EFFECTS OF GRADED SENSORIMOTOR RETRAINING COMPARED TO PILATES EXERCISES ON PAIN INTENSITY, DISABILITY AND HEMODYNAMIC CHANGES IN INDIVIDUALS WITH CHRONIC LOW BACK PAIN: A RANDOMIZED CONTROLLED TRIAL WITH fNIRS

• Grant number: 25/07264-0
• Support Opportunities: Scholarships in Brazil - Doctorate
• Start date: October 01, 2025
• End date: September 30, 2029
• Field of knowledge: Health Sciences - Physiotherapy and Occupational Therapy
• Principal Investigator: Thaís Cristina Chaves
• Grantee: Roger Berg Rodrigues Pereira
• Host Institution: Centro de Ciências Biológicas e da Saúde (CCBS). Universidade Federal de São Carlos (UFSCAR). São Carlos , SP, Brazil

Abstract

Introduction: Biopsychosocial and multimodal interventions are recommended for the treatment of low back pain, combining educational and exercise strategies. Graded Sensorimotor Retraining (GSR) is a strategy that can be used to address somatotopic changes and motor control in patients with chronic pain. GSR can be organized in different stages, aiming to gradually involve the cortical motor networks, helping to minimize the excessive protective response to pain, improve movement variability and provide patients with safety during exposure to movements. However, there are no studies available in the literature evaluating the effectiveness of GSR, specifically compared to recognized interventions for the treatment of chronic nonspecific low back pain (CLBP). And no previous study has evaluated cortical responses through fNIRS (Functional Near-Infrared Spectroscopy), during sensorimotor tests before and after GSR programs. Objective: To verify the effect of GSR when compared to Pilates exercises on the outcomes of pain intensity and disability in patients with CLBP and to investigate possible changes in cortical activity through the fNIRS technique at baseline and immediately after treatment. Methods: One hundred and fifty-two participants with CLBP will be randomly allocated into 2 groups: a group that will undergo GSR and a group that will undergo only Pilates exercises. This is a randomized controlled trial whose primary effects will be pain intensity and disability. All patients will undergo 12 treatment sessions, involving 12 GSR sessions following a gradual sequence of sensorimotor training exercises, and the comparison group will undergo only Pilates exercises. All participants will be evaluated at baseline and at the end of treatment with questionnaires and fNIRS during sensorimotor tests. Patients will be monitored at follow-ups of 3 (immediate post-treatment), 4, 6 and 9 months after randomization. For statistical analysis, mixed effects models will be used, considering time and groups as factors. A significance level of p < 0.05 will be considered. Conclusion: It is expected that these results will contribute to the understanding in the investigation of possible mechanisms associated with improvement in pain and disability, such as changes in cortical activity after a GSR program. (AU)