The Effect of AposTherapy on Pain and Function in a Non Specific Low Back Pain

AposTherapy® is a home-based exercise program utilizing footwear that causes exercise with
normal daily activity that may significantly improve function in patients with back pain in
general, and specifically Axial Low Back Pain (NSLBP). Capitalizing on the reported excellent
adherence and clinical benefit of Apos Therapy in patients with significant back pain, we
propose to evaluate this as a conservative treatment that may supplant/supplement traditional
pain medications and physical therapy in NSLBP population.

A possible potential use of AposTherapy® as a replacement for traditional physical therapy
may yield a less costly, more effective therapy with better adherence. Problems with
traditional therapy include poor patient adherence to both outpatient and home therapy
programs, the added cost of travel (which may be more than $100 per session for ambulette or
access-a-ride for eligible patients), and the lack of continuation in an ongoing exercise
program[6-8], all of which can lead to relapse and need for retreatment. Additionally, access
to physical therapy is limited for many patients since there are not enough available
outpatient therapy services to meet the needs of all patients. Finding an alternative
exercise program that will increase adherence, decrease total therapy visits, and improve
patient's outcomes with decreased dependence on pain medications is a high priority from both
patient care and cost management perspectives.

AposTherapy® potentially overcomes many of these issues by improving/modifying abnormal
biomechanics (therefore decreasing pain), and providing an independent home-based exercise
program utilizing footwear that causes exercise with normal activity by promoting
perturbation. This biomechanical approach may significantly reduce pain and improve function
in patients with nonspecific low back pain (NSLBP). Capitalizing on the reported excellent
adherence and clinical benefit of AposTherapy® in patients with significant NSLBP, we propose
to evaluate the biomechanical exercise (wearing an appropriately calibrated shoe at home for
a prescribed amount of time each day) as a conservative treatment that may supplement or
supplant traditional pain medications, interventional pain procedures and physical therapy in
an at-risk urban inner city population with NSLBP.

Inclusion Criteria:

- •Patients suffering from symptomatic axial lower back pain for at least 24 weeks.

- Patients with VAS pain score of ≥3cm (measured at baseline).

- Males and females between the ages of 30-85.

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- Ambulatory and active patients that can participate in a rehabilitation program
that includes daily walking

- Stable medicine regimen (no recent changes to their pain medication within a
month)

- Able to walk at least 50 meters and scored positive on the STEADI test (Supp. 1)

- Able to understand, read and sign the informed consent form

- English or Spanish speaking

Exclusion Criteria:

- •Patients suffering from active inflammatory joint disease.

- Patients with diagnosis of neuromuscular disease.

- Patients with more than 3 falls in the last 52 weeks, OR any balance related fall
with an injury in the last 52 weeks.

- Patients exhibiting a lack of physical or mental ability to perform or comply
with the study procedure.

- Patients with a history of pathological osteoporotic fracture

- Patients with referred pain consistent with radicular etiology

- Patients with generalized body pain (both upper and lower extremities).

- No spine surgery within 24 weeks.

- No image guided lumbar intervention in the past 8 weeks.

- No major cardiovascular comorbidities (able to enroll in an active exercise
program)

- Patient started on lipid lowering medication in last 12 weeks

- Any change in blood pressure medications

- No recent physical therapy for the back. (within the last 12 weeks)

- No active heart disease (ischemia or heart failure admissions within 24 weeks)
and no active COPD (exacerbation within 24 weeks)

- No active malignancies on ongoing treatment

- Patient with neurological gait pattern.

- Patient requiring assistive device during gait analysis.