Étude de l'effet antalgique et fonctionnel du port d'une orthèse lombaire souple dans la lombalgie aiguë

Non-rigid lumbar supports for the management of non-specific low back pain: A literature review and meta-analysis

BACKGROUND

Clinical practice guidelines for non-specific low back pain do not recommend the use of non-rigid lumbar supports (NRLSs) despite the publication of several positive randomized controlled studies.

OBJECTIVE

We conducted a systematic review with meta-analysis to assess the efficacy of NRLSs in the treatment and prevention of non-specific low back pain.

METHODS

We searched for reports of randomized controlled trials in PubMed, Cochrane Library, EMBASE, Science Direct and Pedro databases. Data were analyzed by disease stage (acute, subacute, and chronic) and type of prevention (primary and secondary). The analysis of methodological quality involved the Physiotherapy Evidence Database (PEDro) scale.

RESULTS

Of the 1581 records retrieved, only 4 full-text articles were included, with 777 patients: 378 in the NRLS group, and 348 in the control group. NRLSs conferred greater amelioration of disability (effect size -0.54, 95% CI -0.90; -0.17) and pain (-0.29, -0.46; -0.12) than standard management. Insufficient data prevented a comparison of the efficiency for acute, subacute and recurrent low back pain as well as meta-regression of responder phenotypes (sociodemographic and other patient characteristics).

CONCLUSION

We demonstrated the overall efficacy of NRLSs for both disability and pain. However, further studies are needed to assess which patients can benefit the most from lumbar supports based on patient phenotype and the characteristics of low back pain. PROSPERO (CRD42018109855).

Characterization of a pressure measuring system for the evaluation of medical devices

The purpose of this study is to evaluate the possible use of four “FSA” thin and flexible resistive pressure mapping systems, designed by Vista Medical (Winnipeg, Manitoba, Canada), for the measurement of interface pressure exerted by lumbar belts onto the trunk. These sensors were originally designed for the measurement of low pressure applied by medical devices on the skin. Two types of tests were performed: standard metrology tests such as linearity, hysteresis, repeatability, reproducibility and drift, and specific tests for this application such as curvature, surface condition and mapping system superposition. The linear regression coefficient is between 0.86 and 0.98; hysteresis is between 6.29% and 9.41%. Measurements are repeatable. The location, time and operator, measurement surface condition and mapping system superposition have a statistically significant influence on the results. A stable measure is verified over the period defined in the calibration procedure, but unacceptable drift is observed afterward. The measurement stays suitable on a curved surface for an applied pressure above 50 mmHg. To conclude, the sensor has acceptable linearity, hysteresis and repeatability. Calibration must be adapted to avoid drift. Moreover, when comparing different measurements with this sensor, the location, the time, the operator and the measurement surface condition should not change; the mapping system must not be superimposed.

Low back pain sufferers: is standing postural balance facilitated by a lordotic lumbar brace?

INTRODUCTION

The use of a lumbar lordosis orthotic device in the treatment of discogenic low back pain could be a valuable option and rehabilitation tool. The lumbar lordosis brace has been designed to meet these requirements and acts as a reminder to the patient to maintain a physiological lumbar lordosis curvature since it comprises a vertical panel on the chest and a curved rigid shell at the back. This lumbar lordosis brace exerts the necessary degree of compression in the lumbar region and achieves correction of the sagittal plane spine balance to improve postural control of the lumbar spine. Quantitative analysis of the centre of pressure (CoP) deviations, which are necessary to maintain the standing posture helps evaluate the impact of such device on postural balance.

PATIENTS AND METHODS

Eleven patients suffering from lumbar pain with discopathy (seven females and four males) had to stand on a force platform with their eyes closed under two basic conditions (fitted or not with a lumbar lordosis brace).

RESULTS

On the antero-posterior axis, the lordosis brace achieved a 6mm CP deviation from its mean position and a 51% reduction in the mean displacement prior to the initiation of the postural control mechanisms.

DISCUSSION

The forces applied by the lumbar lordosis brace (through compression and/or change in the spinal sagittal balance) seem to improve the quality of the patient's balance strategy. Posturography appears as a valuable tool for in situ investigation of the postural benefits achieved when using a thoracolumbosacral orthosis in patients suffering from lumbar pain. LEVEL OF EVIDENCE LEVEL IV: .

Effectiveness of a lumbar belt in subacute low back pain: an open, multicentric, and randomized clinical study

STUDY DESIGN

Multicentric, randomized, and controlled study of clinical evaluation of medical device in subacute low back pain.

OBJECTIVE

To evaluate the effects of an elastic lumbar belt on functional capacity, pain intensity in low back pain treatment, and the benefice on medical cost.

SUMMARY OF BACKGROUND DATA

There is limited evidence of efficiency of lumbar supports for treatment of low back pain. There is also a lack of the methodology in the studies reported on the efficiency of this device.

METHODS

This study is randomized, multicentric, and controlled with 2 groups: a patient group treated with a lumbar belt (BWG) and a control group (CG). The main criteria of clinical evaluation were the physical restoration assessed with the EIFEL scale, the pain assessed by a visual analogic scale, the main economical criteria was the overall cost of associated medical treatments.

RESULTS

One hundred ninety-seven patients have participated. The results show a higher decrease in EIFEL score in BWG than CG between days 0 and 90 (7.6 +/- 4.4 vs. de 6.1 +/- 4.7;P = 0.023). Respectively significant reduction in visual analogic scale was also noticed (41.5 +/- 21.4 vs. 32.0 +/- 20; P = 0.002). Pharmacologic consumption decreased at D90 (the proportion of patients who did not take any medication in BWG is 60.8% vs. 40% in CG;P = 0.029).

CONCLUSION

Lumbar belt wearing is consequent in subacute low back pain to improve significantly the functional status, the pain level, and the pharmacologic consumption. This study may be useful to underline the interest of lumbar support as a complementary and nonpharmacologic treatment beside the classic medication use in low back pain treatment.

Effect of wearing a lumbar orthosis on trunk muscles: study of the muscle strength after 21days of use on healthy subjects

INTRODUCTION

Randomized and controlled study of clinical evaluation of medical device in healthy subjects.

OBJECTIVE

To evaluate the effect of wearing an elastic lumbar support, frequently used in low-back pain prevention or treatment, on the trunk flexors and extensors muscle strength on healthy subjects.

SUMMARY OF BACKGROUND DATA

The long-term use of a lumbar orthosis is still suspected of weakening on the trunk muscles. The results in the existing literature are contradictory but don't seem to confirm this.

METHODS

Trunk muscle isokinetic and isometric strength measured before and after the wearing of an elastic orthosis over a period of 21days by healthy subjects with a control group without orthosis.

RESULTS

There were 20 healthy subjects using orthosis and 9 controls. No changes in isokinetic and isometric strength were observed except for the endurance parameter on extensors: it was significantly more important before than after the lumbar support use (p=0.033).

CONCLUSION

These results disprove any negative effects on muscle strength and add to the existing literature which argues for a more customized prescription of lumbar orthosis depending on the potential muscle strength of the subject.