Analysis of Crepitus in Human Subjects

NCT ID: NCT05425017

Last Updated: 2024-12-05

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

ACTIVE_NOT_RECRUITING

Total Enrollment

12 participants

Study Classification

OBSERVATIONAL

Study Start Date

2024-09-01

Study Completion Date

2025-12-01

Brief Summary

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Chiropractic adjustment has been shown to gap certain joints in the spine, thereby improving mobility in individuals with decreased movement capabilities. During normal motion, joints in the spine produce sounds and vibrations called crepitus. The purpose of this study is to assess how this crepitus may be used as an indicator for joint degeneration in healthy human subjects and those with low back pain, and if chiropractic adjusting causes change in this crepitus. The investigators hypothesize that change in crepitus after adjustment may be a useful indication of changes in joint mobility and joint stiffness.

Detailed Description

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Objective: This is an expansion of the initial study "Analysis of Crepitus in Human Subjects" to assess the feasibility of simultaneously recording zygapophyseal (Z) joint crepitus using piezoelectric accelerometers and Z joint motion using diagnostic ultrasound (US), and qualitatively assess the US images with particular focus on images taken of Z joints exhibiting crepitus. Like the original study (n=12), the results of a recently developed automated method (AM) is compared with two human observers in the analysis of recordings of human lumbar zygapophyseal (Z) joint crepitus. The recordings will be taken during ranges of motion performed before and after lumbar side-posture spinal manipulation (SMT). Methods: Six (6) healthy and 6 low back pain subjects will participate in the study. Using clinical study procedures developed previously, subjects will be given an initial phone screen before being scheduled for a clinical study appointment. At the appointment, subjects will undergo the informed consent process, and those consenting will be further screened and examined by the Research Clinician who will use the inclusion/exclusion criteria to determine eligibility for the study. Eligible subjects will be enrolled and scheduled for an accelerometry visit. At the accelerometry visit, 11 accelerometers will be applied to the lumbar region, allowing assessment of Z joint crepitus. US imaging of the right L4/L5 Z joint will be included. Each subject will undergo full flexion and full extension (ROM) while recordings are made from the accelerometers. Subjects will then undergo bilateral lumbar SMT, and immediately thereafter will undergo repeated ROM while recordings are made. Two human observers and the AM, blinded to the results of one another, will then assess the recordings to identify Z joints from which crepitus originated. The primary outcomes will be: 1) weighted kappa inter-rater reliability statistic comparing AM and the 2 human observers in identifying Z joint crepitus, and 2) ANOVA test statistic comparing time to complete the crepitus analysis by the AM and human observers. Hypotheses: 1) The automated method will be reliable, agreeing with the human observers' analysis. 2) The automated method will be significantly more time efficient than the analyses made by the human observers. Application: The investigators believe that this program will improve the efficiency of identifying the site of Z joint crepitus, thereby advancing the line of investigation designed to use crepitus as a biomarker of spinal joint dysfunction.

Conditions

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Low Back Pain Healthy

Keywords

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crepitus spine noise physiological pathological

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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Low back pain group

Participants currently experiencing low back pain will have small accelerometers taped along spine, Ultrasound (US) Clinician will place an US transducer at the right L4/L5 Z joint. Participants will complete a range of motions while accelerometers are recording back sounds. Subsequently, they will receive a chiropractic adjustment, then repeat the range of motions

Range of motion with spinal adjustment

Intervention Type OTHER

With accelerometers affixed to spine recording vibrations, the participants complete range of motion. After completing, they receive a low back spinal adjustment and repeat range of motion

Healthy group

Participants without low back pain will have small accelerometers taped along spine. Ultrasound (US) Clinician will place a US transducer at the right L4/L5 Z joint. Participants will perform a range of motions while accelerometers are recording back sounds. Subsequently, they will receive a chiropractic adjustment, then repeat the range of motions

Range of motion with spinal adjustment

Intervention Type OTHER

With accelerometers affixed to spine recording vibrations, the participants complete range of motion. After completing, they receive a low back spinal adjustment and repeat range of motion

Interventions

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Range of motion with spinal adjustment

With accelerometers affixed to spine recording vibrations, the participants complete range of motion. After completing, they receive a low back spinal adjustment and repeat range of motion

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

Healthy (no LBP) Subjects (n=6):

* 30 to 75 years of age
* No previous history of LBP lasting for more than two weeks, or no more than three episodes of back pain of brief duration (one week) in any given year (to recruit healthy subjects with no history, or a minimal history, of LBP).
* No presence of current LBP
* Female with a BMI of 28 or less; Male with a BMI of 30 or less.

LBP Subjects Criteria (n=6):

* 30 to 75 years of age
* Current LBP of at least one-week (7 days) duration
* Female with a BMI of 28 or less; Male with a BMI of 30 or less.

* Presence of Current LBP
* Prior spinal surgery
* Presence of current spinal fracture, tumor, infection, or scoliosis of greater than 5 degrees (Cobb's angle, scoliosis decreases ability to place the accelerometers); or other known significant pathology
* Known allergies to latex or adhesives (including Band-Aids) applied to the skin (accelerometers are taped to the skin)
* BMI over 30 for males; BMI over 28 for females (subject will be weighed at exam)
* Pregnancy (because of unique biomechanical patterns and changes in the ranges of motion that occur during pregnancy)
* Positive findings on any of the orthopedic or neurological tests listed on exam form; (because these subjects will be assessed as healthy individuals, indication of somatic pathology or neurological deficit are exclusionary criteria)
* Decreased range of motion (as measured with a goniometer) of the lumbar region (recording during flexion and extension ranges of motion are conducted in the study; consequently a full range of motion is necessary for the healthy subjects). The following ranges will be exclusionary: Flexion: \< 40º (normal = 60º); Extension: \< 10º (normal = 20º);
* Pain or discomfort during set-up for lumbar side-posture spinal manipulation (SMT) or during lumbar SMT given at the conclusion of the examination (the study assesses changes following SMT, consequently ability to tolerate SMT is important)
* Contraindication to manipulative treatment

LBP Subjects:

* Under 30 or over 75 years of age
* Absence of Current LBP of at least one-week (7 days) duration
* BMI over 30 for males; BMI over 28 for females (subject will be weighed at exam)
* Known allergies to latex or adhesives (including Band Aids) applied to the skin (accelerometers are taped to the skin)
* Pregnancy (because of unique biomechanical patterns and changes in the ranges of motion that occur during pregnancy)
* Pain radiating below the knee
* Presence of current spinal fracture, tumor, infection, or scoliosis of greater than 5 degrees (Cobb's angle, scoliosis decreases ability to place the accelerometers); or other known significant pathology
* Prior spinal surgery
* Negative findings on all of the orthopedic or neurological tests listed on exam form
* Contraindication to manipulative treatment

Exclusion Criteria

Healthy Subjects:

* Under 30 or over 75 years of age
Minimum Eligible Age

30 Years

Maximum Eligible Age

75 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Yale University

OTHER

Sponsor Role collaborator

National University of Health Sciences

OTHER

Sponsor Role lead

Responsible Party

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Gregory D. Cramer

Professor and Dean of Research

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Gregory Cramer, DC, PhD

Role: PRINCIPAL_INVESTIGATOR

National University of Health Sciences

Gregory Roytman, DC

Role: PRINCIPAL_INVESTIGATOR

Yale University

Locations

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National University of Health Sciences

Lombard, Illinois, United States

Site Status

National University of Health Science

Lombard, Illinois, United States

Site Status

Countries

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United States

References

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Cramer GD, Ross K, Pocius J, Cantu JA, Laptook E, Fergus M, Gregerson D, Selby S, Raju PK. Evaluating the relationship among cavitation, zygapophyseal joint gapping, and spinal manipulation: an exploratory case series. J Manipulative Physiol Ther. 2011 Jan;34(1):2-14. doi: 10.1016/j.jmpt.2010.11.008.

Reference Type BACKGROUND
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Cramer GD, Budavich M, Bora P, Ross K. A Feasibility Study to Assess Vibration and Sound From Zygapophyseal Joints During Motion Before and After Spinal Manipulation. J Manipulative Physiol Ther. 2017 Mar-Apr;40(3):187-200. doi: 10.1016/j.jmpt.2017.01.003. Epub 2017 Mar 6.

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Cramer GD, Ross K, Raju PK, Cambron J, Cantu JA, Bora P, Dexheimer JM, McKinnis R, Habeck AR, Selby S, Pocius JD, Gregerson D. Quantification of cavitation and gapping of lumbar zygapophyseal joints during spinal manipulative therapy. J Manipulative Physiol Ther. 2012 Oct;35(8):614-21. doi: 10.1016/j.jmpt.2012.06.007. Epub 2012 Aug 14.

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Lascelles BD, Dong YH, Marcellin-Little DJ, Thomson A, Wheeler S, Correa M. Relationship of orthopedic examination, goniometric measurements, and radiographic signs of degenerative joint disease in cats. BMC Vet Res. 2012 Jan 27;8:10. doi: 10.1186/1746-6148-8-10.

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Reference Type RESULT

Other Identifiers

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H2101/H2302

Identifier Type: -

Identifier Source: org_study_id