Archived project

The Newcastle FRED Intervention for Low Back Pain Study

Goal: To examine the effects of a six week programme of physiotherapist-supervised FRED exercise in people with Low Back Pain - specifically on lumbo-pelvic muscle activity (surface and inra-muscular EMG), function, balance, pain, quality of life, and a range of functional activities affected by low back pain.

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Kirsty Lindsay
added a research item
Introduction Exercise with the Functional Re-adaptive Exercise Device (FRED) has previously been shown to activate the lumbar multifidus (LM) and transversus abdominis (TrA) muscles in non-symptomatic volunteers. This study aimed to determine the effects of a six-week FRED exercise intervention on pain intensity, patient-reported function and LM cross sectional area (CSA) in people with chronic non-specific low back pain (LBP). Methods Thirteen participants undertook six weeks of FRED exercise for up to 15 min, three times per week. At six weeks pre-, immediately pre-, immediately post-, and six and 15 weeks post-intervention, participants completed the Numeric Pain Rating Scale, Patient-Specific Functional Scale, and ultrasound imaging was used to assess the size of the LM muscles at L5 level. Changes in outcomes were assessed using effect size, confidence intervals and minimum clinically important difference (MCID). Results There was no improvement in pain intensity following the intervention. Patient-reported function improved by at least twice the MCID for all follow-up assessments compared to immediately pre-intervention (d = 4.20–6.58). Lumbar multifidus CSA showed a large effect size increase from immediately pre-intervention to immediately post-intervention (d = 0.8–1.1); this was maintained at six weeks post-intervention (not measured at 15 weeks post-intervention). Conclusion Six weeks of FRED exercise improved physical function in all 13 participants with chronic non-specific LBP who took part in this study and most participants' lumbar multifidus muscle CSA. On this basis, it may be an effective intervention for people with chronic LBP and should now be tested in a randomised controlled trial.
Tobias Weber
added a research item
Purpose: Lumbar multifidus (LM) and transversus abdominis (TrA) show altered motor control, and LM is atrophied, in people with low-back pain (LBP). The Functional Re-adaptive Exercise Device (FRED) involves cyclical lower-limb movement against minimal resistance in an upright posture. It has been shown to recruit LM and TrA automatically, and may have potential as an intervention for non-specific LBP. However, no studies have yet investigated the effects of changes in FRED movement amplitude on the activity of these muscles. This study aimed to assess the effects of different FRED movement amplitudes on LM and TrA muscle thickness and movement variability, to inform an evidence-based exercise prescription. Methods: Lumbar multifidus and TrA thickness of eight healthy male volunteers were examined using ultrasound imaging during FRED exercise, normalised to rest at four different movement amplitudes. Movement variability was also measured. Magnitude-based inferences were used to compare each amplitude. Results: Exercise at all amplitudes recruited LM and TrA more than rest, with thickness increases of approximately 5 and 1 mm, respectively. Larger amplitudes also caused increased TrA thickness, LM and TrA muscle thickness variability and movement variability. The data suggests that all amplitudes are useful for recruiting LM and TrA. Conclusions: A progressive training protocol should start in the smallest amplitude, increasing the setting once participants can maintain a consistent movement speed, to continue to challenge the motor control system.
Kirsty Lindsay
added a research item
Introduction: The Functional Re-adaptive Exercise Device is a novel rehabilitation tool developed at Northumbria University to help treat low back pain in adults. Previous research suggests that FRED effectively recruits the Lumbar Mulfidus (LM) and Transversus Abdominus (TrA), which have been specifically shown to have maladaptive changes in chronic low back pain. As well as providing a new treatment option for chronic low back pain, it is foreseen that FRED rehabilitation may work as a countermeasure for the spinal deconditioning following spaceflight. This study is supported by Northumbria University and the European Space Agency. Aim: The aim of the study was to look at the effects of a 6-week exercise intervention using FRED on low back pain symptoms, lumbar muscle morphology, and quality of life measures in a clinical population using a case series design. Methods: 13 participants, 6 females, mean age 46±9, height 1.73±0.84m and mean BMI 24.8±3, took part in a study. Baseline data was collected 6 weeks before the intervention and immediately pre-intervention, as well as immediately post-intervention, 6 weeks and 3 months post intervention for follow up. The main outcome measures included ultrasound images of LM and TrA, Intramuscular EMG of LM, TrA, Internal Obliques (IO) and External Obliques (EO), as well off assessments of balance, quality of life measures and FRED movement variability. Results: Initial statistical results will be presented, as well as the clinical implication for FRED use in patient populations.
Dorothee Debuse
added an update
This morning we are collecting data from our last participant following the six-week FRED exercise intervention.
The commitment of our participants to the study has been exemplary (they also report that they all enjoyed it and would like the exercise to continue): out of 234 exercise sessions over 6 weeks only 5 were lost due to colds, and participants were very good at engaging with their log of their daily activity, analgesic intake and concurrent health care interventions.
We think we have a complete set of data for all participants (EMG needs to be analysed yet), which is great, and we now have an absolute stack of data to analyse
I't been an intense time, and we are learning a lot - about differences in motor learning, different responses to the exercise intervention, and the relevance of hope for people with chronic pain.
 
Dorothee Debuse
added a project goal
To examine the effects of a six week programme of physiotherapist-supervised FRED exercise in people with Low Back Pain - specifically on lumbo-pelvic muscle activity (surface and inra-muscular EMG), function, balance, pain, quality of life, and a range of functional activities affected by low back pain.