Efficacy of Passive Joint Mobilization vs Mobilization With Movement on Pain Processing in Patients With Chronic Low Back Pain

NCT ID: NCT04940715

Last Updated: 2021-06-25

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

54 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-09-30

Study Completion Date

2022-03-31

Brief Summary

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Patients with chronic low back pain may have altered pain processing, making them vulnerable to pain or disability. It can be measured with test like pressure pain threshold, temporal summation or conditioned pain modulation. Manual therapy has shown improve this pain processing variables in other conditions (like knee osteoarthritis or lateral elbow pain), although the quality of the evidence is low in terms of temporal summation and controversial in terms of conditioned pain modulation. There are not studies that had investigated the impact of manual therapy techniques on pain processing in patients with chronic low back pain.

Detailed Description

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Study Aims:

Aim #1: The main objective of this study is to determine the efficacy of two manual therapy approaches (passive joint mobilization and mobilization with movement) on pain (measured with Visual Analogue Scale) and pain processing (measured with pressure pain threshold, temporal summation and conditioned pain modulation) in patients with chronic low back pain and see its results on short, medium and long term.

Aim #2: The secondary objective is to compare the effect of both manual therapy techniques with an inactive control group in terms of pain and pain processing.

Aim #3: Determine the efficacy of manual therapy on intervention groups on psychological outcomes as catastrophizing (Pain Catastrophizing Scale), kinesiophobia (Tampa Scale of Kinesiophobia) and depression (Beck Depressive Inventory) and compare them with control group.

Methodology Research Design: Randomized, longitudinal, experimental, prospective, parallel and double-blind study with patients with chronic low back pain.

Participants: Adults between 18-65 years old residing Comunidad de Madrid, all of whom were recruited personally for the study. All patients will read the information sheet explaining what the study will consist, as well as the informed consent form, which they will sign voluntarily beforehand.

Sample Size: The sample size will be calculated by means of the "Gpower 3.0.18" computer program.

Randomization: Randomization will be done through the GraphPad software (GraphPad Software, Inc CA 92037 USA). Patients who meet the inclusion criteria and have none of the exclusion criteria will be entered into the study and the sample will be randomized to obtain three groups in opaque and sealed envelopes: A (passive joint mobilization), B (mobilization with movement) and C (control group).

Masking: The double-blind criteria are met, in which the subjects participating in the study will not know the group to which they were assigned, as well as the physiotherapist in charge of collecting the outcomes data.

Conditions

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Chronic Low-back Pain

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Parallel assignment. Randomized, longitudinal, experimental, prospective, parallel and double-blind study with chronic low back pain adults.
Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Outcome Assessors

Study Groups

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Passive joint mobilization

Patients lay down on a prone position, with their hands around the body and neck placed comfortable. The therapist performed a postero-anterior joint mobilization using Maitland's technique, applying pressure to spinous process of targeted vertebra (the one who reproduces patient's symptoms).

Group Type EXPERIMENTAL

Passive joint mobilization

Intervention Type OTHER

Dosage: 5 sets of 2 minutes with 30 seconds of rest were applied, with a strong force (\>50% of maximum therapist strength), according to patient's irritability and severity.

Mobilization with movement

Patients perform their painful movement (flexion, extension…). If pain wasn't reproduced, a combination of movements will be performed (flexion + rotation…). The most painful vertebral level was assessed too with passive accessory vertebral movements. Afterwards, with the patient on a seated position on a stretcher with feet supported and a belt around the waist, the therapist performed a sustained glide on the targeted vertebra (spinous process) with the force and direction that relieved pain to the lowest level.

Group Type EXPERIMENTAL

Mobilization with movement

Intervention Type OTHER

Dosage: 3 sets of 10 repetitions were performed, with 1-2 minutes of rest between sets.

Control group

Patients were measured at baseline and then were placed on "wait list" until the end of the study. At this time, they were measured again.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Passive joint mobilization

Dosage: 5 sets of 2 minutes with 30 seconds of rest were applied, with a strong force (\>50% of maximum therapist strength), according to patient's irritability and severity.

Intervention Type OTHER

Mobilization with movement

Dosage: 3 sets of 10 repetitions were performed, with 1-2 minutes of rest between sets.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Non-specific chronic low back pain patients, without lower limb pain
* Pain lasting 6 months or more
* Pain measure of 2 or more on a 0 to 10 scale
* Age between 18-65 years old
* Haven't received physical therapy during last month

Exclusion Criteria

* Radiculopathy
* Neurological signs, symptoms or deficit
* Rheumatic/autoimmune/systemic disease
* History of fracture, trauma or previous spinal surgery
* Pregnancy
* Disc herniation
* Neuropathic pain
* Active cancer
* Spondylolysis/Spondylolisthesis
* Cognitive impairment
* Long-term opioid intake
Minimum Eligible Age

18 Years

Maximum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Universidad Rey Juan Carlos

OTHER

Sponsor Role lead

Responsible Party

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Josue Fernandez Carnero

PhD

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Oliver Martínez Pozas, PhD candidate

Role: PRINCIPAL_INVESTIGATOR

Universidad Rey Juan Carlos (Madrid)

Eleuterio A. Sánchez Romero, PhD

Role: STUDY_DIRECTOR

Universidad Europea de Madrid (Madrid)

Josué Fernández Carnero, PhD

Role: STUDY_DIRECTOR

Universidad Rey Juan Carlos (Madrid)

Héctor Beltrán Alacreu, PhD

Role: STUDY_DIRECTOR

Universidad de Castilla La-Mancha (Toledo)

Locations

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Universidad Rey Juan Carlos

Alcorcón, Madrid, Spain

Site Status

Countries

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Spain

Central Contacts

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Josué Fernández, PhD

Role: CONTACT

+34 91 488 89 49

Oliver Martínez, PhD candidate

Role: CONTACT

+34 691 78 14 59

References

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den Bandt HL, Paulis WD, Beckwee D, Ickmans K, Nijs J, Voogt L. Pain Mechanisms in Low Back Pain: A Systematic Review With Meta-analysis of Mechanical Quantitative Sensory Testing Outcomes in People With Nonspecific Low Back Pain. J Orthop Sports Phys Ther. 2019 Oct;49(10):698-715. doi: 10.2519/jospt.2019.8876. Epub 2019 Aug 23.

Reference Type BACKGROUND
PMID: 31443625 (View on PubMed)

Neelapala YVR, Bhagat M, Frey-Law L. Conditioned Pain Modulation in Chronic Low Back Pain: A Systematic Review of Literature. Clin J Pain. 2020 Feb;36(2):135-141. doi: 10.1097/AJP.0000000000000778.

Reference Type BACKGROUND
PMID: 31764164 (View on PubMed)

McPhee ME, Vaegter HB, Graven-Nielsen T. Alterations in pronociceptive and antinociceptive mechanisms in patients with low back pain: a systematic review with meta-analysis. Pain. 2020 Mar;161(3):464-475. doi: 10.1097/j.pain.0000000000001737.

Reference Type BACKGROUND
PMID: 32049888 (View on PubMed)

Alkhawajah HA, Alshami AM. The effect of mobilization with movement on pain and function in patients with knee osteoarthritis: a randomized double-blind controlled trial. BMC Musculoskelet Disord. 2019 Oct 18;20(1):452. doi: 10.1186/s12891-019-2841-4.

Reference Type BACKGROUND
PMID: 31627723 (View on PubMed)

Lascurain-Aguirrebena I, Newham D, Critchley DJ. Mechanism of Action of Spinal Mobilizations: A Systematic Review. Spine (Phila Pa 1976). 2016 Jan;41(2):159-72. doi: 10.1097/BRS.0000000000001151.

Reference Type BACKGROUND
PMID: 26751060 (View on PubMed)

Aspinall SL, Jacques A, Leboeuf-Yde C, Etherington SJ, Walker BF. No difference in pressure pain threshold and temporal summation after lumbar spinal manipulation compared to sham: A randomised controlled trial in adults with low back pain. Musculoskelet Sci Pract. 2019 Oct;43:18-25. doi: 10.1016/j.msksp.2019.05.011. Epub 2019 May 31.

Reference Type BACKGROUND
PMID: 31176287 (View on PubMed)

Arribas-Romano A, Fernandez-Carnero J, Molina-Rueda F, Angulo-Diaz-Parreno S, Navarro-Santana MJ. Efficacy of Physical Therapy on Nociceptive Pain Processing Alterations in Patients with Chronic Musculoskeletal Pain: A Systematic Review and Meta-analysis. Pain Med. 2020 Oct 1;21(10):2502-2517. doi: 10.1093/pm/pnz366.

Reference Type BACKGROUND
PMID: 32100027 (View on PubMed)

Other Identifiers

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1003202108421

Identifier Type: -

Identifier Source: org_study_id

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