Rehabilitation of Patients With Modic Changes in the Lumbar Spine
The purpose of this study is to compare patients with low back pain (LBP) and Modic Changes from The Backcenter Funen, Ringe:
To compare the effect of two types of non-operative treatments:
A. exercise and advice to be physically active
B. restitution and advice not to overload the spine
- To investigate if the results of the treatment are influenced by gender, age, smoking, and physical load.
|Study Design:||Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single Blind (Outcomes Assessor)
Primary Purpose: Treatment
|Official Title:||Rehabilitation of Patients With Modic Changes in the Lumbar Spine - a Randomized Controlled Trial|
- The primary outcome measure is actual LBP, as measured with an "11 point box scale". [ Time Frame: 10 weeks and 12 months ] [ Designated as safety issue: No ]
- General Health, as measured with the EQ-5D (EuroQol) [ Time Frame: 10 weeks and 12 months ] [ Designated as safety issue: No ]
- General improvement, as measured with two global instruments a 7-point transition question and an assessment score consisting of a "bothersomeness index" [ Time Frame: 10 weeks and 12 months ] [ Designated as safety issue: No ]
- Physical functions measured with "Roland Morris Disability Questionnaire" [ Time Frame: 10 weeks and 12 months ] [ Designated as safety issue: No ]
|Study Start Date:||March 2007|
|Study Completion Date:||September 2011|
|Primary Completion Date:||September 2011 (Final data collection date for primary outcome measure)|
Active Comparator: Exercise and advise to stay active
The exercise group received exercises for the stabilising muscles in the low back and abdomen together with dynamic exercises, exercises for postural instability and light physical fitness training.
Back exercise: At home every day. In groups once a week. Duration 10 weeks.
Experimental: Rest and use of flexible lumbar belt
The rest group was instructed to avoid hard physical activity and to rest twice daily for one hour, by lying down
Restitution: At home 2 times one hour. Meetings every 2 weeks. Duration 10 weeks.
The clinical experience is that many patients with Modic changes have relatively severe and persistent LBP, which typically appears to be resistant to treatment. Furthermore, a retrospective study at The Backcenter Funen, Ringe, shows that patients with MC fail to improve engaging physical activity. This is unfortunate, because the typical rehabilitation for patients with persistent LBP is back exercises and information about keeping physically active. This means that this relatively large subgroup of patients with Modic changes probably does not improve with the rehabilitation tools used today.
A randomised controlled trial has therefore been designed to study the specific subgroup of patients with Modic changes. In this study we will compare the present "state-of-the art" rehabilitation approach to persistent LBP (namely to exercise and keep active) with a new concept (restitution). The justification for this is that restitution reduces mechanical stress on the vertebrae and therefore would allow heeling of the possible micro fractures in Modic changes.
|Spine Centre of Southern Denmark|
|Middelfart, Denmark, 5500|
|Study Chair:||Claus Manniche, Prof.Dr.Med.||Spine Centre of Southern Denmark|