Table 1 Description of study interventions based on the Template for Intervention Description and Replication (TIDieR) checklist [30]
Item | Experimental group | Control group |
|---|---|---|
1. Brief name | Sensorimotor training | Low-intensity cardiovascular training |
2. Why? | Sensorimotor control is believed to be impaired in chronic non-specific low back pain. PPT is a well- defined SMT method with standardised applications. PPT is indicated for postural specific back pain, functional instability of weight-bearing joints (e.g. knee or ankle instability), hypermobility, and other postural deficiencies | Physical activity at low intensity for only 15Â minutes is not expected to induce a specific treatment effect to the sensorimotor system [19] but can improve the global perception of well-being and can, therefore, be recommended as part of CNLBP treatment [61] |
3. What materials? | PPT uses the Posturomed therapy device [29], which is a labile platform restricted to damped anterior-posterior and mediolateral sway. Patients will receive an exercise diary to record adherence and progress | Cardio-exercise machines: elliptical cross-trainer, treadmill, stationary bike-ergometer. Patients will receive an exercise diary to record adherence and progress. |
4. What procedures? | Nine therapy sessions, each lasting 15 minutes. Therapy instructions advise seven stages of difficulty. On all stages the patient is asked to provoke oscillation by stepping on site. After 3 steps, the patient must stand still on 1 leg for 2 seconds before he or she repeats the steps. Difficulty is increased by a) decreasing the damping through release of the breaks and b) through added juggling of a ball during the motor task and trunk rotation (dual-task and divided attention). The next stage is reached once stabilisation in the previous stage is secured. The exercise is repeated for as many times as it can be performed adequately without losing balance. The moment where sensory depletion is observed by the supervising therapist, the exercise is interrupted. The exercise should be repeated for approximately 15 minutes | Nine therapy sessions, each lasting 15 minutes. Choosing either the treadmill, elliptical cross-trainer, or a stationary bike, the patient will be instructed and positioned according to body constitution. Next, patients will be asked to begin the exercise at a comfortable pace where speaking is still possible (Borg scale 6–9) and to maintain this intensity for 15 minutes |
5. Who provides? | Physiotherapists trained in PPT | Physiotherapists and sport scientists |
6. How? | Both intervention groups will receive initial instruction by a therapist. The patients will then perform the exercises individually with passive supervision by the therapist (e.g. promoting to next difficulty level) | |
7. Where? | Both interventions will be performed in the medical training centre for physical exercise within the clinic | |
8. When and how much? | During the 4.5-week intervention program, patients will receive the same allocation of 9 sessions for 15 minutes each (twice a week). This is added to the 30 minutes of conventional therapy both groups are entitled to according to their physician’s referral | |
9. Tailoring | Particularly the conventional therapy will be tailored to the needs and abilities of each individual patient. The therapist may apply any form of active or passive treatment during the first 30Â minutes (excluding PPT) | |
Patients will always start with the easiest level, but it is not rigorously prescribed which level they must achieve. They should try to reach sensorimotor depletion as judged by the supervising therapist (i.e. can no longer stabilise all segments at the given level of difficulty) | The low-intensity cardiovascular training is in itself tailored, as it requires each patient train at his or her individual recovery level (Borg scale 6–9). | |