Motor Skill Training Improves Pain, Function in Chronic Low Back Pain

By Anne Harding

January 21, 2021

NEW YORK (Reuters Health) - Motor skill training (MST) can have lasting beneficial effects for people with chronic low back pain (LBP), a new study in JAMA Neurology shows.

"This is a non-pharmacologic treatment that is very person-specific and people adhere to it. In addition, the outcomes are not just short-term. They persist for up to 12 months," Dr. Linda van Dillen of the Program in Physical Therapy at Washington University School of Medicine in St. Louis told Reuters Health in a phone interview.

While exercise is effective for chronic LBP and clinical practice guidelines recommend it, Dr. van Dillen and her team note, it's not clear what type of exercise is best and how effective various exercise treatments are long-term.

In MST, person-specific strategies are developed to help a person learn to function with less pain. "We examine the person and identify the movements and postures that are associated with the person's LBP during functional activities," Dr. van Dillen explained. "It's really based on trying to drive learning so that they'll have not just short-term improvement but, as importantly, long-term improvement."

She and her colleagues randomized 154 people with chronic, nonspecific LBP to receive MST or strength and flexibility exercise (SFE) of the trunk and lower limbs, the current standard approach to exercise treatment of chronic LBP. All study participants had a modified Oswestry Disability Questionnaire (MODQ) score of 20% or higher.

Both treatments were delivered in six weekly hour-long sessions, and patients were followed up at six and 12 months. Half of the participants in each group received booster treatments at six months.

The intent-to-treat analysis included 149 patients. After treatment, MODQ scores were 7.9 points lower with MST compared to SFE. At six months, the MST group's MODQ scores were 5.6 lower, and they were 5.7 points lower at one year. Receiving booster treatments didn't affect MODQ scores for MST or SFE.

While non-pharmacologic treatments for LBP result in short-term improvements, Dr. van Dillen noted, patients "don't tend to hold on to those improvements long-term."

Adherence to SFE fell off over the course of the current study, she added, but adherence to MST stayed high. "If people get it, then they tend to stick with it."

The next steps in the research will be to look at a "larger, more generalizable sample," Dr. van Dillen said, and whether MST is beneficial for acute LBP.

SOURCE: https://bit.ly/38Ax8ri JAMA Neurology, online December 28, 2020.

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