title: Tactile acuity training for patients with chronic low back pain: a pilot randomised controlled trial.
abstract: BACKGROUND
  Chronic pain can disrupt the cortical representation of a painful body part. This disruption may play a role in maintaining the individual's pain. Tactile acuity training has been used to normalise cortical representation and reduce pain in certain pain conditions. However, there is little evidence for the effectiveness of this intervention for chronic low back pain (CLBP). The primary aim of this study was to inform the development of a fully powered randomised controlled trial (RCT) by providing preliminary data on the effect of tactile acuity training on pain and function in individuals with CLBP. The secondary aim was to obtain qualitative feedback about the intervention.
  
  
  METHODS
  In this mixed-methods pilot RCT 15 individuals were randomised to either an intervention (tactile acuity training) or a placebo group (sham tactile acuity training). All participants received 3 sessions of acuity training (intervention or sham) from a physiotherapist and were requested to undertake daily acuity home training facilitated by an informal carer (friend/relative). All participants also received usual care physiotherapy. The primary outcome measures were pain (0-100visual analogue scale (VAS)) and function (Roland Morris Disability Questionnaire (RMDQ)). Participants and their informal carers were invited to a focus group to provide feedback on the intervention.
  
  
  RESULTS
  The placebo group improved by the greatest magnitude for both outcome measures, but there was no statistically significant difference (Mean difference (95%CI), p-value) between groups for change in pain (25.6 (-0.7 to 51.9), p = 0.056) or function (2.2 (-1.6 to 6.0), p = 0.237). Comparing the number of individuals achieving a minimally clinically significant improvement, the placebo group had better outcomes for pain with all participants achieving ≥30% improvement compared to only a third of the intervention group (6/6 vs. 3/9, p = 0.036). Qualitatively, participants reported that needing an informal carer was a considerable barrier to the home training component of the study.
  
  
  CONCLUSIONS
  This pilot RCT found tactile acuity training to be no more effective than sham tactile acuity training for function and less effective for pain in individuals with CLBP. That the intervention could not be self-applied was a considerable barrier to its use.
  
  
  BACKGROUND
  ISRCTN98118082.
authors.affiliation: Health and Social Care Institute, Teesside University, Middlesbrough TS1 3BA, UK. c.ryan@tees.ac.uk.
authors.forename: Cormac
authors.initials: C
authors.lastname: Ryan
authors.forename: Nicholas
authors.initials: N
authors.lastname: Harland
authors.forename: Benjamin T
authors.initials: BT
authors.lastname: Drew
authors.forename: Denis
authors.initials: D
authors.lastname: Martin
mesh_terms: D000328:Adult; D000368:Aged; D059350:Chronic Pain / Q000503:physiopathology / Q000628:therapy*; D004193:Discrimination Learning; D005260:Female; D017144:Focus Groups; D006701:Home Nursing; D006801:Humans; D017116:Low Back Pain / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D046709:Pattern Recognition, Physiological / Q000502:physiology; D026741:Physical Therapy Modalities; D010865:Pilot Projects; D036301:Qualitative Research; D020127:Recovery of Function; D017603:Signal Detection, Psychological; D016037:Single-Blind Method; D013003:Somatosensory Cortex / Q000503:physiopathology; D011795:Surveys and Questionnaires; D055698:Touch Perception / Q000502:physiology*; D064232:Visual Analog Scale