This study tested a graded sensorimotor retraining program for 3 participants with chronic nonspecific low back pain (CNSLBP) lasting over 12 months. The program aimed to influence cortical representation and was delivered over 10 weeks in clinic and at home. All 3 participants showed reductions in pain intensity, interference of pain with daily life, and disability during and after treatment, with no adverse reactions. Statistical analysis confirmed decreasing trends across the baseline, treatment, and follow-up phases. This is the first report of a comprehensive graded sensorimotor retraining program for CNSLBP.

1. Managing chronic nonspecific low back pain with a sensorimotor retraining
approach: exploratory multiple-baseline study of 3 participants
Benedict M. Wand1, Neil E. O’Connell2, Flavia Di Pietro3, Max Bulsara4
1School of Physiotherapy, University of Notre Dame Australia,
2 Department of Health Sciences and Social Care, Brunel University, UK,
3Neuroscience Research Australia,
4Institute of Health and Rehabilitation Research, University of Notre Dame Australia.
Background and aims: Chronic nonspecific low back pain (CNSLBP) is a common
healthcare problem for which current interventions are only moderately successful [1].
There is growing evidence of extensive cortical reorganisation and perceptual Data analysis: A combined person-period data set was
disturbances which may contribute to the condition [2]. The aim of this study was to test
constructed to evaluate outcomes over time. A parametric
whether a graded sensorimotor retraining program, aimed at influencing cortical
linear mixed-model quantified the relationship between pain
representation, would reduce pain intensity, interference of pain on daily life and self
intensity, the interference of pain on daily life, and disability with
reported disability. We also investigated the safety of this intervention by recording any
phase of the program (fixed-effect parameter).
adverse reactions to the program.
Methods: Participants were recruited on the basis of disabling CNSLBP for at least 12 Results: All participants showed reduction in pain, pain’s
months. The Brief Pain Inventory was used to measure pain intensity and pain’s interference with daily life and disability. Improvements were
interference with daily life. Disability was measured via the Roland-Morris Disability maintained during the post-treatment period. No participant
Questionnaire. Participants were assessed weekly throughout three phases: a no- recorded any adverse reaction to treatment.
treatment baseline phase, a ten week graded sensorimotor retraining phase performed
both in the clinic and at home, and finally for a one-month follow up phase. A multiple- Summary of main findings: The three participants
baseline A1-B-A2 design was used. showed persistent decreases in pain intensity, interference of
pain with daily life, and self-reported disability during the
treatment phase as well as maintenance of improvements during
the one-month follow-up phase. Trends observed in individual
data were confirmed with the mixed-model analysis. This is the
first report of a comprehensive graded sensorimotor program for
CNSLBP.
Summary of the retraining program
Changes in pain intensity.
Regression coefficient for
trend between phases
among all three participants
combined: -2.02 (p = 0.001).
Changes in interference of
pain on daily life.
Regression coefficient for
trend between phases:
-2.25 (p < 0.001).
Where to from here?
Further investigation of a sensorimotor retraining
program for CNSLBP with more robust experimental
Changes in the three primary
designs is warranted. Refinement of the approach is
outcomes over time.
also needed, particularly with respect to which
Changes in disability. The dashed vertical lines
components of the program might offer patients the
represent the changes in
Regression coefficient
most benefit. Finally, exploration of the relationship
experimental phase.
for trend between between training strategies and neuroimaging in this
phases: -4.86 (p <0.001). group may offer very useful data.
[1] van Tulder MW, et al. 2006. Eur Spine J. 15: S64-S81.
[2] Lotze M, et al. 2007. Curr Rheumatol Rep. 9: 488-496.