacomprehensivecognitiveassessmentwhileundergoingthe

sportsmedicinephysicalapproachtocorrectfunctionaldeficits(Chan,2016)• AstudybyMayer,GatchelandEvansinitiallyevaluatedtheassociationbetween

ageandtreatmentoutcomesofpatientswithchronicdisablingspinaldisordersundergoingFR(Mayer,2001)

• ThreeparticularaspectsofFRarebeingapplied• MyofascialReleaseTechniques(MFRT)• NeuralFlossing(NF)• ProprioceptiveNeuromuscularFacilitation(PNF)

Anderson, R., Wise, D., Sawyer, T., & Chan, C. (2005). Integration of Myofascial Trigger Point Release and ParadoxialRelaxation Training Treatment of Chronic Pelvic Pain in Men. The Journal of Urology, 174(1), 155-160. doi:10.1097/01.ju.0000161609.31185.d5Annesi, J. (2012). Supported Exercise Improves Controlled Eating and Weight through Its Effects on Psychosocial Factors: Extending a Systematic Research Program Toward Treatment Development. permj, 16(1), 7-18. doi:10.7812/11-136Arokoski, J. P., Valta, T., Kankaanpää, M., & Airaksinen, O. (2004). Activation of lumbar paraspinal and abdominal muscles during therapeutic exercises in chronic low back pain patients11No commercial party having a direct financial interest in theresults of the research supporting this article has or will confer a benefit upon the authors(s) or upon any organization with which the author(s) is/are associated. Archives of Physical Medicine and Rehabilitation, 85(5), 823-832. doi:10.1016/j.apmr.2003.06.013Bajaj, J. S., Thacker, L. R., Wade, J. B., Sanyal, A. J., Heuman, D. M., Sterling, R. K., … Revicki, D. A. (2011). PROMIS computerised adaptive tests are dynamic instruments to measure health-related quality of life in patients with cirrhosis. Alimentary Pharmacology & Therapeutics, 34(9), 1123-1132. doi:10.1111/j.1365-2036.2011.04842.xBiggan, J. R., Melton, F., Horvat, M. A., Ricard, M., Keller, D., & Ray, C. T. (2014). Increased Load Computerized Dynamic Posturography in Prefrail and Nonfrail Community-Dwelling Older Adults. Journal of Aging and Physical Activity, 22(1), 96-102. doi:10.1123/japa.2012-0209Bokarius, A. V., & Bokarius, V. (2010). Evidence-Based Review of Manual Therapy Efficacy in Treatment of Chronic Musculoskeletal Pain. Pain Practice, 10(5), 451-458. doi:10.1111/j.1533-2500.2010.00377.xBressler, H. B., Keyes, W. J., Rochon, P. A., & Badley, E. (1999). The Prevalence of Low Back Pain in the Elderly. Spine, 24(17), 1813. doi:10.1097/00007632-199909010-00011Castro-Sánchez, A. M., Matarán-Peñarrocha, G. A., Granero-Molina, J., Aguilera-Manrique, G., Quesada-Rubio, J. M., & Moreno-Lorenzo, C. (2011). Benefits of Massage-Myofascial Release Therapy on Pain, Anxiety, Quality of Sleep, Depression, and Quality of Life in Patients with Fibromyalgia. Evidence-Based Complementary and Alternative Medicine, 2011, 1-9. doi:10.1155/2011/561753Chan, A. Y., Ford, J. J., Surkitt, L. D., Richards, M. C., Slater, S. L., Davidson, M., & Hahne, A. J. (2016). Individualised functional restoration plus guideline-based advice versus advice alone for non-reducible discogenic low back pain: a randomisedcontrolled trial. Physiotherapy. doi:10.1016/j.physio.2016.08.001Deschamps, T., Beauchet, O., Annweiler, C., Cornu, C., & Mignardot, J. (2014). Postural control and cognitive decline in older adults: Position versus velocity implicit motor strategy. Gait & Posture, 39(1), 628-630. doi:10.1016/j.gaitpost.2013.07.001Desthieux, C., Dadoun, S., Foltz, V., Rozenberg, S., Fautrel, B., & Gossec, L. (2016). Functional restoration programs in patients with chronic low back pain and body composition: No change in muscle mass assessed through Dual X-ray absorptiometry in 94 patients, a monocenter longitudinal study. Joint Bone Spine. doi:10.1016/j.jbspin.2015.10.018Gatchel, R. J., Peng, Y. B., Peters, M. L., Fuchs, P. N., & Turk, D. C. (2007). The biopsychosocial approach to chronic pain: Scientific advances and future directions. Psychological Bulletin, 133(4), 581-624. doi:10.1037/0033-2909.133.4.581Institute of Medicine (U.S.). (2011). Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: National Academies Press. Kim, S. (2015). Efficacy of tendon and nerve gliding exercises for carpal tunnel syndrome: a systematic review of randomized controlled trials. J Phys Ther Sci, 27(8), 2645-2648. doi:10.1589/jpts.27.2645Loeser, J. D., & Melzack, R. (1999)Southwick, S. M., & Charney, D. S. (2012). The Science of Resilience: Implications for the Prevention and Treatment of Depression. Science, 338(6103), 79-82. doi:10.1126/science.1222942Tekur, P., Chametcha, S., Hongasandra, R., & Raghuram, N. (2010). Effect of yoga on quality of life of CLBP patients: A randomized control study. International Journal of Yoga, 3(1), 10. doi:10.4103/0973-6131.66773Van der Kolk, N. M., & King, L. A. (2013). Effects of exercise on mobility in people with Parkinson's disease. Movement Disorders, 28(11), 1587-1596. doi:10.1002/mds.25658Van Hooff, M. L., Van der Merwe, J. D., O’Dowd, J., Pavlov, P. W., Spruit, M., De Kleuver, M., & Van Limbeek, J. (2010). Daily functioning and self-management in patients with chronic low back pain after an intensive cognitive behavioral programme for pain management. European Spine Journal, 19(9), 1517-1526. doi:10.1007/s00586-010-1435-5Vibe Fersum, K., O'Sullivan, P., Skouen, J., Smith, A., & Kvåle, A. (2012). Efficacy of classification-based cognitive functional therapy in patients with non-specific chronic low back pain: A randomized controlled trial. EJP, 17(6), 916-928. doi:10.1002/j.1532-2149.2012.00252.xHealth ABC Cohort and Implications for the Future. Pain Med, 4(4), 311-320. doi:10.1111/j.1526-4637.2003.03042.xWeiner, D. K., Rudy, T. E., Morrow, L., Slaboda, J., & Lieber, S. (2006). The Relationship Between Pain, Neuropsychological Performance, and Physical Function in Community-Dwelling Older Adults with Chronic Low Back Pain. Pain Med, 7(1), 60-70. doi:10.1111/j.1526-4637.2006.00091.x

• Thisstudywasfocusedoninvestigatingtheeffectsoftwodifferenttypesofexerciseinterventionsonchroniclow-backpainbyusingbiopsychosocialandpainperceptionevaluations

• Studyhypothesiswassupported• METgroup’sphysicalfunctionimprovedsignificantlyovertheTET

group’s• Post-testdataindicatedprominentdifferencesamongthePROMISmeasuresof

fatigueandpaininterference• StudiesinvestigatingtheefficacyofaspectsofbothMETandTETinthetreatment

ofCLBPyieldanalogousresults• InastudyconductedbyCherkinetal,thethreetrialsdesignedtoassessmassage

asatreatmentforCLBPallproducedpositiveresults• Furlanetalconductedastudythatcomparedmassagetreatmentwithexerciseas

oneofitscontrolgroupsandfoundthatpatientswhoreceivedmassagetreatmentimprovedtheirphysicalfunctionfasterandmoreefficientlythantheexercisegroupintermsofshort-termfunction

• Theremighthavebeensomepotentiallyconfoundingfactorsthatmayormaynothaveplayedaroleininfluencingthefindings

• Sourcesofpossiblebias• Selectionprocess• Notproperlyrepresentativeofpopulationintermsofeducationand

incomelevels• Studyprovidedthefirstcomprehensivebiopsychosocialresultsinthescientific

literature,usingdifferentoutcomemeasures,intheunder-studiedelderlypopulationwithCLBP

• The process of aging makes an individual more susceptible to falls and experiencing chronic low-back pain

• Because 8 out of 10 individuals experience an episode of LBP at some point in their lives, the necessity to increase options for treatment grow increasingly important

• The effects that come along with the aging process can catalyze disturbances in the balance systems of the elderly, affecting an individual’s ability to control posture, putting him/her at a higher risk for falling.

• The results of this study yielded significant differences between the CLBP enduring elderly who underwent MET treatment or TET treatment.

• The MET group scored significantly lower on the PROMIS exam in the fatigue and pain interference aspects after treating their CLBP with massage in addition to other FR treatments, rather than exercise.

• No significant differences were found among groups regarding balance variables measured by the Neurocomm balance systems, though there were minor trends in conditions 4, 5 and 6 of the NeuroCom.

http

://b

rain

ask.

com

/wp-

cont

ent/

uplo

ads/

2016

/12/

chro

nic-

low

er-b

ack-

pain

1.jp

g

http://img.medscape.com/thumbnail_library/is_150518_lower_back_pain_800x600.jpg

http://stretchcoach.com/wp-content/uploads/pnf-stretch_2.jpg

htt

p:/

/aw

om

ansh

eal

th.c

om

/th

e-b

enef

its-

of-

pn

f-p

rop

rio

cep

tive

-neu

rom

usc

ula

r

http://qualitychiro.com/wp-content/uploads/2015/10/myofascial.jpg

htt

p:/

/ww

w.c

hh

c.co

.uk/

wp

-co

nte

nt/

up

load

s/2

01

4/0

4/W

ebsi

te-o

ffer

-im

age

-wit

h-lo

go1

.jpg

http://www.vfchiro.com/wp-content/uploads/2015/12/fascia.jpg

htt

p:/

/ww

w.d

ynam

icch

iro

pra

ctic

.co

m/c

on

ten

t/im

ages

/lo

w_b

ackp

ain

ResearchQuestionandHypothesisPurpose: Compare changes in pain and function achieved in a standard fitness program versus an individualized therapy program consisting of multi-dimensional exercises.

H1: The application of an individualized multidimensional exercise therapy treatment will result in positive changes in physical function, walking pattern and brain processing as measured by subjective questionnaires.H0: The application of an individualized multidimensional exercise therapy treatment will not result in positive changes in physical function, walking pattern and brain processing as measured by subjective questionnaires.

http://www.spine-health.com/files/blog-images/lower-back-strain-lc.jpg http://www.physio-pedia.com/Supraspinatus_tendonitis

Methods

Table 2: Age breakdown between groups

Table 1: Gender breakdown between groups

• Participants will be recruited through the research center and the University• Participants in the research center who reported chronic low-back pain (CLBP) were asked for

participation in this study• The existing data collected on the participants within the research center that will be used in the

current low-back study is an indication of chronic low-back pain provided by a two-question inventory administered to participants under the currently existing IRB protocol.

• The participants with CLBP and the desire to participate in the study will then fill out a consent form informing of all risks, benefits, and aims associated with the current low-back study.

• The inclusion criteria are as follows:• Each participant is of 60 years of age or older• Is a client of the research center• Is willing to attend therapy sessions, complete the exercise program, in addition to

pretest and post testing sessions.• The exclusion criteria include males and females under 60 years old participating in the study, no

physician approval for exercise, and not categorized as having CLBP according to the NIH definition

ParticipantsPre and Post-Test Procedure

Intervention Procedures• Multidisciplinary Exercise Therapy (MET)

• Subjects were assessed for hip and low-back range of motion, flexibility, muscle strength and motor control

• 45 minute sessions, 2 times a week• Myofascial Release Techniques (MFRT)• Neural Flossing (NF)• Proprioceptive Neuromuscular Facilitation (PNF)

• Traditional Senior Exercise Therapy (TET)• Program administered within the CHLL• TET includes aerobic, strength and balance activities developed to reduce falls• This group intervention will be guided by an instructor • Exercises will include both seated and standing activities focusing on improving

strength and increasing muscle• Typical class activities will include tasks of daily living such as

• Chair stands• Ascending/descending stairs• Walking• Chair supported squats• Lightly seated aerobics

Table1a:NeuroCommeasuresbeforebothMETandTETtreatmentswereadministered.

Table1a:NeuroCommeasuresbeforeMETandTETtreatmentswereadministered.

Table2a:ProKineticsmeasuresMETandTETtreatmentswereadministered

Table2b:ProKineticsmeasuresafterMETandTETtreatmentswereadministered

Table3a:PROMISmeasuresMETandTETtreatmentswereadministered

Table3b:PROMISmeasuresafterMETandTETtreatmentswereadministered

• PROMIS 29- psychosocial outcomes are measured through the 29 question form with seven subscales including physical function, anxiety, depression, fatigue, sleep disturbance, life satisfaction and pain interference

• Patient-Specific Function Scale- used to quantify patient specific activity limitation and measure function outcomes after interventions

• Neurocom Sensory Organization Test (SOT)- objectively identifies abnormalities in the participants use of the three sensory systems that contribute to postural control

• ProtoKinetics motion analysis system will be used to record full body motion using non invasive techniques with no sensors or special clothing required

• For both the MET both the MET and TET, the measurements will take place three times:• Pre-assessment done prior to beginning the randomly assigned MET or TET specific

exercise program• Post assessment done at the end of the 4-week exercise intervention with MET or

TET• 6 month exercise intervention follow up assessment that is done 6 months after the

beginning of the MET or TET exercise interventions.

https://www.researchgate.net/figure/49736575_fig1_Figure-1

http://ard.bmj.com/content/74/Suppl_2/829.1/F1.large.jpg

https://perform.concordia.ca/booking/facilities/walkway_platform.jpg http://www.peakrehabva.com/wp-content/uploads/2016/01/peak_rehab_patient_specific_pain_scale.png

ATreatmentOutcomeStudyontheEfficacyofTwoTherapyInterventionsforChronicLow-BackPain inanElderly

Population