INTRODUCTION Chronic non-specific low back pain (CNSLBP) is self-defining, as it is a
long-lasting low back pain for which the exact cause is unknown in most cases. CLBP is a
disease that causes pain and disability). It has a high social impact, as it often causes
unemployment and early retirement, representing a major threat and burden to health, society
and the economy. CNSLBP is associated with a high burden of direct costs, such as treatment
costs (consultations, hospitalisation, medication, diagnosis, and emergency services) as well
as indirect costs (lost or reduced productivity, etc. It is estimated that 5% of chronic
patients consume 75% of the total cost of care for this disease and it is one of the main
causes of temporary disability and permanent disability. The total number of DALYs (number of
years lost due to illness, disability) associated with CNSLBP in Europe amounts to
10,731,256.71 according to the 2019 global burden of disease study, and is expected to
increase, especially in Western Europe. Currently, CNSLBP is considered a health priority,
which does not directly impact on the risk of death but has a high impact on quality of life.
There are a myriad of therapeutic options for the treatment of CNSLBP. Undoubtedly, those
that have demonstrated the best results are all active modalities. Therapy modalities with a
more passive character also have a proven analgesic efficacy, but their effect does not last
over time. Studies reveal similar effects when different active therapy modalities are
compared, such as walking, Pilates, abdominal exercises, analytical or functional strength
exercises, stretching, among others. However, to date, we have not found a protocol that
integrates the best exercises of the different modalities in the optimal workloads.
HYPOTHESIS The hypothesis put forward in this project is that a programme based on
semi-directed therapeutic exercise and health education, in people with and without visual
impairment, achieves better results in movement capacity, functional capacity, strength and
body constitution, compared to a treatment based on passive analgesic techniques, in patients
with CNSLBP.
GENERAL AND SPECIFIC OBJECTIVES The overall objective of this project is to compare the
impact of a semi-directed therapeutic exercise and health education programme in CLBP
patients, with and without visual impairment, compared to passive analgesic treatment.
The specific objectives to be achieved are:
To quantify the difference in scores on the OSWESTRY LOW BACK DISABILITY QUESTIONNAIRE
(ODI), between the group of patients receiving the exercise programme (group A) and the
passive analgesic treatment (group B).
The degree of disability generated by the CLBP will be compared in both groups at the
beginning and at the end of the intervention. This will allow us to create a structured
recommendation on the best intervention model for the treatment of these patients.
Quantify what are the main differences in the movement pattern of the subjects in the
active group (A) and the passive group (B).
Significant differences, which we aim to objectify, are expected in terms of movement
patterns, measured by sensors, after two opposite interventions.
To identify differences in the results obtained with the different intervention
modalities in subjects (participants) with and without visual impairment.
It will be interesting to identify in each of the groups whether there are differences
in terms of results in subjects with and without visual impairment, thus being able to
establish visual impairment as a conditioning factor in the treatment process of these
patients.
To analyse adherence to treatment in both groups. Comparing the number of drop-outs in
both groups, as well as the degree of compliance with the homework tasks (group A),
would allow us to identify adherence to two totally opposite treatment modalities.
To find the percentage of homework completion in the active group. As this is a
semi-directed exercise programme, intervention group A, part of the tasks will be
carried out without the presence of the physiotherapist. It will be interesting to
understand what percentage of the subjects do or do not complete the home tasks, by
means of activity monitoring devices.
To identify difficulties in the understanding and execution of home sessions by visually
impaired people. We know that even for people without visual impairment, the correct
understanding of tasks at home can be extremely difficult. In this case, it will be
possible to identify how the visual impairment interferes with this process by
monitoring the patient on a weekly basis.
To find out the individual effectiveness of the exercises selected in the programme.
There is little evidence regarding the movements selected for strength work in CLBP
patients. Some authors have successfully employed whole body functional work, abdominal
stabilisation exercises, extensor chain strengthening exercises, gait; however, there is
still a lack of work experimenting with these exercise modalities.
Analyse the tools used in the study for the visually impaired user.
The patient with CNSLBP and visual impairment faces some challenges in accessing digital
content. It will be important to understand whether or not the elements used are effective
for this population.
All these objectives seek as a common interest the contribution of scientific evidence that
supports the use of intelligent sensors in musculoskeletal pathology and that, integrated in
telecare PTAs and through the use of artificial intelligence, allow the physiotherapist to be
able to establish with greater precision a personalised diagnosis, as well as to serve
patients as a feedback system that allows them to be an active part of their diagnosis and
treatment.