Reliability of Sensorimotor Tests and related Cortical Activity and Effect of Graded Sensorimotor Retraining compared Pilates Exercises in Chronic Low Back Pain: A fNIRS study

• Grant number: 24/17025-0
• Support Opportunities: Regular Research Grants
• Start date: September 01, 2025
• End date: August 31, 2028
• Field of knowledge: Health Sciences - Physiotherapy and Occupational Therapy
• Principal Investigator: Thaís Cristina Chaves
• Grantee: Thaís Cristina Chaves
• Host Institution: Centro de Ciências Biológicas e da Saúde (CCBS). Universidade Federal de São Carlos (UFSCAR). São Carlos , SP, Brazil
• City of the host institution: São Carlos
• Associated researchers: Ana Carolina de Campos ; Benedict Martin Wand ; Guilherme Thomaz de Aquino Nava ; Helen Cristina Nogueira Carrer

Abstract

Introduction: Biopsychosocial and multimodal interventions are recommended for the treatment of low back pain, combining educational and exercise strategies. Graded Sensorimotor Retraning (GSR) can be used to address somatotopic and motor control changes in patients with chronic pain. GSR can be organized into different stages, aiming to gradually involve cortical motor networks, helping to minimize excessive protective pain responses, improving movement variability, and providing patients with a safety context to adhere to exercises. However, there is no previous study that assessed the effectiveness of GSR compared to interventions recognized in the literature to treat patients with chronic nonspecific low back pain (CLBP) like Pilates exercises. Additionally, no previous study has evaluated cortical activity using fNIRS (Functional Near-Infrared Spectroscopy) during sensorimotor tests, pre- and post-GSR. Hence, this project comprises two studies: Study#1 - to describe the reliability of cortical hemodynamic responses (oxy and deoxyhemoglobin) will be recorded using fNIRS during sensorimotor tests in patients with CLBP and asymptomatic controls; and Study#2 which aims to identify the effect of GSR compared to Pilates exercises on the outcomes of pain intensity and disability in patients with CLBP and to investigate possible changes pre and post-treatment in cortical activity through the fNIRS technique. Methods: Study#1 will be a longitudinal study in which 40 patients with CLBP and 40 asymptomatic controls will be submitted to sensorimotor tests in baseline assessment and after 7 days (retest). During the tests, the hemodynamic response will be recorded using fNIRS in the areas of pre-frontal cortex and primary motor cortex. In study 2, 152 participants with CLBP will be randomly allocated into 2 groups: a group will receive GSR and another group that will receive only Pilates-based Equipment exercises. This is a randomized controlled trial whose primary outcomes will be pain intensity and disability. A 12-week program will be delivered for the GSR in which the patients will be submitted to a graded exercise sensorimotor training program and the control group will be submitted to Pilates exercises. All participants will be evaluated at baseline and the end of treatment with questionnaires and fNIRS during sensorimotor tests. Patients will be assessed at 3, 4 and 6-month after randomization follow-ups. Reliability analyses using the Intraclass Correlation Coefficient will be used to analyze the data from study#1 and mixed method effects for study#2. Conclusion: These results are expected to contribute to the understanding of the consistency of fNIRS measurements in patients with CLBP during sensorimotor tests and to shedding light on the possible mechanisms associated with improvement in pain and disability, such as changes in cortical activity, after sensorimotor training programs. (AU)