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Haas M, Boiché J, Chevance G, Latrille C, Brusseau M, Courbis AL, Dupeyron A. Motivation toward physical activity in patients with chronic musculoskeletal disorders: a meta-analysis of the efficacy of behavioural interventions. Sci Rep 2024; 14:18740. [PMID: 39138217 DOI: 10.1038/s41598-024-67948-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 07/17/2024] [Indexed: 08/15/2024] Open
Abstract
Musculoskeletal disorders (MDs) represent a global health issue, which can lead to disability. Physical activity (PA) reduces pain and increases physical function among patients with MDs. To promote behavioural changes, it seems important to focus on modifiable factors, such as motivation. Thus, this review aims to assess effects of interventions targeting PA on motivation towards PA. Searches used terms referring to "physical activity", "motivation" and "chronic musculoskeletal disorders" on the databases PubMed, PsychINFO, MEDLINE, EMBASE, PEDro and Web of Science. All types of intervention-including but not limited to RCTs-were eligible for inclusion. Risk of bias was assessed with the Quality Assessment Tool for Studies with Diverse Designs (QATSDD). Among 6 489 abstracts identified, there were 387 eligible studies and 19 were included, reporting in total 34 effect sizes. The meta-analysis concerned 1 869 patients and indicated a small effect of interventions on change in motivation towards PA (d = 0.34; 95% CI [0.15; 0.54]; p < .01; k = 33). Behavioural interventions positively impact PA motivation in patients with MDs. In the literature, most studies focused on intervention's effect on fear of movement. Future research should assess other explicit motivational constructs, as well as implicit processes.
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Affiliation(s)
- Matthieu Haas
- EuroMov Digital Health in Motion, University of Montpellier, IMT Mines Ales, Montpellier, France.
| | - Julie Boiché
- EuroMov Digital Health in Motion, University of Montpellier, IMT Mines Ales, Montpellier, France
| | | | - Christophe Latrille
- EuroMov Digital Health in Motion, University of Montpellier, IMT Mines Ales, Montpellier, France
- PhyMedExp, University of Montpellier, INSERM, CNRS, CHRU, Montpellier, France
| | - Mathis Brusseau
- EuroMov Digital Health in Motion, University of Montpellier, IMT Mines Ales, Montpellier, France
| | - Anne-Lise Courbis
- EuroMov Digital Health in Motion, University of Montpellier, IMT Mines Ales, Montpellier, France
| | - Arnaud Dupeyron
- EuroMov Digital Health in Motion, University of Montpellier, IMT Mines Ales, Montpellier, France
- Department of Physical Medicine and Rehabilitation, CHU de Nîmes, Univ de Montpellier, Nîmes, France
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Isozaki AB, Brant JM. The Impact of Pain on Mobility in Patients with Cancer. Semin Oncol Nurs 2024; 40:151672. [PMID: 38902182 DOI: 10.1016/j.soncn.2024.151672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 05/14/2024] [Accepted: 05/16/2024] [Indexed: 06/22/2024]
Abstract
OBJECTIVES Provide an overview of how pain impacts mobility in patients with cancer. METHODS A literature search was conducted in PubMed and on Google Scholar using search terms, cancer pain with mobility, acute and chronic pain syndromes, enhanced recovery after surgery, nursing care, and rehabilitation. Peer-reviewed research studies, review articles, and pain guidelines and position papers were reviewed to provide an overview on cancer pain, its impact on mobility, and the nurse's role in managing pain and optimizing mobility and functional outcomes. RESULTS Firty-two references were included in this overview. This body of literature is replete with studies on the management of pain; however, the tie between pain and mobility has not been well described aside from the breakthrough pain literature. This manuscript weaves these two important concepts together to better inform nurses and other clinicians regarding the importance of managing pain to even begin mobilizing patients, especially following surgery and for other painful conditions. CONCLUSIONS Oncology nurses play an integral role in assessing and managing cancer pain. It is important for nurses to recognize how their pain management interventions lead to improved mobility and functioning in patients with cancer. IMPLICATIONS FOR NURSING PRACTICE Nurses comprise the largest workforce around the globe and are well-equipped to assess and manage cancer pain in all cancer care settings. As leaders within the healthcare team, making recommendations to better control pain and communicating with other team members regarding the pain plan is essential in improving mobility in patients with cancer.
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Affiliation(s)
- Annette Brant Isozaki
- Bone Marrow Transplant, CAR T Cell, and Investigational Therapy Unit, City of Hope National Medical Center, Duarte, California
| | - Jeannine M Brant
- Executive Director, Clinical Science & Innovation, City of Hope National Medical Center, Duarte, California.
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Jaster C, Klugarová J, Królikowska A, Kołcz A, Peričić TP, Bała MM, Vrbová T, Becker R, Prill R. Promoting running as the best treatment for lower back pain in physiotherapy practice: a best practice implementation project. JBI Evid Implement 2024; 22:281-290. [PMID: 38958067 DOI: 10.1097/xeb.0000000000000441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
OBJECTIVES This project aimed to promote running as the best treatment for lower back pain (LBP) in an outpatient setting. INTRODUCTION LBP is one of the most prevalent conditions worldwide. Sixty-two percent of all Germans experience episodes of non-specific back pain at least once a year, with one-fifth developing chronic conditions. Intervertebral disc (IVD) degeneration is a natural process, contributing to periods of acute LBP. However, the scientific literature and guidelines partially overlook the significance of water management in IVD. This implementation project sought to address this gap by educating patients about this process. Running and/or walking were chosen as general approaches for treatment rather than specific disease-related approaches. METHODS This implementation project was conducted in an outpatient physiotherapy clinic in Brandenburg, Germany, utilizing the JBI Evidence Implementation Framework. An evidence-informed clinical audit and feedback strategy was used to measure compliance with ten audit criteria. Five physiotherapists and 20 patients took part in the audits. RESULTS At baseline, only 20% of participating physiotherapists screened for yellow flags regarding psychological issues. However, after project implementation, this criterion scored 100% compliance. Some patients performed exercises independently, but confusion persisted regarding the choice of beneficial exercises. Patients continued running, but those who took a break due to pain expressed uncertainty about resuming. CONCLUSIONS The project highlighted the effectiveness of collaborative efforts between patients and therapists to address the issue. The project team's conviction in action and solution strategies serves as the foundation for this collaboration. This implementation strategy provided "running" patients with the confidence to either resume or reintegrate running after an extended break. SPANISH ABSTRACT http://links.lww.com/IJEBH/A222.
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Affiliation(s)
- Christina Jaster
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School Theodor Fontane, Brandenburg a.d.H., Germany
- Evidence Based Practice in Brandenburg: A JBI Affiliated Group, Brandenburg Medical School Theodor Fontane, Brandenburg a.d.H., Germany
| | - Jitka Klugarová
- Cochrane Czech Republic, Czech Republic: A JBI Centre of Excellence, Czech GRADE Network, Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
- Institute of Special Education Studies, Palacký University Olomouc, Olomouc, Czech Republic
| | - Aleksandra Królikowska
- Ergonomics and Biomedical Monitoring Laboratory, Department of Physiotherapy, Faculty of Health Sciences, Wrocław Medical University, Wrocław, Poland
| | - Anna Kołcz
- Ergonomics and Biomedical Monitoring Laboratory, Department of Physiotherapy, Faculty of Health Sciences, Wrocław Medical University, Wrocław, Poland
| | - Tina Poklepović Peričić
- Department of Prosthodontics, Study of Dental Medicine, University of Split School of Medicine, Split, Croatia
| | - Małgorzata M Bała
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Kraków, Poland
| | - Tereza Vrbová
- Cochrane Czech Republic, Czech Republic: A JBI Centre of Excellence, Czech GRADE Network, Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
- Institute of Special Education Studies, Palacký University Olomouc, Olomouc, Czech Republic
| | - Roland Becker
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School Theodor Fontane, Brandenburg a.d.H., Germany
- Evidence Based Practice in Brandenburg: A JBI Affiliated Group, Brandenburg Medical School Theodor Fontane, Brandenburg a.d.H., Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg a.d.H., Germany
| | - Robert Prill
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School Theodor Fontane, Brandenburg a.d.H., Germany
- Evidence Based Practice in Brandenburg: A JBI Affiliated Group, Brandenburg Medical School Theodor Fontane, Brandenburg a.d.H., Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg a.d.H., Germany
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Jochimsen KN, Archer KR, Pollini RA, Parker RA, Enkhtsetseg N, Jacobs CA, Vranceanu AM. A Mind-Body Intervention to Improve Physical Activity for Patients with Chronic Hip-Related Pain: Protocol for a Mixed Methods Study. J Pers Med 2024; 14:499. [PMID: 38793081 PMCID: PMC11122466 DOI: 10.3390/jpm14050499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 04/25/2024] [Accepted: 05/06/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Pain and dysfunction persist for most patients following hip-related pain treatment. Additionally, individuals with hip-related pain are typically less physically active than individuals without hip pain, despite evidence that regular physical activity reduces chronic musculoskeletal pain. Poor psychological health is common in patients with hip-related pain and further reinforces low physical activity. Mind-body interventions can improve psychological health and activity levels but have yet to be integrated to provide comprehensive, psychologically informed care for patients with hip-related pain. Thus, we are using the NCCIH intervention development framework to develop Helping Improve PSychological Health (HIPS), a novel, multimodal mind-body intervention to improve physical activity for individuals with hip-related pain and poor psychological health. METHODS We will recruit physical therapists (N = 20) and patients with hip-related pain (N = 20) to participate in 60 min qualitative interviews (focus groups with therapists; one-on-one interviews with patients). Using these data, we will develop the initial HIPS intervention and provider training materials. One physical therapist will be trained to deliver the HIPS intervention to five participants in an open pilot trial. Participants will attend six 30 min HIPS intervention sessions. We will collect quantitative data on satisfaction, improvement, and physical activity, alongside qualitative exit interviews with participants and the physical therapist in order to refine the HIPS intervention and provider training materials. RESULTS This study has been approved by the MGB IRB. We aim to develop and test the initial feasibility of the HIPS intervention in an open pilot trial. The findings from this project will inform a subsequent feasibility RCT.
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Affiliation(s)
- Kate N. Jochimsen
- Center for Health Outcomes and Interdisciplinary Research (CHOIR), Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
| | - Kristin R. Archer
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Robin A. Pollini
- Department of Behavioral Medicine & Psychiatry, West Virginia University, Morgantown, WV 26506, USA
- Department of Epidemiology & Biostatistics, West Virginia University, Morgantown, WV 26506, USA
| | - Robert A. Parker
- Biostatistics Center, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Nomin Enkhtsetseg
- Center for Health Outcomes and Interdisciplinary Research (CHOIR), Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Cale A. Jacobs
- Mass General Brigham Sports Medicine, Boston, MA 02115, USA
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA 02115, USA
| | - Ana Maria Vranceanu
- Center for Health Outcomes and Interdisciplinary Research (CHOIR), Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
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Vaegter HB, Kinnunen M, Verbrugghe J, Cunningham C, Meeus M, Armijo-Olivo S, Bandholm T, Fullen BM, Wittink H, Morlion B, Reneman MF. Physical activity should be the primary intervention for individuals living with chronic pain A position paper from the European Pain Federation (EFIC) 'On the Move' Task Force. Eur J Pain 2024. [PMID: 38703009 DOI: 10.1002/ejp.2278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 04/11/2024] [Accepted: 04/17/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND There is clear evidence demonstrating the benefits of physical activity (PA) on pain and overall health, however, PA is challenging for many individuals living with chronic pain. Even non-exercise specialists can (cost) effectively promote PA, but many health professionals report a number of barriers in providing guidance on PA, suggesting that it is not consistently promoted. This expert position paper summarizes the evidence and provides five recommendations for health professionals to assess, advise and support individuals living with any chronic pain condition with a long life expectancy in adopting and sustaining physically active lifestyles. METHODS This position paper was prepared by the 'On The Move' Task Force of the European Pain Federation EFIC. Final recommendations were endorsed by the European Pain Forum, Pain Alliance Europe and the Executive Board of EFIC. RESULTS We recommend that all health professionals (1) Take a history of the persons' PA levels, and put PA on the agenda, (2) Advise that PA is important and safe for individuals living with chronic pain, (3) Deliver a brief PA intervention and support individuals living with chronic pain in becoming physically active, (4) Discuss acceptable levels of PA-related soreness and pain and (5) Provide ongoing support in staying physically active. SIGNIFICANCE Physical activity is safe and offers several advantages, including general health benefits, low risk of side effects, low cost and not requiring access to healthcare. Adoption of these recommendations can improve the quality of care and life of individuals living with chronic pain and reduce their overall health risks.
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Affiliation(s)
- Henrik Bjarke Vaegter
- Pain Research Group, Pain Center, University Hospital Odense, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Marja Kinnunen
- Patient Representative Pain Alliance Europe (PAE), Brussels, Belgium
- Finnish Musculoskeletal Association, Helsinki, Finland
| | - Jonas Verbrugghe
- REVAL - Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hogescholl Utrecht, Hasselt, Belgium
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
| | - Caitriona Cunningham
- UCD School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Mira Meeus
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
- Pain in Motion International Research Group (PiM), www.paininmotion.be, Brussels, Belgium
| | - Susan Armijo-Olivo
- University of Applied Sciences Osnabrück, Faculty of Economics and Social Sciences, Osnabrück, Germany
- Faculties of Rehabilitation Medicine and Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Thomas Bandholm
- Physical Medicine & Rehabilitation Research-Copenhagen (PMR-C), Department of Physical and Occupational Therapy, Department of Orthopedic Surgery, Department of Clinical Research, Copenhagen University Hospital Amager-Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Brona M Fullen
- UCD School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
- UCD Centre for Translational Pain Research, University College Dublin, Dublin, Ireland
| | - Harriet Wittink
- Research Group Lifestyle and Health, Hogeschool Utrecht University of Applied Sciences Utrecht
| | - Bart Morlion
- The Leuven Centre for Algology, UZ Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, Unit Anaesthesiology and Algology, KU Leuven, Leuven, Belgium
| | - Michiel F Reneman
- University of Groningen, University Medical Centre Groningen, Department of Rehabilitation Medicine, Groningen, The Netherlands
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Kurz R, Hebron C. "Finding a new normal: the lived experience of persons' journey towards coping with persistent low back pain". Physiother Theory Pract 2024; 40:983-998. [PMID: 36373211 DOI: 10.1080/09593985.2022.2144782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 11/01/2022] [Accepted: 11/01/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Persistent low back pain (PLBP) is the biggest global cause of disability. Persons with PLBP experience biographic disruption and existential crisis. Guidelines recommend a biopsychosocial approach to management, with the emphasis on coping strategies. PURPOSE However, there is a paucity of research exploring the lived experience of persons who self-identify as coping with PLBP. METHOD The study used an interpretive phenomenological approach, analyzing transcripts from 1:1 interviews with six persons who self-identify as coping with PLBP. Poetic language was used to elicit empathic, embodied relational understanding and convey a richer understanding of the phenomenon that authentic quotations might not able to reveal. FINDINGS AND CONCLUSION Participants' descriptions conveyed the sense of a journey, starting with the loss of a sense of self as they engaged in the pain battle, followed by a transition toward a new 'normal,' in which time, acceptance and trust in their own intuition were meaningful components. Although anxiety and fear were a continued presence, but they became more manageable. Society's role in the coping process was significantly meaningful and is something which requires reflections from therapists' and more widely.
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Affiliation(s)
- Raffaela Kurz
- School of Health Sciences, University of Brighton, 49 Darley Road, Eastbourne BN20 7UR, UK
- Physiotherapy MSK Department, Sussex Community NHS Foundation Trust, Horsham Hospital, Hurst Road, Horsham RH12 2DR, UK
| | - Clair Hebron
- School of Health Sciences, University of Brighton, 49 Darley Road, Eastbourne BN20 7UR, UK
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Hooker JE, Brewer JR, McDermott K, Kanaya M, Somers TJ, Keefe F, Kelleher S, Fisher HM, Burns J, Wilson R, Kulich R, Polykoff G, Parker RA, Greenberg J, Vranceanu AM. Improving multimodal physical function in adults with heterogeneous chronic pain; Protocol for a multisite feasibility RCT. Contemp Clin Trials 2024; 138:107462. [PMID: 38286223 PMCID: PMC10932927 DOI: 10.1016/j.cct.2024.107462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/27/2023] [Accepted: 01/24/2024] [Indexed: 01/31/2024]
Abstract
BACKGROUND Chronic pain is associated with substantial impairment in physical function, which has been identified as a top concern among persons with pain. GetActive-Fitbit, a mind-body activity program, is feasible, acceptable, and associated with improvement in physical function among primarily White, sedentary individuals with pain. In preparation for a multisite efficacy trial, we must examine feasibility across multiple sites with diverse patient populations. Here we describe the protocol of a multisite, feasibility RCT comparing GetActive-Fitbit with a time- and attention-matched educational comparison (Healthy Living for Pain). We aim to 1) test multisite fidelity of clinician training; 2) evaluate multisite feasibility benchmarks, including recruitment of chronic pain patients taking <5000 steps/day and racial and ethnic minorities; and 3) optimize fidelity and study protocol in preparation for a future multisite efficacy trial. METHODS Clinician training fidelity was assessed via roleplays and mock group sessions. Feasibility (i.e., recruitment, acceptability, credibility, adherence, satisfaction), multimodal physical function (e.g., self-report, 6-Minute Walk Test, step-count), and other psychosocial outcomes are assessed at baseline, posttest, and 6 months. Protocol optimization will be assessed using exit interviews and cross-site meetings. RESULTS The trial is ongoing. Clinician training is complete. 87 participants have been recruited. 54 completed baseline assessments and randomization, 44 are mid-intervention, and 9 have completed the intervention and posttest. CONCLUSIONS This study addresses the critical need for feasible, acceptable mind-body-activity interventions for chronic pain that follow evidence-based guidelines and improve all aspects of physical function across diverse populations. Results will inform a future fully-powered multisite efficacy trial. CLINICAL TRIAL REGISTRATION NCT05700383.
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Affiliation(s)
- Julia E. Hooker
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Julie R. Brewer
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Katherine McDermott
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Millan Kanaya
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Tamara J. Somers
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, Durham, NC, United States
| | - Francis Keefe
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, Durham, NC, United States
| | - Sarah Kelleher
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, Durham, NC, United States
| | - Hannah M. Fisher
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, Durham, NC, United States
| | - John Burns
- Rush University, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Rebecca Wilson
- Rush University, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
- Rush University, Department of Family and Preventive Medicine, Rush University Medical Center, Chicago, IL, United States
| | - Ronald Kulich
- Harvard Medical School, Boston, MA, United States
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, United State
| | - Gary Polykoff
- Harvard Medical School, Boston, MA, United States
- Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA, United States
| | - Robert A. Parker
- Biostatistics Center, Massachusetts General Hospital, Boston, MA United States
| | | | - Jonathan Greenberg
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Ana-Maria Vranceanu
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
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Babiloni-Lopez C, Fritz N, Ramirez-Campillo R, Colado JC. Water-Based Exercise in Patients With Nonspecific Chronic Low-Back Pain: A Systematic Review With Meta-Analysis. J Strength Cond Res 2024; 38:206-219. [PMID: 38085630 DOI: 10.1519/jsc.0000000000004635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
ABSTRACT Babiloni-Lopez, C, Fritz, N, Ramirez-Campillo, R, and Colado, JC. Water-based exercise in patients with nonspecific chronic low-back pain: a systematic review with meta-analysis. J Strength Cond Res 38(1): 206-219, 2024-This study aimed to systematically review and synthesize evidence (i.e., active [land-based training] and nonactive controls [e.g., receiving usual care]) regarding the effects of water-based training on patients with nonspecific chronic low-back pain (NSCLBP). Web of Science (WOS), PubMed (MEDLINE), EMBASE, EBSCO (SPORTDiscus; CINAHL), and PEDro were searched, with no date restrictions, until October 2021. The included studies satisfied the following criteria: (a) NSCLBP (≥12 weeks) patients, (b) water-based intervention, (c) control group (land-based trained; nonactive group), and (d) outcomes related to pain, disability, quality of life, or flexibility. The main outcome analyzed in the meta-analysis was pain intensity. Secondary outcomes included disability, body mass index, and flexibility. The random-effects model was used, and effect size (ES) values are presented with 95% confidence intervals (CIs). The impact of heterogeneity was assessed (I2 statistic), with values of <25%, 25-75%, and >75% representing low, moderate, and high levels, respectively. Alpha was set at p < 0.05. In conclusion, 15 studies (n = 524) were meta-analyzed. After intervention, pain intensity was reduced compared with nonactive controls (ES = -3.61; p < 0.001) and a similar reduction was noted when compared with land-based trained group (ES = -0.14; p = 0.359). Greater decrease in disability (ES = 2.15; p < 0.001) and greater increase in sit-and-reach (i.e., flexibility; ES = -2.44; p < 0.001) were noted after intervention compared with the nonactive group. In conclusion, water-based exercise therapy reduces pain intensity, disability, and increases flexibility in NSCLBP compared with nonactive subjects and was equally effective compared with land-based exercise to reduce pain. Favorable effects may be expected at ≤8 weeks. However, due to several methodological issues (e.g., high heterogeneity), for the improvement of most outcomes, we are unable to provide other than a weak recommendation in favor of intervention compared with control treatment.
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Affiliation(s)
- Carlos Babiloni-Lopez
- Research Group in Prevention and Health in Exercise and Sport, University of Valencia, Valencia, Spain
| | - Nicole Fritz
- Research Group in Prevention and Health in Exercise and Sport, University of Valencia, Valencia, Spain
- Department of Health, University of Los Lagos, Puerto Montt, Chile; and
| | - Rodrigo Ramirez-Campillo
- Research Group in Prevention and Health in Exercise and Sport, University of Valencia, Valencia, Spain
- Exercise and Rehabilitation Sciences Institute, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, Chile
| | - Juan C Colado
- Research Group in Prevention and Health in Exercise and Sport, University of Valencia, Valencia, Spain
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Vanti C, Ferrari S, Chiodini M, Olivoni C, Bortolami A, Pillastrini P. Sexual Disability in Low Back Pain: Diagnostic and Therapeutic Framework for Physical Therapists. Healthcare (Basel) 2023; 12:80. [PMID: 38200986 PMCID: PMC10778778 DOI: 10.3390/healthcare12010080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/18/2023] [Accepted: 12/26/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND The literature shows a relationship between sexual activity and low back pain (LBP). The aim of this work is to provide a theoretical framework and practical proposal for the management of sexual disability in individuals with LBP. METHODS Based on a literature review, a team of specialized physical therapists developed a pattern for the management of LBP-related sexual disability. RESULTS A patient reporting LBP-related sexual disability may be included in one of four clinical decision-making pathways corresponding to one of the following: #1 standard physical therapy (PT); #2 psychologically informed physical therapy (PIPT); #3 PIPT with referral; or #4 immediate referral. Standard PT concerns the management of LBP-related sexual disability in the absence of psychosocial or pathological issues. It includes strategies for pain modulation, stiffness management, motor control, stabilization, functional training, pacing activities comprising education, and stay-active advice. PIPT refers to patients with yellow flags or concerns about their relationship with partners; this treatment is oriented towards a specific psychological approach. "PIPT with referral" and "Immediate referral" pathways concern patients needing to be referred to specialists in other fields due to relationship problems or conditions requiring medical management or pelvic floor or sexual rehabilitation. CONCLUSIONS The proposed framework can help clinicians properly manage patients with LBP-related sexual disability.
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Affiliation(s)
- Carla Vanti
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater University of Bologna, Via Massarenti 9, 40138 Bologna, Italy; (C.V.); (P.P.)
| | | | - Marco Chiodini
- Poliambulatorio Medico Associato, Via Monsignor Bertazzoni, 1, 46027 San Benedetto Po, Italy;
| | - Cesare Olivoni
- Studio Associato Fisioterapico Gallinucci Olivoni, Piazzale Marconi, 3/4, 48025 Riolo Terme, Italy;
| | | | - Paolo Pillastrini
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater University of Bologna, Via Massarenti 9, 40138 Bologna, Italy; (C.V.); (P.P.)
- Unit of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Pelagio Palagi 9, 40138 Bologna, Italy
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Kastelic K, Šarabon N, Burnard MD, Lipovac D, Pedišić Ž. Association of meeting 24-hour movement guidelines with low back pain among adults. AIMS Public Health 2023; 10:964-979. [PMID: 38187895 PMCID: PMC10764968 DOI: 10.3934/publichealth.2023062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/13/2023] [Accepted: 11/09/2023] [Indexed: 01/09/2024] Open
Abstract
Background According to recently published 24-hour movement guidelines, adults should spend: ≥150 minutes/week in moderate-to-vigorous physical activity (MVPA); <8 hours/day in sedentary behaviour (SB); and 7-9 hours/day sleeping. Objective We explored the association between meeting these recommendations and low back pain (LBP)-the most common musculoskeletal disorder. Methods We collected self-reported data from 2333 adults about: MVPA, SB and sleep duration; frequency and intensity of LBP; and sociodemographic and lifestyle characteristics. Results Meeting a combination of SB and sleep recommendations was associated with lower odds of LBP in the past week and past month (adjusted odds ratio [OR]: 0.64 and 0.52, respectively; p < 0.05 for both). Among LBP sufferers, meeting any combination of recommendations that includes sleep was associated with lower odds of frequent (OR range: 0.49-0.61; p < 0.05 for all) and intense (OR range: 0.39-0.66; p < 0.05 for all) LBP in the past week, while meeting a combination of SB and sleep recommendations or all three recommendations was associated with lower odds of intense LBP in the past month and past year (OR range: 0.50-0.68; p < 0.05 for all). The likelihood of experiencing higher frequency and intensity of LBP decreased with the number of recommendations met (p for linear trend < 0.05). Conclusion Meeting the SB and sleep recommendations in combination is associated with a lower likelihood of LBP, while adhering to the overall 24-hour movement guidelines or any combination of recommendations that includes sleep is associated with lower frequency and intensity of LBP among LBP sufferers.
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Affiliation(s)
- Kaja Kastelic
- Andrej Marušič Institute, University of Primorska, Muzejski trg 2, 6000 Koper, Slovenia
- InnoRenew CoE, Livade 6a, 6310 Izola, Slovenia
| | - Nejc Šarabon
- InnoRenew CoE, Livade 6a, 6310 Izola, Slovenia
- Faculty of Health Sciences, University of Primorska, Polje 42, 6310 Izola, Slovenia
| | - Michael D. Burnard
- Andrej Marušič Institute, University of Primorska, Muzejski trg 2, 6000 Koper, Slovenia
- InnoRenew CoE, Livade 6a, 6310 Izola, Slovenia
| | - Dean Lipovac
- Andrej Marušič Institute, University of Primorska, Muzejski trg 2, 6000 Koper, Slovenia
- InnoRenew CoE, Livade 6a, 6310 Izola, Slovenia
| | - Željko Pedišić
- Institute for Health and Sport, Victoria University, Building P, Footscray Park Campus, Ballarat Road, Footscray VIC 3011, Melbourne, Australia
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11
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Zhang HW, Tan HP, Feng QX. Low Back Pain in Resident Doctors with Standardized Training in China: A Cross-Sectional Study. Risk Manag Healthc Policy 2023; 16:2459-2468. [PMID: 38024497 PMCID: PMC10660694 DOI: 10.2147/rmhp.s437810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/08/2023] [Indexed: 12/01/2023] Open
Abstract
Background Low back pain (LBP) is a prevalent occupational disease with high morbidity among healthcare workers. Since the implementation of standardized residency training in China in 2015, the training intensity has significantly increased, which may lead to a higher incidence of LBP. However, epidemiological studies on LBP among resident doctors with standardized training remain scarce. Objective To investigate the prevalence and associated factors of LBP among resident doctors with standardized training in a tertiary hospital in China. Methods A cross-sectional study was conducted using self-administered questionnaires to collect information on demographics, lifestyle factors, work-related factors, and LBP from 345 resident doctors. Descriptive statistics were used to analyze the prevalence of LBP. Logistic regression analysis was performed to identify factors associated with LBP. Results Among 345 participants, the 1-year prevalence of LBP was 75.9%. Multivariable analysis revealed that physical exercise, weekly working hours, and prolonged sitting were independent risk factors for LBP. Conclusion The prevalence of LBP among resident doctors was high. Promoting physical exercise, controlling working hours, and improving sitting posture may help prevent LBP. The study was limited by its cross-sectional design and self-reported data. Future studies should use longitudinal designs, objective measures, and larger and more representative samples to further explore the epidemiology and etiology of LBP among resident doctors with standardized training.
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Affiliation(s)
- Han-Wen Zhang
- Department of Pain Management, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan Province, People’s Republic of China
| | - Hong-Ping Tan
- Department of Pain Management, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan Province, People’s Republic of China
| | - Qiu-Xia Feng
- Outpatient Department, Nanchong Psychosomatic Hospital, Nanchong, Sichuan Province, People’s Republic of China
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12
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Sany SA, Mitsi M, Tanjim T, Rahman M. The effectiveness of different aerobic exercises to improve pain intensity and disability in chronic low back pain patients: a systematic review. F1000Res 2023; 11:136. [PMID: 37854288 PMCID: PMC10579857 DOI: 10.12688/f1000research.75440.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/11/2023] [Indexed: 10/20/2023] Open
Abstract
Background: Physical activity, including aerobic exercise, is highly recommended for chronic low back pain (CLBP) patients to improve pain intensity and functional disability. Objectives: To assess the effectiveness of different aerobic exercises to reduce pain intensity and functional disability in patients with CLBP. Methods: A computer-aided search was performed to find Randomised Controlled Trials (RCTs) that evaluated the effectiveness of different aerobic exercises in CLBP. Articles published between January 2007 to December 2020 were included in the review. Quality assessment using the PEDro scale, extraction of relevant information, and evaluation of outcomes were done by two reviewers independently. Results: A total of 17 studies were included that involved 1146 participants. Outcomes suggested that aerobic exercise combined with other interventions was more effective than aerobic exercise alone. Aerobic exercise with higher frequency (≥ 5 days/week) and longer duration (≥ 12 weeks) were effective to gain clinically significant (≥ 30%) improvements. Environment and using pedometer did not seem to influence the outcomes. Conclusions: Pain intensity and functional disability in CLBP patients can be minimized by prescribing aerobic exercise. However, to get better improvements, aerobic exercise should be done in combination with other interventions and at optimum frequency and duration. Further studies should emphasize examining the optimal doses and duration of different aerobic exercises.
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Affiliation(s)
- Shabbir Ahmed Sany
- Department of Community Medicine, Faridpur Medical College, Faridpur, Dhaka, Bangladesh
| | - Maria Mitsi
- National Centre for Sport and Exercise Medicine, School of Sport,Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, LE11 3TU, UK
| | - Taukir Tanjim
- International Centre For Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Minhazur Rahman
- Department of Community Medicine, Faridpur Medical College, Faridpur, Dhaka, Bangladesh
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13
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Exercise Therapy in Nonspecific Low Back Pain among Individuals with Lower-Limb Amputation: A Systematic Review. Life (Basel) 2023; 13:life13030772. [PMID: 36983927 PMCID: PMC10059211 DOI: 10.3390/life13030772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/07/2023] [Accepted: 03/10/2023] [Indexed: 03/14/2023] Open
Abstract
Low back pain is very common condition that often becomes a long-lasting problem in prostheses users after lower limb amputation. The presented study aims to decide the potential benefits of exercise therapy on low back pain among lower limb amputees by using a systematic review. The PICO technique was used to answer the primary issue of this review: Does exercise treatment lessen the prevalence of low back pain in the population of lower limb amputees? Systematic review was conducted in the following databases: Medline-PubMed, EMBASE, Scopus, and Web of Science. Studies up to September 2010 published in English are included. Aim, target population, development and execution strategies, and treatment suggestions were among the data gathered. The primary outcomes of interest were exercise interventions as a therapy for low back pain but only two articles met including criteria. The search was broadened and 21 studies describing biomechanical changes in gait and pelvic-spine posture were analysed. This review indicates that movement therapy is a potential treatment strategy in low back pain among amputees. The major limitation of the study is the very heterogenous group of subjects in terms of amputation level, baseline activity level and comorbidities. We used a procedure that was registered in PROSPERO (CRD42022345556) to perform this systematic review of systematic reviews. There is a necessity of good quality research for concluding a consensus of exercise intervention.
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14
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Parfenov VA. Treatment of acute non-specific back pain, the use of group B vitamins. NEUROLOGY, NEUROPSYCHIATRY, PSYCHOSOMATICS 2022. [DOI: 10.14412/2074-2711-2022-6-98-102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- V. A. Parfenov
- Department of Nervous Diseases and Neurosurgery, N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
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15
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Amiri S. The effect of exercise on health-related quality of life in persons with musculoskeletal pain: A meta-analysis of randomised control trials. Musculoskeletal Care 2022; 20:812-820. [PMID: 35686507 DOI: 10.1002/msc.1659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Exercise has positive effects on musculoskeletal pain. In this project, the impact of exercise was studied on improving health-related quality of life in persons with musculoskeletal pain. METHOD The study design was a systematic review and meta-analysis. A search was conducted to find original studies in four sources, including PubMed, Web of Science, the Cochrane Library and Scopus, and this search was limited to the original articles published until April 2021, which were in English. For each study, the effect size was calculated. The analysis was based on the random-effects method. RESULT Twenty-Seven randomised control trial studies were included in the meta-analysis. The total population of participants in the meta-analysis was 1927 persons. Exercise improves health-related quality of life in these persons and the hedges' g was 0.66 (95% CI = 0.38-0.94; I2 = 88.29%). DISCUSSION Overall, based on the findings, exercise is associated with improving the health-related quality of life of persons with musculoskeletal pain, and therefore the health implications of this finding are beneficial to the general population and professionals.
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Affiliation(s)
- Sohrab Amiri
- Medicine, Quran and Hadith Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
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16
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What Modifies the Effect of an Exercise Treatment for Chronic Low Back Pain? A Meta-epidemiologic Regression Analysis of Risk of Bias and Comparative Effectiveness. J Orthop Sports Phys Ther 2022; 52:792-802. [PMID: 35960505 DOI: 10.2519/jospt.2022.11149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE: To investigate how risk of bias and intervention type modify effect sizes of exercise interventions that are intended to reduce chronic low back pain intensity. DESIGN: Systematic review with meta-epidemiologic regression analysis. LITERATURE SEARCH: PubMed, CENTRAL, Embase, and CINAHL (until January 31, 2021). STUDY SELECTION CRITERIA: Systematic reviews with meta-analyses of randomized controlled exercise trials. DATA SYNTHESIS: The dependent variable was pain, calculated as standardized mean difference (SMD). Potential effect modifiers were risk of bias, exercise modes, study, and meta-analyses characteristics. Multilevel meta-regressions and inverse variance-weighted meta-regressions with random intercepts were modelled. RESULTS: Data from 26 systematic reviews (k = 349 effect sizes, n = 18,879 participants) were analysed. The overall mean effect was SMD: -0.35 (k = 349, [95% CI -0.02 to -0.7]). There was a clinically relevant effect overestimation in studies with a high risk of bias due to missing outcomes (each k = 197, Beta coefficient = -1.9 [95% CI -2.9 to -.9]) and low sample size (B = 0.01 [.001 to .01], [ie, one participant more leads to an SMD decrease of 0.01]). There was a clinically relevant underestimation of the effect when studies were at high risk of bias in allocation concealment (B = 1.3 [.5 to 2.1]) and outcome measurement (B = 1.3 [.44 to 2.0]). Motor control and stabilization training (B = -1.3 [-2.3 to -.37]) had the largest effects; stretching (B = 1.3 [-.03 to .5]) had the smallest effect. CONCLUSIONS: The effects of exercise trials at high risk of bias may be overestimated or underestimated. After accounting for risk of bias, motor control and stabilization exercises may represent the most effective exercise therapies for chronic low back pain. J Orthop Sports Phys Ther 2022;52(12):792-802. Epub: 12 August 2022. doi:10.2519/jospt.2022.11149.
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17
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Rozhkov DO, Shevtsova KV, Grinyuk VV, Parfenov VA. Results of ELBRUS clinical non-interventional study. NEUROLOGY, NEUROPSYCHIATRY, PSYCHOSOMATICS 2022. [DOI: 10.14412/2074-2711-2022-5-49-54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Objective: non-interventional study ELBRUS (Etoricoxib in the Treatment of Back Pain) was conducted to investigate the efficacy and safety of daily administration of Rixia® (Etoricoxib) 60 mg per day in patients with chronic non-specific low back pain (CNSLBP).Patients and methods. The study included 50 patients (31 women and 19 men, mean age 54.3±16.8 years) with CNSLBP. Educational conversation, cognitive therapy, regular therapeutic exercises, identification and treatment of comorbidities were conducted. Patients received etoricoxib 60 mg once daily. Pain intensity was assessed on a 10-point numerical rating scale (NRS), pain-related disability was assessed on the Oswestry Scale (ODS), and emotional state was assessed on the Hospital Anxiety and Depression Scale (HADS).Results and discussion. The causes of CNSLBP were: in 5 (10%) patients – sacroiliac joint involvement, in 14 (28%) – lower lumbar facet joints involvement, in 3 (6%) – myofascial pain, the remaining 28 (56%) patients had a combination of several reasons. As a result of complex treatment, the intensity of pain at rest decreased on average from 4.0±2.5 to 1.4±1.3 points, while moving – from 6.6±1.9 to 2.8±1.8 points, at night – from 2.7±2 to 0.7±0.9 points according to the NRS, disability – from 39±18.9 to 19.9±14.6% according to the ODS, the severity of anxiety – from 6.5±3.9 to 3.3±2.4 points and depression from 5.0±3.7 to 3.1±2.9 points according to HADS (p<0.001). The duration of treatment was 14.14±3.6 days on average. No adverse events were observed during treatment with etoricoxib. Conclusion. The efficacy and safety of etoricoxib in the complex therapy of patients with CNSLBP was noted. Keywords: chronic nonspecific low back pain, non-steroidal anti-inflammatory drugs, etoricoxib, Rixia®>˂0.001). The duration of treatment was 14.14±3.6 days on average. No adverse events were observed during treatment with etoricoxib.Conclusion. The efficacy and safety of etoricoxib in the complex therapy of patients with CNSLBP was noted.
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Affiliation(s)
- D. O. Rozhkov
- N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
| | - K. V. Shevtsova
- N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
| | - V. V. Grinyuk
- N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
| | - V. A. Parfenov
- N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
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18
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Grooten WJA, Boström C, Dedering Å, Halvorsen M, Kuster RP, Nilsson-Wikmar L, Olsson CB, Rovner G, Tseli E, Rasmussen-Barr E. Summarizing the effects of different exercise types in chronic low back pain - a systematic review of systematic reviews. BMC Musculoskelet Disord 2022; 23:801. [PMID: 35996124 PMCID: PMC9394044 DOI: 10.1186/s12891-022-05722-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 08/02/2022] [Indexed: 11/18/2022] Open
Abstract
Background In chronic LBP (CLBP), guideline-endorsed treatment is to stay active, return to normal activity, and to exercise. Several reviews on various exercise types used in CLBP have been published. We aimed to identify systematic reviews of common exercise types used in CLBP, to appraise their quality, and to summarize and compare their effect on pain and disability. Methods We searched the databases OVID MEDLINE, EMBASE, COCHRANE LIBRARY, and WEB OF SCIENCE (Core collection) for systematic reviews and meta-analyses on adults between 18 and 70 years of age suffering from chronic or recurrent LBP for a period of at least 12 weeks, which investigated the effects of exercises on pain and disability. All searches were conducted without language restriction. The search was performed up until 2022–01-26. The included reviews were grouped into nine exercise types: aerobic training, aquatic exercises, motor control exercises (MCE), resistance training, Pilates, sling exercises, traditional Chinese exercises (TCE), walking, and yoga. The study quality was assessed with AMSTAR-2. For each exercise type, a narrative analysis was performed, and the level of evidence for the effects of exercise was assessed through GRADE. Results Our database search resulted in 3,475 systematic reviews. Out of the 253 full texts that were screened, we included 45 systematic reviews and meta-analyses. The quality of the included reviews ranged from high to critically low. Due to large heterogeneity, no meta-analyses were performed. We found low-to-moderate evidence of mainly short-term and small beneficial effects on pain and disability for MCE, Pilates, resistance training, TCE, and yoga compared to no or minimal intervention. Conclusions Our findings show that the effect of various exercise types used in CLBP on pain and disability varies with no major difference between exercise types. Many of the included systematic reviews were of low-to-moderate quality and based on randomized controlled trials with high risk of bias. The conflicting results seen, undermine the certainty of the results leading to very-low-to-moderate quality of evidence for our results. Future systematic reviews should be of higher quality to minimize waste of resources. Trial registration PROSPERO: Reg no 190409 Registration date 01AUG 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05722-x.
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Affiliation(s)
- Wilhelmus Johannes Andreas Grooten
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, 141 83, Huddinge, Sweden.,Department of Occupational Therapy and Physiotherapy, Women's Health and Allied Health Professionals' Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Carina Boström
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, 141 83, Huddinge, Sweden.,Department of Occupational Therapy and Physiotherapy, Women's Health and Allied Health Professionals' Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Åsa Dedering
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, 141 83, Huddinge, Sweden.,The Health and Medical Care Administration, Region Dalarna, Falun, Sweden
| | - Marie Halvorsen
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, 141 83, Huddinge, Sweden.,Department of Occupational Therapy and Physiotherapy, Women's Health and Allied Health Professionals' Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Roman P Kuster
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, 141 83, Huddinge, Sweden
| | - Lena Nilsson-Wikmar
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, 141 83, Huddinge, Sweden
| | - Christina B Olsson
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, 141 83, Huddinge, Sweden.,Academic Primary Healthcare Centre, Region Stockholm, Stockholm, Sweden
| | - Graciela Rovner
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, 141 83, Huddinge, Sweden.,ACT Institutet Sweden, Gothenburg, Sweden
| | - Elena Tseli
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, 141 83, Huddinge, Sweden.,School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Eva Rasmussen-Barr
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, 141 83, Huddinge, Sweden.
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19
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Essman M, Lin CY. The Role of Exercise in Treating Low Back Pain. Curr Sports Med Rep 2022; 21:267-271. [PMID: 35946845 DOI: 10.1249/jsr.0000000000000982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT The purpose of this review is to highlight the role of exercise in preventing and managing acute and chronic axial low back pain (LBP). LBP is one of the leading contributors to years lived with disability as well as health care expenditures in the United States. With an expected increase in prevalence due to an aging population, sports medicine providers have a unique opportunity to provide effective treatment strategies incorporating exercise advice and prescription. Although the majority of individuals with acute LBP will have their symptoms resolve spontaneously, almost 40% will have recurrence or develop chronic LBP within 1 year. No single exercise method has been shown to be more effective than another. The evidence for walking programs, aerobic exercise, yoga, Pilates, and tai chi for LBP is discussed. Our review summarizes the beneficial role of a personalized exercise program and related counseling strategies in the prevention and management of LBP.
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Affiliation(s)
- Matthew Essman
- Department of Rehabilitation Medicine, University of Washington Medical Center, Seattle, WA
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20
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Vermue DJ, Dol MV, Ansuategui Echeita J, Dekker R, Schiphorst Preuper HR, Reneman MF. Maximal aerobic capacity is associated with lifting capacity, but not with self-reported functioning measures in patients with primary chronic low back pain: a cross-sectional study. BMJ Open Sport Exerc Med 2022; 8:e001253. [PMID: 35692438 PMCID: PMC9137331 DOI: 10.1136/bmjsem-2021-001253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2022] [Indexed: 11/28/2022] Open
Abstract
Objective Maximal exercise testing is considered the gold standard to assess V̇O2max. However, maximal exercise testing was previously deemed unfeasible and unsafe in chronic low back pain (CLBP) patients. Consequently, most previous studies on aerobic capacity and functioning in patients with CLBP were performed with submaximal testing protocols. A recent study demonstrated the safety, feasibility and tolerance of maximal exercise testing in patients with CLBP. Therefore, the relation between aerobic capacity and functioning should be reevaluated. This cross-sectional study aims to determine the relationship between maximal aerobic capacity and four measures of functioning: lifting capacity, work ability, pain-related disability and physical functioning in patients with CLBP. Methods The maximal aerobic capacity of patients with CLBP was assessed with a maximal cardiopulmonary exercise test. Functioning was measured with a floor-to-waist lifting capacity test and three questionnaires: Work Ability Score, Pain Disability Index and Physical Functioning subscale of RAND-36. The associations between maximal aerobic capacity and each of the functioning measures were analysed with multiple linear regression analyses while controlling for potential confounders. Results Data of n=74 patients with CLBP were analysed. After controlling for potential confounders, maximal aerobic capacity was moderately associated with lifting capacity (β=0.32, p=0.006), but not with any of the other functioning measures (β=−0.08 to 0.12, p>0.288). Conclusion A higher level of maximal aerobic capacity is moderately associated with a higher lifting capacity, but not with self-reported work ability, pain-related disability and physical functioning.
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Affiliation(s)
- Daniël J Vermue
- Rehabilitation Medicine, University Medical Centre Groningen, Groningen, The Netherlands
| | - Max V Dol
- Rehabilitation Medicine, University Medical Centre Groningen, Groningen, The Netherlands
| | | | - Rienk Dekker
- Rehabilitation Medicine, University Medical Centre Groningen, Groningen, The Netherlands
| | | | - Michiel F Reneman
- Rehabilitation Medicine, University Medical Centre Groningen, Groningen, The Netherlands
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21
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Leivas EG, Bittencourt JV, Ferreira AS, Nogueira LAC. Is it possible to discriminate workers with a higher prevalence of low back pain considering daily exposure time in a work-related lumbar posture? A diagnostic accuracy study. ERGONOMICS 2022; 65:877-885. [PMID: 34727016 DOI: 10.1080/00140139.2021.2001577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 10/27/2021] [Indexed: 06/13/2023]
Abstract
The study aimed to develop and validate a cut-off for daily postures to discriminate workers with low back pain. The self-reported episode of low back pain in the last year and during the previous week and the total spent time in occupational postures of 529 workers were used to screen workers who more likely would report low back pain. The receiver operating characteristics curve verified the ability of daily time in each posture in discriminating workers with low back pain in a training sample. Then, the chi-squared test and measurements of the diagnostic accuracy were performed in the testing sample. The daily time spent in a given posture was not able to accurately discriminate against workers with low back pain. Total time spent walking was the only daily posture that discriminated workers with low back pain in the last year in the testing sample, albeit with low accuracy. Practitioner Summary: The daily time spent in a given posture was not able to accurately distinguish workers with low back pain. Total spent time in walking presented modest diagnostic accuracy and should be interpreted cautiously. The spent time in a particular posture did not detect workers with LBP in the last week.
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Affiliation(s)
- Eduardo Gallas Leivas
- Rehabilitation Science Postgraduation Program, Augusto Motta University Centre (UNISUAM), Rio de Janeiro, Brazil
| | - Juliana Valentim Bittencourt
- Rehabilitation Science Postgraduation Program, Augusto Motta University Centre (UNISUAM), Rio de Janeiro, Brazil
| | - Arthur Sá Ferreira
- Rehabilitation Science Postgraduation Program, Augusto Motta University Centre (UNISUAM), Rio de Janeiro, Brazil
| | - Leandro Alberto Calazans Nogueira
- Rehabilitation Science Postgraduation Program, Augusto Motta University Centre (UNISUAM), Rio de Janeiro, Brazil
- Physiotherapy Department, Federal Institute of Rio de Janeiro (IFRJ), Rio de Janeiro, Brazil
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22
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Nah S, Park SS, Choi S, Jang HD, Moon JE, Han S. Associations of walking and resistance training with chronic low back pain in older adults: A cross-sectional analysis of Korean National Health and Nutrition Examination Survey data. Medicine (Baltimore) 2022; 101:e29078. [PMID: 35356936 PMCID: PMC10684243 DOI: 10.1097/md.0000000000029078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 02/21/2022] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT Physical activities, such as resistance training and walking, are known to be effective against chronic low back pain (CLBP). However, few studies have examined the associations of walking and resistance training with CLBP in the general older population. Therefore, this study analyzed these relationships in the older Korean population (aged ≥65 years), with the goal of determining which exercise is better for CLBP.This cross-sectional study analyzed Korean National Health and Nutrition Examination Survey data for the period 2012 to 2015. The Korean National Health and Nutrition Examination Survey, which provides representative data for the Korean population, uses a clustered, multistage, random sampling method with stratification based on geographic area, age, and sex. Three multiple logistic regression models were generated in this study to determine the associations of walking and resistance training with CLBP.A total of 5233 participants were enrolled, 3641 (69.6%) of whom were free from CLBP; the remaining 1592 (30.4%) had CLBP. 78.4% and 64.8% of the non-CLBP and CLBP group patients, respectively, walked at least once a week. Also, 23.5% and 11.6% of the participants in the non-CLBP and CLBP groups, respectively, engaged in resistance training at least once a week. In the multiple logistic regression analysis, which was adjusted for all potential confounders, walking was significantly associated with a lower risk of CLBP (1-2d/wk: odds ratio [OR] = 0.65, P = .002; 3-4d/wk: OR = 0.69, P = .004; ≥5 d/wk: OR = 0.57, P < .001). However, resistance training showed no association with the risk of CLBP.In this cross-sectional study, walking was associated with a lower risk of CLBP. In particular, walking >5days per week had the maximum benefit in a lower risk of CLBP. Therefore, clinicians can consider recommending walking to patients with CLBP for optimal pain improvement.
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Affiliation(s)
| | | | | | | | | | - Sangsoo Han
- Correspondence: Sangsoo Han, Department of Emergency Medicine,Soonchunhyang University Bucheon Hospital, 170 Jomaru-ro, Bucheon 14584,Republic of Korea (e-mail: ).
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Walking, Cycling, and Swimming for Nonspecific Low Back Pain: A Systematic Review With Meta-analysis. J Orthop Sports Phys Ther 2022; 52:85-99. [PMID: 34783263 DOI: 10.2519/jospt.2022.10612] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate the effectiveness of walking/running, cycling, or swimming for treating or preventing nonspecific low back pain (LBP). DESIGN Intervention systematic review. LITERATURE SEARCH Five databases were searched to April 2021. STUDY SELECTION CRITERIA Randomized controlled trials evaluating walking/running, cycling, or swimming to treat or prevent LBP were included. DATA SYNTHESIS We calculated standardized mean differences (SMDs) and 95% confidence intervals (CIs). Certainty of evidence was evaluated with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS No trials assessed LBP prevention or addressed acute LBP. Nineteen trials (2362 participants) assessed treatment of chronic/recurrent LBP. Low-certainty evidence suggests that walking/running was less effective than alternate interventions in reducing pain in the short term (8 trials; SMD, 0.81; 95% CI: 0.28, 1.34) and medium term (5 trials; SMD, 0.80; 95% CI: 0.10, 1.49). High-certainty evidence suggests that walking/running was less effective than alternate interventions at reducing disability in the short term (8 trials; SMD, 0.22; 95% CI: 0.06, 0.38) and medium term (4 trials; SMD, 0.28; 95% CI: 0.05, 0.51). There was high-certainty evidence of a small effect in favor of walking/running compared to minimal/no intervention for reducing pain in the short term (10 trials; SMD, -0.23; 95% CI: -0.35, -0.10) and medium term (6 trials; SMD, -0.26; 95% CI: -0.40, -0.13) and disability in the short term (7 trials; SMD, -0.19; 95% CI: -0.33, -0.06). Scarcity of trials meant few conclusions could be drawn regarding cycling and swimming. CONCLUSION Although less effective than alternate interventions, walking/running was slightly more effective than minimal/no intervention for treating chronic/recurrent LBP. J Orthop Sports Phys Ther 2022;52(2):85-99. Epub 16 Nov 2021. doi:10.2519/jospt.2022.10612.
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Mouratidis K, Yiannakou A. COVID-19 and urban planning: Built environment, health, and well-being in Greek cities before and during the pandemic. CITIES (LONDON, ENGLAND) 2022; 121:103491. [PMID: 34658478 PMCID: PMC8501234 DOI: 10.1016/j.cities.2021.103491] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 08/10/2021] [Accepted: 10/04/2021] [Indexed: 05/05/2023]
Abstract
The coronavirus disease (COVID-19) pandemic has led to dramatic changes in quality of life, bringing to the forefront of the debate the question of planning and design of pandemic-resilient cities. Using quasi-longitudinal survey data (via a social media campaign) and geospatial data from Greek cities, we evaluate changes in health and well-being during COVID-19 compared to the pre-COVID-19 period, and then explore in detail how specific built environment characteristics in Athens and Thessaloniki relate to health and well-being before and during COVID-19. Results suggest that overall health, life satisfaction, happiness, personal relationships satisfaction, leisure satisfaction, satisfaction with income, and satisfaction with vacations all decreased during COVID-19, while anxiety and back pain increased during COVID-19. The role of the urban built environment in health and well-being was found to differ considerably for the COVID-19 period compared to pre-COVID-19. Proximity to large parks, proximity to numerous local facilities, lower neighborhood density, living further from the city center, and living in a larger dwelling were associated with better health and well-being outcomes during COVID-19. Urban planning and relevant policies that cities adopt should carefully focus on mitigating implications for critical issues such as the quest for sustainable urban development and city forms.
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Affiliation(s)
- Kostas Mouratidis
- Department of Urban and Regional Planning, Norwegian University of Life Sciences, Norway
- School of Spatial Planning and Development, Aristotle University of Thessaloniki, Greece
| | - Athena Yiannakou
- School of Spatial Planning and Development, Aristotle University of Thessaloniki, Greece
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25
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The influence of cognitive factors in relation to the patients' treatment adherence for non-specific chronic low-back pain. A case series. J Bodyw Mov Ther 2022; 29:271-278. [DOI: 10.1016/j.jbmt.2021.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 08/11/2021] [Accepted: 10/17/2021] [Indexed: 11/20/2022]
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ROMÃO CATARINAISABELGUERREIRO, MERCÊ CRISTIANAISABELANDRÉ, BRANCO MARCOANTÓNIOCOLAÇO. THE INFLUENCE OF PHYSICAL ACTIVITY ON THE PREVALENCE OF LOW BACK PAIN AMONG THE PORTUGUESE POPULATION. COLUNA/COLUMNA 2022. [DOI: 10.1590/s1808-185120222102258674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: I) To investigate the influence of physical activity (PA) on levels of low back pain, and II) To classify the respondents regarding low back pain. Methods: Collection of responses, through an online questionnaire, from 199 adults aged between 18 and 65 years (36.05 ± 11.90 years). The following inclusion criteria were applied: I) Suffering or have suffered pain in the spine at some point in life; and as an exclusion criterion: I) Being outside the required age range. Results: Investigating the level of pain and the risk of low back pain, there was a significant association (r = 0.481; p≤0.01) between these two factors, indicating that the higher the levels of pain, the higher the risk of low back pain. Those who presented higher levels of chronic pain either did not practice any physical activity (58.8%), or practiced formal PA (42.9%) or practiced informal PA (30.7%). Those who had practiced physical exercise for three months or more mostly did not have chronic pain (70.1%). Conclusions: There was a decrease in chronic low back pain which was associated with increased time and frequency of PA, as well as the practice of postural physical exercises. Level of Evidence I; Prognostic Studies— Investigating the Effect of a Patient Characteristic on the Outcome of Disease.
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Karaarslan F, Yılmaz H, Akkurt HE, Gül S, Kardeş S. Effectiveness of peloid therapy in patients with chronic low back pain: a single-blind controlled study. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2021; 65:1799-1809. [PMID: 33931829 DOI: 10.1007/s00484-021-02137-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/18/2021] [Accepted: 04/21/2021] [Indexed: 06/12/2023]
Abstract
The aim of this study was to compare peloid therapy in addition to home exercise with home exercise alone in terms of pain, function, quality of life, and depression in patients with chronic low back pain (cLBP). A total of 106 cLBP patients were divided into two equal groups as treatment and control. The peloid therapy group had peloid therapy (with a total of 15 sessions on 5 days per week for 3 weeks duration with 45 °C temperature lasting 30 min/day) + home exercise program. The control group was only given a home exercise program. Patients completed the visual analog scale-pain (VAS-pain), patient and physician global assessments (VAS-PGA and VAS-PhGA), revised Oswestry disability index (rODI) for functional status, the short form-36 (SF-36) for quality of life, and Beck Depression Inventory (BDI) for depression three times as before treatment, after treatment (3rd week), and 1 month after the end of treatment. Assessments in the 3rd week at the end of treatment revealed statistically significant improvements for rODI (p = 0.013), VAS-pain (p = 0.039), and VAS-PhGA (p = 0.002) parameters in the peloid therapy group compared to the control group. Assessments in the 1st month after the end of treatment revealed statistically significant improvements in rODI (p < 0.001), VAS-pain (p < 0.001), VAS-PGA (p = 0.002), VAS-PhGA (p < 0.001), and SF-36VE (p = 0.022) parameters in the peloid therapy group compared to the control group. Peloid therapy + home exercise was statistically significantly superior to home exercise alone in improving pain and function in patients with cLBP. Peloid therapy may be recommended as a non-pharmacological treatment for cLBP patients. There is a need for randomized studies with longer follow-up including biochemical parameters to verify the beneficial effects observed in this study and elaborate the mechanisms of action.
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Affiliation(s)
- Fatih Karaarslan
- Department of Medical Ecology and Hydroclimatology, Gülhane Faculty of Medicine, University of Health Sciences, Ankara, Turkey.
| | - Halim Yılmaz
- Department of Physical Medicine and Rehabilitation, Konya Training and Research Hospital, University of Health Sciences, Konya, Turkey
| | - Halil Ekrem Akkurt
- Department of Physical Medicine and Rehabilitation, Konya Training and Research Hospital, University of Health Sciences, Konya, Turkey
| | - Süleyman Gül
- Department of Physical Medicine and Rehabilitation, Konya Training and Research Hospital, University of Health Sciences, Konya, Turkey
| | - Sinan Kardeş
- Department of Medical Ecology and Hydroclimatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Hayden JA, Ellis J, Ogilvie R, Stewart SA, Bagg MK, Stanojevic S, Yamato TP, Saragiotto BT. Some types of exercise are more effective than others in people with chronic low back pain: a network meta-analysis. J Physiother 2021; 67:252-262. [PMID: 34538747 DOI: 10.1016/j.jphys.2021.09.004] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 09/06/2021] [Indexed: 12/29/2022] Open
Abstract
QUESTION What are the effects of specific types of exercise treatments on pain intensity and functional limitation outcomes for adults with chronic low back pain? DESIGN Systematic review with network meta-analysis of randomised controlled trials. PARTICIPANTS Adults with non-specific low back pain for ≥ 12 weeks. INTERVENTION Exercise treatments prescribed or planned by a health professional that involved conducting specific activities, postures and/or movements with a goal to improve low back pain outcomes. OUTCOME MEASURES Pain intensity (eg, visual analogue scale or numerical rating scale) and back-related functional limitations (eg, Roland Morris Disability Questionnaire or Oswestry Disability Index), each standardised to range from 0 to 100. RESULTS This review included 217 randomised controlled trials with 20,969 participants and 507 treatment groups. Most exercise types were more effective than minimal treatment for pain and functional limitation outcomes. Network meta-analysis results were compatible with moderate to clinically important treatment effects for Pilates, McKenzie therapy, and functional restoration (pain only) and flexibility exercises (function only) compared with minimal treatment, other effective treatments and other exercise types. The estimated mean differences for these exercise types compared with minimal treatment ranged from -15 to -19 for pain and from -10 to -12 for functional limitation. CONCLUSION This review found evidence that Pilates, McKenzie therapy and functional restoration were more effective than other types of exercise treatment for reducing pain intensity and functional limitations. Nevertheless, people with chronic low back pain should be encouraged to perform the exercise that they enjoy to promote adherence. REGISTRATION DOI:10.1002/14651858.CD009790.
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Affiliation(s)
- Jill A Hayden
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, Canada.
| | - Jenna Ellis
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, Canada
| | - Rachel Ogilvie
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, Canada
| | - Samuel A Stewart
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, Canada
| | - Matthew K Bagg
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia; WA SportsMed Physiotherapy, Perth, Australia
| | - Sanja Stanojevic
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, Canada
| | - Tiê P Yamato
- Musculoskeletal Health Sydney, School of Public Health, University of Sydney, Sydney, Australia; Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| | - Bruno T Saragiotto
- Musculoskeletal Health Sydney, School of Public Health, University of Sydney, Sydney, Australia; Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
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Abstract
BACKGROUND Low back pain has been the leading cause of disability globally for at least the past three decades and results in enormous direct healthcare and lost productivity costs. OBJECTIVES The primary objective of this systematic review is to assess the impact of exercise treatment on pain and functional limitations in adults with chronic non-specific low back pain compared to no treatment, usual care, placebo and other conservative treatments. SEARCH METHODS We searched CENTRAL (which includes the Cochrane Back and Neck trials register), MEDLINE, Embase, CINAHL, PsycINFO, PEDro, SPORTDiscus, and trials registries (ClinicalTrials.gov and World Health Organization International Clinical Trials Registry Platform), and conducted citation searching of relevant systematic reviews to identify additional studies. The review includes data for trials identified in searches up to 27 April 2018. All eligible trials have been identified through searches to 7 December 2020, but have not yet been extracted; these trials will be integrated in the next update. SELECTION CRITERIA We included randomised controlled trials that assessed exercise treatment compared to no treatment, usual care, placebo or other conservative treatment on the outcomes of pain or functional limitations for a population of adult participants with chronic non-specific low back pain of more than 12 weeks' duration. DATA COLLECTION AND ANALYSIS Two authors screened and assessed studies independently, with consensus. We extracted outcome data using electronic databases; pain and functional limitations outcomes were re-scaled to 0 to 100 points for meta-analyses where 0 is no pain or functional limitations. We assessed risk of bias using the Cochrane risk of bias (RoB) tool and used GRADE to evaluate the overall certainty of the evidence. When required, we contacted study authors to obtain missing data. To interpret meta-analysis results, we considered a 15-point difference in pain and a 10-point difference in functional limitations outcomes to be clinically important for the primary comparison of exercise versus no treatment, usual care or placebo. MAIN RESULTS We included 249 trials of exercise treatment, including studies conducted in Europe (122 studies), Asia (38 studies), North America (33 studies), and the Middle East (24 studies). Sixty-one per cent of studies (151 trials) examined the effectiveness of two or more different types of exercise treatment, and 57% (142 trials) compared exercise treatment to a non-exercise comparison treatment. Study participants had a mean age of 43.7 years and, on average, 59% of study populations were female. Most of the trials were judged to be at risk of bias, including 79% at risk of performance bias due to difficulty blinding exercise treatments. We found moderate-certainty evidence that exercise treatment is more effective for treatment of chronic low back pain compared to no treatment, usual care or placebo comparisons for pain outcomes at earliest follow-up (MD -15.2, 95% CI -18.3 to -12.2), a clinically important difference. Certainty of evidence was downgraded mainly due to heterogeneity. For the same comparison, there was moderate-certainty evidence for functional limitations outcomes (MD -6.8 (95% CI -8.3 to -5.3); this finding did not meet our prespecified threshold for minimal clinically important difference. Certainty of evidence was downgraded mainly due to some evidence of publication bias. Compared to all other investigated conservative treatments, exercise treatment was found to have improved pain (MD -9.1, 95% CI -12.6 to -5.6) and functional limitations outcomes (MD -4.1, 95% CI -6.0 to -2.2). These effects did not meet our prespecified threshold for clinically important difference. Subgroup analysis of pain outcomes suggested that exercise treatment is probably more effective than education alone (MD -12.2, 95% CI -19.4 to -5.0) or non-exercise physical therapy (MD -10.4, 95% CI -15.2 to -5.6), but with no differences observed for manual therapy (MD 1.0, 95% CI -3.1 to 5.1). In studies that reported adverse effects (86 studies), one or more adverse effects were reported in 37 of 112 exercise groups (33%) and 12 of 42 comparison groups (29%). Twelve included studies reported measuring adverse effects in a systematic way, with a median of 0.14 (IQR 0.01 to 0.57) per participant in the exercise groups (mostly minor harms, e.g. muscle soreness), and 0.12 (IQR 0.02 to 0.32) in comparison groups. AUTHORS' CONCLUSIONS We found moderate-certainty evidence that exercise is probably effective for treatment of chronic low back pain compared to no treatment, usual care or placebo for pain. The observed treatment effect for the exercise compared to no treatment, usual care or placebo comparisons is small for functional limitations, not meeting our threshold for minimal clinically important difference. We also found exercise to have improved pain (low-certainty evidence) and functional limitations outcomes (moderate-certainty evidence) compared to other conservative treatments; however, these effects were small and not clinically important when considering all comparisons together. Subgroup analysis suggested that exercise treatment is probably more effective than advice or education alone, or electrotherapy, but with no differences observed for manual therapy treatments.
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Affiliation(s)
- Jill A Hayden
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, Canada
| | - Jenna Ellis
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, Canada
| | - Rachel Ogilvie
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, Canada
| | - Antti Malmivaara
- Centre for Health and Social Economics (CHESS), National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Maurits W van Tulder
- Department of Health Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam, Netherlands
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Hu J, Yang J. HUMAN BODY’S HEALTH FUNCTION IMPROVEMENT BY VARIOUS WHOLE-BODY SPORTS EXERCISES. REV BRAS MED ESPORTE 2021. [DOI: 10.1590/1517-8692202127032021_0107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Introduction Studies have shown that physical exercise is beneficial to people’s overall physical and mental health, but few research reports on the effects of different physical exercises on people’s human health. Object The paper explores the difference in human health function between people who adhere to traditional health sports and those who rarely exercise and provide a scientific basis for applying and promoting traditional health sports in TCM “prevention of disease”. Methods The paper surveyed 526 people who regularly participate in physical exercises and rarely exercise. The exercise items are divided into Tai Chi/Tai Chi sword group, Health Qigong Baduanjin group, Health Qigong Wuqinxi group, and Health Qigong Yijin group. Warp group, walking/jogging group. Results There are differences in the mental indicators of the people in different exercise groups. The overall average percentage levels of and NK cells in each exercise group and the tiny exercise group are different, and the difference is statistically significant (P<0.05). Conclusions Persisting in physical exercise is beneficial to the balance of health and function of the population. Level of evidence II; Therapeutic studies - investigation of treatment results.
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Affiliation(s)
- Ji Hu
- Beijing Sport University, China
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Alzahrani H, Mackey M, Stamatakis E, Shirley D. Wearables-based walking program in addition to usual physiotherapy care for the management of patients with low back pain at medium or high risk of chronicity: A pilot randomized controlled trial. PLoS One 2021; 16:e0256459. [PMID: 34437607 PMCID: PMC8389429 DOI: 10.1371/journal.pone.0256459] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 07/31/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Although chronic low back pain (LBP) is a leading cause of disability and accounts for large costs, none of the available conventional treatments are clearly more favourable in treating people at increased risk of chronicity. OBJECTIVES To examine the feasibility and initial efficacy of a wearables-based walking intervention in addition to usual physiotherapy care in people with LBP at risk of chronicity. METHODS Twenty-six adult participants, diagnosed with non-specific LBP with medium or high risk of chronicity, were recruited from physiotherapy private practices. Participants were randomized into usual physiotherapy care (control, n = 14) and usual physiotherapy care plus a wearables-based walking intervention (experimental, n = 12). The intervention duration was 8 weeks. Feasibility outcomes included recruitment rate, adherence to the intervention, dropout rate, and serious adverse events reporting rate. Other outcomes included disability and pain (primary); and physical activity level, daily walking steps, depression, pain catastrophizing and fear of movement (secondary). The outcomes were assessed at baseline, post-intervention and 26 weeks post-randomization follow-up. RESULTS Adherence of experimental participants with the prescribed walking program was moderate. Four participants dropped out during the intervention, and no serious adverse events were reported. Participants in the experimental group showed significant improvement in pain at 26 weeks (β = -0.38; 95% confidence interval (CI) -0.66, -0.10; P = .013), compared with the control group. No between-group differences were found for disability at any time point and pain immediately post-intervention. Experimental participants demonstrated post-intervention improvement in light-intensity (β = 156.71; 95% CI 86.79, 226.64; P < .001), moderate-intensity physical activity (β = 0.46; 95% CI 0.12, 0.80; P = .012), and daily walking steps (β = 7099.13; 95% CI 4522.93, 9675.32; P < .001). Experimental participants demonstrated post-intervention increase in pain catastrophizing (β = 0.52, 95% CI 0.18, 0.86; P = .006). No between-group differences were found for pain catastrophizing at 26 weeks and other secondary outcomes. CONCLUSION Usual physiotherapy care plus a wearables-based walking intervention program was safe and moderately feasible, and provided significant reduction in pain at 26 weeks as well as increasing the total volume of light- and moderate-intensity physical activity, and daily walking steps immediately post-intervention.
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Affiliation(s)
- Hosam Alzahrani
- Department of Physical Therapy, College of Applied Medical Sciences, Taif University, Taif, Saudi Arabia
| | - Martin Mackey
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Emmanuel Stamatakis
- Charles Perkins Centre, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Debra Shirley
- Discipline of Physiotherapy, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Yalçın Ü. Paravertebral intramuscular ozone therapy in lumbar disc hernia: A comprehensive retrospective study. J Back Musculoskelet Rehabil 2021; 34:597-604. [PMID: 33523038 DOI: 10.3233/bmr-200129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Clinical studies assessing the impacts of ozone on the musculoskeletal framework are slowly expanding. OBJECTIVE In this study, we analyzed the impact of paravertebral ozone treatment (OT) injection treatment on distress and disability in patients with lumbar disc hernia (LDH). METHODS The records of 432 patients with L4-5 and L5-S1 LDH were examined retrospectively. 298 patients who met the inclusion criteria and who provided written informed consent were divided into two groups. Each group received 15 sets of physiotherapy at a rate of five sets every week (study group (n= 139), control group (n= 159)). Six OT injections were applied solely to the study group, two days per week. A visual pain score (VAS) was set up for distress and the Oswestry Disability Questionnaire (ODI) for disablement was administered when the groups were called to control before treatment, towards the end of the treatment, and three months after the treatment ended. RESULTS The groups had significantly reduced (p< 0.05) VAS and ODI scores following and three months after the treatment contrasted with their scores before the treatment. The Physiotherapy + OT group had significantly lower (p< 0.05) VAS and ODI scores than the physiotherapy group following and three months after the treatment. CONCLUSIONS Paravertebral OT injection is quite a safe and helpful treatment technique in LDH patients. Further studies should be conducted to investigate the long-term outcomes of the paravertebral OT application.
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Polaski AM, Phelps AL, Smith TJ, Helm ER, Morone NE, Szucs KA, Kostek MC, Kolber BJ. Integrated Meditation and Exercise Therapy: A Randomized Controlled Pilot of a Combined Nonpharmacological Intervention Focused on Reducing Disability and Pain in Patients with Chronic Low Back Pain. PAIN MEDICINE (MALDEN, MASS.) 2021; 22:444-458. [PMID: 33621332 PMCID: PMC7901850 DOI: 10.1093/pm/pnaa403] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE This pilot trial examined the effects of a combined intervention of mindfulness meditation followed by aerobic walking exercise compared with a control condition in chronic low back pain patients. We hypothesized that meditation before exercise would reduce disability, pain, and anxiety by increasing mindfulness prior to physical activity compared with an audiobook control group. PARTICIPANTS Thirty-eight adults completed either meditation and exercise treatment (MedExT) (n=18) or an audiobook control condition (n=20). SETTING Duquesne University Exercise Physiology Laboratory. DESIGN A pilot, assessor-blinded, randomized controlled trial. METHODS Over a 4-week period, participants in the MedExT group performed 12-17 minutes of guided meditation followed by 30 minutes of moderate-intensity walking exercise 5 days per week. Measures of disability, pain, mindfulness, and anxiety were taken at baseline and postintervention. Pain perception measurements were taken daily. RESULTS Compared with the control group, we observed larger improvements in disability in the MedExT intervention, although the changes were modest and not statistically significant (mean between-group difference, -1.24; 95% confidence interval [CI], -3.1 to 0.6). For secondary outcome measures, MedExT increased mindfulness (within-group) from pre-intervention to postintervention (P=0.0141). Additionally, mean ratings of low back pain intensity and unpleasantness significantly improved with time for the MedExT group compared with that of the control group, respectively (intensity P=0.0008; unpleasantness P=0.0022). CONCLUSION . Overall, 4 weeks of MedExT produced suggestive between-group trends for disability, significant between-group differences for measures of pain, and significant within-group increases in mindfulness.
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Affiliation(s)
- Anna M Polaski
- Department of Biological Sciences, Duquesne University, Pittsburgh, Pennsylvania, USA
- Chronic Pain Research Consortium, Duquesne University, Pittsburgh, Pennsylvania, USA
| | - Amy L Phelps
- Chronic Pain Research Consortium, Duquesne University, Pittsburgh, Pennsylvania, USA
- Palumbo-Donahue School of Business, Duquesne University, Pittsburgh, Pennsylvania, USA
| | - Thomas J Smith
- Counseling and Wellbeing Center, Duquesne University, Pittsburgh, Pennsylvania, USA
| | - Eric R Helm
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Natalia E Morone
- Section of General Internal Medicine, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Kimberly A Szucs
- Chronic Pain Research Consortium, Duquesne University, Pittsburgh, Pennsylvania, USA
- Department of Occupational Therapy, Duquesne University, Pittsburgh, Pennsylvania, USA
| | - Matthew C Kostek
- Chronic Pain Research Consortium, Duquesne University, Pittsburgh, Pennsylvania, USA
- Department of Physical Therapy, Duquesne University, Pittsburgh, Pennsylvania, USA
| | - Benedict J Kolber
- Department of Biological Sciences, Duquesne University, Pittsburgh, Pennsylvania, USA
- Chronic Pain Research Consortium, Duquesne University, Pittsburgh, Pennsylvania, USA
- Department of Neuroscience and Center for Advanced Pain Studies, University of Texas at Dallas, Richardson, Texas, USA
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Lang AE, Hendrick PA, Clay L, Mondal P, Trask CM, Bath B, Penz ED, Stewart SA, Baxter GD, Hurley DA, McDonough SM, Milosavljevic S. A randomized controlled trial investigating effects of an individualized pedometer driven walking program on chronic low back pain. BMC Musculoskelet Disord 2021; 22:206. [PMID: 33607979 PMCID: PMC7896363 DOI: 10.1186/s12891-021-04060-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 02/05/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Walking is an easily prescribed physical activity for people with low back pain (LBP). However, the evidence for its effectiveness to improve pain and disability levels for people with chronic low back pain (CLBP) within a community setting has not been evaluated. This study evaluates the effectiveness of a clinician guided, pedometer-driven, walking intervention for increasing physical activity and improving clinical outcomes compared to education and advice. METHODS Randomized controlled trial recruiting N = 174 adults with CLBP. Participants were randomly allocated into either a standardized care group (SG) or pedometer based walking group (WG) using minimization allocation with a 2:1 ratio to the WG. Prior to randomization all participants were given a standard package of education and advice regarding self-management and the benefits of staying active. Following randomization the WG undertook a physiotherapist guided pedometer-driven walking program for 12 weeks. This was individually tailored by weekly negotiation of daily step targets. Main outcome was the Oswestry Disability Index (ODI) recorded at baseline, 12 weeks, 6 and 12 months. Other outcomes included, numeric pain rating, International Physical Activity Questionnaire (IPAQ), Fear-Avoidance Beliefs Questionnaire (FABQ), Back Beliefs questionnaire (BBQ), Physical Activity Self-efficacy Scale, and EQ-5D-5L quality of life estimate. RESULTS N = 138 (79%) participants completed all outcome measures at 12 weeks reducing to N = 96 (55%) at 12 months. Both observed and intention to treat analysis did not show any statistically significant difference in ODI change score between the WG and the SG at all post-intervention time points. There were also no significant between group differences for change scores in all secondary outcome measures. Post hoc sensitivity analyses revealed moderately disabled participants (baseline ODI ≥ 21.0) demonstrated a greater reduction in mean ODI scores at 12 months in the WG compared to SG, while WG participants with a daily baseline step count < 7500 steps demonstrated a greater reduction in mean ODI scores at 12 weeks. CONCLUSIONS Overall, we found no significant difference in change of levels of (ODI) disability between the SG and WG following the walking intervention. However, ODI responses to a walking program for those with moderate levels of baseline disability and those with low baseline step count offer a potential future focus for continued research into the benefit of walking as a management strategy for chronic LBP. TRIAL REGISTRATION United States National Institutes of Health Clinical Trails registry (http://ClinicalTrials.gov/) No. NCT02284958 (27/10/2014).
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Affiliation(s)
- Angelica E Lang
- College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Paul A Hendrick
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Lynne Clay
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Prosanta Mondal
- College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | | | - Brenna Bath
- College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Erika D Penz
- College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Samuel A Stewart
- Faculty of Medicine, Dalhousie University, Halifax Regional Municipality, Nova Scotia, Canada
| | - G David Baxter
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Deidre A Hurley
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
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TEKİN V, AKÇAY Ş, ŞENGÜL İ, KAYA T, GOKSEL KARATEPE A. Non-spesifik kronik bel ağrılı hastalarda aerobik egzersiz programının etkisi. CUKUROVA MEDICAL JOURNAL 2020. [DOI: 10.17826/cumj.731853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Olkoski MM, Silva MF, Guenka LC, Pelegrinelli AR, Dela Bela LF, Dias JM, Nogueira JF, Pereira GO, Souza DC, Carvalho RG, Facci LM, Cardoso JR. Comparing the effects of aquatic exercises with or without high intensity on the functional status, muscular endurance, and performance of patients with chronic low back pain. J Sports Med Phys Fitness 2020; 61:699-706. [PMID: 33314877 DOI: 10.23736/s0022-4707.20.11265-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The prevalence of low back pain is lower when physical fitness (aerobic and muscular) is higher. Strength exercises are important for subjects with low back pain, but there are few studies on the inclusion of aerobic exercise in low back pain programs. The aim of this study was to compare the effects of aquatic exercises with or without high-intensity component on the functional status, lumbar and abdominal muscle endurance, and performance of subjects with chronic low back pain. METHODS Forty-eight volunteers between 20 and 60 years old were randomly allocated to an experimental group AEDWR (aquatic exercises plus deep-water running group, N.=25) or to a control group AE (aquatic exercises only group, N.=23). The dependent variables included functional status (Repeated Sit-to-Stand test), lumbar (Sorensen test) and abdominal (One Minute Abdominal test) muscle endurance, and physical performance (Maximum Physical Fitness test), which were measured before and after the 9-week intervention and at 21 weeks of follow-up. RESULTS Lumbar endurance was higher in the AEDWR group at the end of the treatment, with a mean difference (MD) of 43.2 seconds, 95% confidence intervals (CI) (9.6; 76.7), P=0.01, d̅=0.74, and better in the follow-up with MD=40.2 seconds, 95% CI (7.1; 73.3), P=0.02, d̅=0.71, than in the AE group. Participant performance also improved on the 9th week in the AEDWR group, with an MD=0.53 kgf, 95% CI (0.008; 0.98), P=0.02, d̅=0.60. CONCLUSIONS The addition of deep-water running exercise to aquatic exercises improved lumbar muscle endurance and performance when compared with aquatic exercises only, and this effect was maintained during the follow-up to lumbar muscle endurance.
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Affiliation(s)
- Mabel M Olkoski
- Department of Production of Animal Alimentary Products, Agro-veterinary Center, Santa Catarina State University, Lages, Brazil
| | - Mariana F Silva
- Laboratory of Biomechanics and Clinical Epidemiology, PAIFIT Research Group, State University of Londrina, Londrina, Brazil
| | - Leandro C Guenka
- Laboratory of Biomechanics and Clinical Epidemiology, PAIFIT Research Group, State University of Londrina, Londrina, Brazil
| | | | | | - Josilainne M Dias
- School of Medicine, Mato Grosso do Sul State University, Campo Grande, Brazil
| | | | - Gabriele O Pereira
- Laboratory of Biomechanics and Clinical Epidemiology, PAIFIT Research Group, State University of Londrina, Londrina, Brazil
| | - Daniella C Souza
- Laboratory of Biomechanics and Clinical Epidemiology, PAIFIT Research Group, State University of Londrina, Londrina, Brazil
| | - Rodrigo G Carvalho
- College of Physical Education, Federal University of Vale do São Francisco, Petrolina, Brazil
| | - Ligia M Facci
- Aquatic Physiotherapy Center and Laboratory of Biomechanics and Clinical Epidemiology, PAIFIT Research Group, State University of Londrina, Londrina, Brazil
| | - Jefferson R Cardoso
- Aquatic Physiotherapy Center and Laboratory of Biomechanics and Clinical Epidemiology, PAIFIT Research Group, State University of Londrina, Londrina, Brazil -
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Nduwimana I, Nindorera F, Thonnard JL, Kossi O. Effectiveness of walking versus mind-body therapies in chronic low back pain: A systematic review and meta-analysis of recent randomized controlled trials. Medicine (Baltimore) 2020; 99:e21969. [PMID: 32871946 PMCID: PMC7458239 DOI: 10.1097/md.0000000000021969] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Walking and mind-body therapies (MBTs) are commonly recommended to relieve pain and improve function in patients with chronic low back pain (CLBP). The purpose of this study was to compare the effectiveness of walking and MBTs in CLBP. METHODS We included randomized controlled trials (RCTs) comparing walking or MBTs to any other intervention or control in adults with CLBP. Studies were identified through PubMed, Cochrane Library, PsycINFO, Scopus, and ScienceDirect databases. The research was limited to studies published in English and French between January 2008 and December 2018. Two reviewers independently selected the studies, extracted data, and assessed studies quality using the Physiotherapy Evidence Database (PEDro) scale. Statistical analyses were performed under a random-effects model. We analyzed pain and activity limitation, with the calculation of standardized mean differences and 95% confidence intervals for the different treatment effects. RESULTS Thirty one randomized controlled trials involving 3193 participants were analyzed. Walking was as effective as control interventions in the short-term and slightly superior in the intermediate term with respect to pain (Standardized mean differences (SMD) = -0.34; 95% CI, -0.65 to -0.03; P = .03) and activity limitation (SMD = -0.30; 95% CI, -0.50 to -0.10; P = .003). In contrast, yoga was more effective than control interventions in the short term in terms of pain (SMD = -1.47; 95% CI, -2.26 to -0.68; P = .0003) and activity limitation (SMD = -1.17; 95% CI, -1.80 to -0.55; P = .0002). Yoga was no longer superior to the control interventions for pain at the 6-month follow-up. CONCLUSION MBTs, especially yoga, seem to be more effective in the short term, and walking seems to be more effective in the intermediate term, for the relief of pain and activity limitation in patients with CLBP. A combination of walking and MBTs fits the biopsychosocial model and might be valuable therapy for CLBP throughout follow-up due to combined effects.
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Affiliation(s)
- Ildephonse Nduwimana
- Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium
- National Center for Physical Therapy and Rehabilitation (CNRKR), Bujumbura, Burundi
| | - Félix Nindorera
- Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium
- National Center for Physical Therapy and Rehabilitation (CNRKR), Bujumbura, Burundi
| | - Jean Louis Thonnard
- Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium
- National Center for Physical Therapy and Rehabilitation (CNRKR), Bujumbura, Burundi
| | - Oyene Kossi
- Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium
- Department of Rehabilitation, University Hospital of Parakou
- National School of Public Health and Epidemiology, University of Parakou, Parakou, Bénin
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Braun C, Voigt-Radloff S. [Treatment of non-specific low back pain: Evidence map of systematic reviews from 2015 to 2019]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2020; 149:12-21. [PMID: 32151527 DOI: 10.1016/j.zefq.2020.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/22/2020] [Accepted: 01/22/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Low back pain represents a major healthcare challenge in Germany and worldwide. The research field is highly dynamic. The aim of this evidence map was to create a compact overview of current systematic reviews on interventions for non-specific low back pain. METHODS Medline (PubMed), the Cochrane Database of Systematic Reviews and Epistemonikos were systematically searched from March 2015 to March 2019 for systematic reviews addressing any interventions for acute, subacute or chronic non-specific low back pain and reporting at least one patient-relevant outcome. Key information on the characteristics and conclusions of the included reviews were extracted and aspects of the methodological quality of the included reviews were assessed independently by two reviewers. The data were tabulated. RESULTS The search identified 1,436 records. 53 systematic reviews were included in the evidence map. The quality of the reviews and of the studies included therein varied. The reviews addressed a variety of different interventions, with considerable heterogeneity of their characteristics and methodological aspects. Many reviews found evidence for positive effects of the studied interventions, some found evidence for no effect, but the quantity and quality of the evidence were often judged as insufficient for formulating robust conclusions. Relatively few data were available on adverse events. CONCLUSION This evidence map provides a compact resource for the use of current systematic reviews on interventions for non-specific low back pain. The methodological deficits of many reviews require a careful approach towards their findings and conclusions and suggest a need for methodologically rigorous reviews.
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Affiliation(s)
- Cordula Braun
- Institut für Evidenz in der Medizin (für Cochrane Deutschland Stiftung), Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Deutschland.
| | - Sebastian Voigt-Radloff
- Institut für Evidenz in der Medizin (für Cochrane Deutschland Stiftung), Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Deutschland
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Norris CM. Back rehabilitation - The 3R's approach. J Bodyw Mov Ther 2020; 24:289-299. [PMID: 31987559 DOI: 10.1016/j.jbmt.2019.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 10/23/2019] [Indexed: 10/25/2022]
Abstract
Exercise is vital to the management of low back pain (LBP). However, research, social media, and fitness industry interests can leave therapists confused about best practice in exercise prescription for this clinical condition. The 3R's approach to back rehabilitation is introduced as an evidence-based framework for developing patient specific exercise throughout the back-pain journey. Clinical guidelines for the management of LBP are presented, and both exercise and psychological considerations are overviewed. The contrast between biomedical and biopsychosocial models of healthcare is introduced in relation to LBP and the requirements of a successful rehabilitation programme. Interacting factors in LBP, red flags, and motor skill classification are considered. The concept of tissue capacity is introduced, and the healing timescale addressed. Both are used as a foundation for exercise choice and progression. Simple methods of structuring an exercise programme are drawn from the fitness industry and adapted for use in rehabilitation. The 3R's approach consists of 3 interrelated and overlapping phases - reactive, recovery, and resilience. Treatment aims for each are introduced with guidance given to indicate appropriate patient progression between phases. Exercise examples of each stage are illustrated with consideration given to clinical reasoning, teaching method, safety and effectiveness.
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Lee JH, Choi KH, Kang S, Kim DH, Kim DH, Kim BR, Kim W, Kim JH, Do KH, Do JG, Ryu JS, Min K, Bahk SG, Park YH, Bang HJ, Shin KH, Yang S, Yang HS, Yoo SD, Yoo JS, Yoon KJ, Yoon SJ, Lee GJ, Lee SY, Lee SC, Lee SY, Lee IS, Lee JS, Lee CH, Lim JY, Han JY, Han SH, Sung DH, Cho KH, Kim SY, Kim HJ, Ju W. Nonsurgical treatments for patients with radicular pain from lumbosacral disc herniation. Spine J 2019; 19:1478-1489. [PMID: 31201860 DOI: 10.1016/j.spinee.2019.06.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 06/02/2019] [Accepted: 06/04/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Lumbosacral disc herniation (LDH) is one of the most frequent musculoskeletal diseases causative of sick leave in the workplace and morbidity in daily activities. Nonsurgical managements are considered as first line treatment before surgical treatment. PURPOSE This clinical practice guideline (CPG) is intended to provide physicians who treat patients diagnosed with LDH with a guideline supported by scientific evidence to assist in decision-making for appropriate and reasonable treatments. STUDY DESIGN/SETTING A systematic review. PATIENT SAMPLE Studies of human subjects written in Korean or English that met the following criteria were selected: patients aged ≥18 years, clinical presentation of low back and radicular leg pain, diagnosis of LDH on radiological evaluation including computed tomography or magnetic resonance imaging. OUTCOMES MEASURES Pain and functional evaluation scales such as visual analogue scale, numeric rating scale, and Oswestry disability index METHODS: The MEDLINE (PubMed), EMBASE, Cochrane Review, and KoreaMed databases were searched for articles regarding non-surgical treatments for LDH published up to July 2017. Of the studies fulfilling these criteria, those investigating clinical results after non-surgical treatment including physical and behavioral therapy, medication, and interventional treatment in terms of pain control and functional improvements were chosen for this study. RESULTS Nonsurgical treatments were determined to be clinically effective with regards to pain reduction and functional improvement in patients with LDH. Nevertheless, the evidence level was generally not evaluated as high degree, which might be attributed to the paucity of well-designed randomized controlled trials. Exercise and traction were strongly recommended despite moderate level of evidence. Epidural injection was strongly recommended with high degree of evidence and transforaminal approach was more strongly recommended than caudal approach. CONCLUSIONS This CPG provides new and updated evidence-based recommendations for treatment of the patients with LDH, which suggested that, despite an absence of high degrees of evidence level, non-surgical treatments were clinically effective.
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Affiliation(s)
- Jung Hwan Lee
- Namdarun Rehabilitation Clinic, Yongin-si, Gyeongg-do, South korea
| | - Kyoung Hyo Choi
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
| | - Seok Kang
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Seoul, South Korea
| | - Dong Hwan Kim
- Department of Physical and Rehabilitation Medicine, College of Medicine, Kyung Hee University Hospital, South Korea
| | - Du Hwan Kim
- Department of Physical and Rehabilitation Medicine, Dongsan Medical Center, School of Medicine, Keimyung University, Daegu, South Korea
| | - Bo Ryun Kim
- Department of Rehabilitation Medicine, School of Medicine, Jeju National University, Jeju, South Korea
| | - Won Kim
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jung Hwan Kim
- Rehabilitation Hospital and Research Institute, National Rehabilitation Center, Seoul, South Korea
| | - Kyung Hee Do
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, South Korea
| | - Jong Geol Do
- Department of Physical and Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Ju Seok Ryu
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundnang Hospital, Seoul, South Korea
| | - Kyunghoon Min
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Sung Gin Bahk
- Department of Physical Medicine & Rehabilitation, Seocho Se Barun Hospital, Seoul, South Korea
| | - Yun Hee Park
- Department of Physical Medicine and Rehabilitation, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Heui Je Bang
- Department of Rehabilitation Medicine, College of Medicine, Chungbuk National University, Cheongju, South Korea
| | - Kyoung-Ho Shin
- Heal & Tun Rehabilitation Medicine Clinic, Seongnam-si, Gyeonggi-do, South Korea
| | - Seoyon Yang
- Department of Physical and Rehabilitation Medicine, Seoul Hyundai Hospital, Seoul, South Korea
| | - Hee Seung Yang
- Department of Physical and Rehabilitation Medicine, Veterans medical center, Seoul, South Korea
| | - Seung Don Yoo
- Department of Physical and Rehabilitation Medicine, Kyung Hee university, College of Medicine, Seoul, South Korea
| | - Ji Sung Yoo
- Department of Rehabilitation Medicine, Research Institute and Hospital, National Cancer Center, South Korea
| | - Kyung Jae Yoon
- Department of Physical and Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Se Jin Yoon
- Department of Physical and Rehabilitation Medicine, Danam Rehabilitation Hospital, South Korea
| | - Goo Joo Lee
- Department of Rehabilitation Medicine, Chungbuk National University Hospital, Cheongju, South Korea
| | - Sang Yoon Lee
- Department of Rehabilitation Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Sang Chul Lee
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Seung Yeol Lee
- Department of Physical Medicine and Rehabilitation, College of Medicine, Soonchunhyang University Hospital, Seoul, South Korea
| | - In-Sik Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine and Konkuk University Medical Center, Seoul, South Korea
| | - Jung-Soo Lee
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Chang-Hyung Lee
- Department of Physical and Rehabilitation Medicine, Pusan National University Yangsan Hospital, School of Medicine, Pusan National University, Busan, South Korea
| | - Jae-Young Lim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jae-Young Han
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Seung Hoon Han
- Department of Rehabilitation Medicine, Hanyang University Guri Hospital, Seoul, South Korea
| | - Duk Hyun Sung
- Department of Physical Medicine and Rehabilitation, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Kang Hee Cho
- Department of Physical and Rehabilitation Medicine, Chungnam National University, Daejeon, South Korea
| | - Soo Young Kim
- Department of Family Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Hyun Jung Kim
- Department of Preventive Medicine, Institute for Evidence-based Medicine, Cochrane Korea, College of Medicine, Korea University, Seoul, South Korea
| | - Woong Ju
- Department of Obstetrics and Gynecology, Ewha Womans University, Seoul, South Korea
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Malfliet A, Ickmans K, Huysmans E, Coppieters I, Willaert W, Bogaert WV, Rheel E, Bilterys T, Wilgen PV, Nijs J. Best Evidence Rehabilitation for Chronic Pain Part 3: Low Back Pain. J Clin Med 2019; 8:E1063. [PMID: 31331087 PMCID: PMC6679058 DOI: 10.3390/jcm8071063] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 07/03/2019] [Accepted: 07/16/2019] [Indexed: 02/07/2023] Open
Abstract
Chronic Low Back Pain (CLBP) is a major and highly prevalent health problem. Given the high number of papers available, clinicians might be overwhelmed by the evidence on CLBP management. Taking into account the scale and costs of CLBP, it is imperative that healthcare professionals have access to up-to-date, evidence-based information to assist them in treatment decision-making. Therefore, this paper provides a state-of-the-art overview of the best evidence non-invasive rehabilitation for CLBP. Taking together up-to-date evidence from systematic reviews, meta-analysis and available treatment guidelines, most physically inactive therapies should not be considered for CLBP management, except for pain neuroscience education and spinal manipulative therapy if combined with exercise therapy, with or without psychological therapy. Regarding active therapy, back schools, sensory discrimination training, proprioceptive exercises, and sling exercises should not be considered due to low-quality and/or conflicting evidence. Exercise interventions on the other hand are recommended, but while all exercise modalities appear effective compared to minimal/passive/conservative/no intervention, there is no evidence that some specific types of exercises are superior to others. Therefore, we recommend choosing exercises in line with the patient's preferences and abilities. When exercise interventions are combined with a psychological component, effects are better and maintain longer over time.
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Affiliation(s)
- Anneleen Malfliet
- Research Foundation-Flanders (FWO), 1090 Brussels, Belgium.
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium.
- Pain in Motion International Research Group, 1090 Brussels, Belgium.
- Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Laarbeeklaan 101, 1090 Brussel, Belgium.
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, 9000 Gent, Belgium.
| | - Kelly Ickmans
- Research Foundation-Flanders (FWO), 1090 Brussels, Belgium
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium
- Pain in Motion International Research Group, 1090 Brussels, Belgium
- Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Laarbeeklaan 101, 1090 Brussel, Belgium
| | - Eva Huysmans
- Research Foundation-Flanders (FWO), 1090 Brussels, Belgium
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium
- Pain in Motion International Research Group, 1090 Brussels, Belgium
- Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Laarbeeklaan 101, 1090 Brussel, Belgium
- Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, 1090 Brussels, Belgium
| | - Iris Coppieters
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium
- Pain in Motion International Research Group, 1090 Brussels, Belgium
- Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Laarbeeklaan 101, 1090 Brussel, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, 9000 Gent, Belgium
| | - Ward Willaert
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium
- Pain in Motion International Research Group, 1090 Brussels, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, 9000 Gent, Belgium
| | - Wouter Van Bogaert
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium
- Pain in Motion International Research Group, 1090 Brussels, Belgium
| | - Emma Rheel
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium
- Pain in Motion International Research Group, 1090 Brussels, Belgium
- Department of Experimental-Clinical and Health Psychology, Ghent University, 9000 Ghent, Belgium
| | - Thomas Bilterys
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium
- Pain in Motion International Research Group, 1090 Brussels, Belgium
| | - Paul Van Wilgen
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium
- Pain in Motion International Research Group, 1090 Brussels, Belgium
- Transcare, Transdisciplinary Pain Management Centre, 9728 EE Groningen, The Netherlands
| | - Jo Nijs
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium.
- Pain in Motion International Research Group, 1090 Brussels, Belgium.
- Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Laarbeeklaan 101, 1090 Brussel, Belgium.
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Gerasimova ON, Parfenov VA, Kalimeeva EY. Treatment of patients with acute and subacute dorsalgia. NEUROLOGY, NEUROPSYCHIATRY, PSYCHOSOMATICS 2018. [DOI: 10.14412/2074-2711-2018-3-36-41] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Objective: to investigate the efficiency of treatment for acute and subacute dorsalgia, by providing information to patients and by using nonsteroidal anti-inflammatory drugs (NSAIDs) without conducting physical therapy, reflexotherapy, and manual therapy. Patients and methods. A total of 140 patients (87 women and 53 men; mean age 50.7±17.6 years) with acute and subacute back pain were followed up. Out of them 127 (91%) patients were found to have nonspecific (musculoskeletal) pain; 13 (9%) had discogenic radiculopathy. All the patients were informed of the benign nature of the disease, the high probability of its rapid resolution, the feasibility of abandoning prolonged bedrest, and the lack of need for physical therapy, reflexotherapy, massage, and manual therapy. To reduce pain, the patients received meloxicam 15 mg/day orally or intramuscularly or first 15 mg/day intramuscularly and then orally. The investigators assessed pain intensity with the numerical rating scale and functional activity restrictions with the Roland-Morris disability (RMD) questionnaire. Results. After treatment, the visual analogue scale pain intensity scores decreased from an average of 6.4 to 1.0; the RMD scores dropped from 6.8 to 1.4 (p<0.001). The duration of treatment averaged 11.0±4.4 days. Comparison of different meloxicam dosage regimens showed no significant differences; a positive result was noted in all cases. No adverse events were observed during treatment. Conclusion. The investigation has shown the high efficiency of management in patients with acute and subacute dorsalgia, by providing information to patients (an education conversation), by using meloxicam, and by applying a personalized approach (treatment for concomitant diseases and conditions). Refusing physiotherapy, massage, acupuncture, and manual therapy substantially reduces the cost of treatment in patients with acute dorsalgia.
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Affiliation(s)
| | - V. A. Parfenov
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia, Moscow
| | - E. Yu. Kalimeeva
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia, Moscow
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