Lumbar Spondylosis Clinical Trial
Official title:
Back in the Game: An Immediate Functional Progression Program for Adolescent Athletes With Spondylolysis: A Multi-Center Randomized Pilot Trial
Spondylolysis, a stress fracture in the pars interarticularis of a lumbar vertebra, is the most common identifiable cause of low back pain (LBP) in adolescent athletes, occurring in 14-30% of athletes who experience LBP. Spondylolysis can cause significant pain and disability and months of exclusion from sports or an active lifestyle. Standard care of spondylolysis in adolescent athletes is primarily based on expert opinion, with dramatic variations in clinical practice, including restrictive bracing, extended rest periods before the intervention, long durations out of sport and activity, and suboptimal long-term clinical outcomes. As the next step towards our research goal, the overall objective of this pilot study is to perform a pilot randomized controlled trial to assess a novel rehabilitation strategy, the immediate functional progression program (IFPP), for treating active spondylolysis in adolescent athletes. Participants randomized to the IFPP group will begin physical therapy immediately (<1 week) after diagnosis. In contrast, those in the standard care group (control) will not start physical therapy until their pain has resolved. Aim 1 will evaluate the effects of the IFPP on outcomes (Function, Pain, Quality of Life, and Edema on MRI) among adolescent athletes with an active spondylolysis. Aim 2 will assess the feasibility of performing a full randomized trial using the novel IFPP to treat athletes ages 10-19 with an active spondylolysis. Aim 3 will compare the tolerability of the IFPP to standard care. This pilot study will lay the necessary groundwork to perform a larger hypothesis-driven randomized controlled trial.
Status | Recruiting |
Enrollment | 60 |
Est. completion date | September 1, 2024 |
Est. primary completion date | July 1, 2024 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 10 Years to 19 Years |
Eligibility | Inclusion criteria 1. Age between 10 and 19 years. 2. Active spondylolysis diagnosed by a participating physician using MRI. Signs of active spondylolysis are defined as edema in the posterior elements of the lumbar vertebrae at the pars interarticularis with or without a fracture. 3. Organized sport participation at least two times per week at the time of diagnosis or onset of LBP. Exclusion criteria 1. Previous rest from activity > four weeks due to LBP 2. Numbness or tingling in any lumbar dermatome. 3. Other injury or condition that would alter the plan of care for spondylolysis (i.e., pregnancy, anterior cruci-ate ligament tear in the knee, concussion). 4. History of lumbar spine surgery. |
Country | Name | City | State |
---|---|---|---|
United States | Nationwide Children's Hospital | Columbus | Ohio |
United States | Children's Hospital of Colorado | Denver | Colorado |
Lead Sponsor | Collaborator |
---|---|
Nationwide Children's Hospital | Children's Hospital Colorado |
United States,
d'Hemecourt PA, Zurakowski D, d'Hemecourt CA, Curtis C, Ugrinow V, Deriu L, Micheli LJ. Validation of a new instrument for evaluating low back pain in the young athlete. Clin J Sport Med. 2012 May;22(3):244-8. doi: 10.1097/JSM.0b013e318249a3ce. — View Citation
Klein G, Mehlman CT, McCarty M. Nonoperative treatment of spondylolysis and grade I spondylolisthesis in children and young adults: a meta-analysis of observational studies. J Pediatr Orthop. 2009 Mar;29(2):146-56. doi: 10.1097/BPO.0b013e3181977fc5. — View Citation
Selhorst M, Allen M, McHugh R, MacDonald J. REHABILITATION CONSIDERATIONS FOR SPONDYLOLYSIS IN THE YOUTH ATHLETE. Int J Sports Phys Ther. 2020 Apr;15(2):287-300. — View Citation
Selhorst M, Fischer A, Graft K, Ravindran R, Peters E, Rodenberg R, MacDonald J. Long-Term Clinical Outcomes and Factors That Predict Poor Prognosis in Athletes After a Diagnosis of Acute Spondylolysis: A Retrospective Review With Telephone Follow-up. J Orthop Sports Phys Ther. 2016 Dec;46(12):1029-1036. doi: 10.2519/jospt.2016.7028. Epub 2016 Nov 8. — View Citation
Selhorst M, Fischer A, Graft K, Ravindran R, Peters E, Rodenberg R, Welder E, MacDonald J. Timing of Physical Therapy Referral in Adolescent Athletes With Acute Spondylolysis: A Retrospective Chart Review. Clin J Sport Med. 2017 May;27(3):296-301. doi: 10.1097/JSM.0000000000000334. — View Citation
Selhorst M, MacDonald J, Martin LC, Rodenberg R, Krishnamurthy R, Ravindran R, Fischer A. Immediate functional progression program in adolescent athletes with a spondylolysis. Phys Ther Sport. 2021 Nov;52:140-146. doi: 10.1016/j.ptsp.2021.08.009. Epub 202 — View Citation
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Change in Micheli Functional Scale (MFS) | The Micheli Functional Scale is a measure of function and pain designed for adolescent athletes with low back pain. The MFS is score on 0-100% scale with 0% representing no disability and 100% representing maximum disability. | Baseline, 1 month, 3 months, 6 months, 1 year | |
Primary | Change in edema on MRI | Patients will have a repeat MRI performed at 3 months. A radiologist will assess for change in the spondylolytic lesion, edema and anterolisthesis. | Baseline, 3 months | |
Primary | Change in Quality of Life | Pediatric Quality of Life Inventory (PedsQL). The PedsQL is a 23-item health status instrument that assesses five domains of health (physical functioning, emotional functioning, psychosocial functioning, social functioning, and school functioning) in children and adolescents ages 2 to 18. Each item uses a 5-point Likert scale from 0 (Never) to 4 (Almost always). Items are reversed scored and linearly transformed to a 0-100 scale as follows: 0=100, 1=75, 2=50, 3=25, 4=0. Higher scores indicate better Health Related Quality of Life. | Baseline, 1 month, 3 months, 6 months, 1 year | |
Primary | Time to return to sport (days) | The number of days from diagnosis of spondylolysis to the point the patient passes all criteria of the PT program and is cleared to return to sport. | 1-6 months | |
Secondary | Change in Cross Sectional Area of Lumbar Multifidus | change in the cross-sectional area and fatty infiltrate of the lumbar multifidus using MRI at the L4/L5 and L5/S1 levels | Baseline, 3 months | |
Secondary | Change in Depressive Symptoms | The Patient-Reported Outcomes Measurement Information System® (PROMIS®) pediatric depressive symptoms short form is an eight-item questionnaire that assesses negative mood, loss of interest, feelings of worthless-ness, and loneliness. All items used a seven-day recall period and five-point (0-4) response options: never, rarely, sometimes, often, and almost always. Raw scores range from 0-32 with higher scores representing greater depressive symptoms. In a sample of pediatric individuals, 8-17 years, the PROMIS® pediatric depressive symptoms item bank demonstrated good test-retest reliability (r = 0.76) and internal consistency (a = 0.86). | Baseline, 1 month, 3 months, 6 months, 1 year | |
Secondary | Change in Fear Avoidance Beliefs | Fear-Avoidance Beliefs Questionnaire-Physical Activity (FABQ-PA) subscale: The FABQ-PA subscale quantifies the patient's fear of pain and beliefs about avoiding activity. 59 The FABQ-PA is a 4-item self-reported questionnaire. Each item is scored 0-6, with higher scores representing higher levels of fear-avoidance beliefs (0-24). Higher levels of fear-avoidance beliefs are associated with greater self-limiting activity. | Baseline, 1 month, 3 months, 6 months, 1 year |
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