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Chrobok L, Espejo T, Riedel HB, Kirchberger J, Overberg JA, Felber F, Perrot G, Nickel CH, Bingisser R. On-Site Physiotherapy in Emergency Department Patients Presenting with Nonspecific Low Back Pain: A Randomized Controlled Trial. J Clin Med 2024; 13:3149. [PMID: 38892860 PMCID: PMC11173222 DOI: 10.3390/jcm13113149] [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: 04/12/2024] [Revised: 05/13/2024] [Accepted: 05/24/2024] [Indexed: 06/21/2024] Open
Abstract
Background: There is a high incidence of nonspecific Low Back Pain (LBP) in patients visiting Emergency Departments (EDs), but there is a lack of knowledge regarding emergency physiotherapy for LBP. The effect of on-site physiotherapy in these patients was therefore never demonstrated. We assessed short-term outcomes, feasibility and patient satisfaction with physiotherapy in ED patients presenting with nonspecific LBP. Methods: A block-randomized, controlled, open-label trial with a follow-up of 42 days. Patients aged 18 years or older presenting to an ED with nonspecific LBP were prospectively enrolled. Both groups received the same booklet with written information on LBP management and exercises. Patients in the intervention group were given additional instructions by a certified physiotherapist. Results: We included 86 patients in the primary analysis. The median age was 40, and 40.7% were female. At day 7, the median Oswestry Disability Index (ODI) was 2 points lower in the intervention group compared to the control group, which was not statistically significant. There was no between-group difference in pain at day 7. Patients who received physiotherapy felt significantly more confident with the exercises they were taught (p = 0.004, effect size = 0.3 [95% CI 0.1 to 0.5]). Conclusions: On-site physiotherapy in ED patients presenting with nonspecific low back pain is associated with higher patient satisfaction, compared to standard of care. The effect of physiotherapy was small, with only minimal improvement in disability, but without a reduction in pain. Despite the very small effect size, physiotherapeutic interventions should be investigated in larger cohorts with an extended intervention including patient education, exercises, and other physiotherapeutic modalities.
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Affiliation(s)
- Leon Chrobok
- Emergency Department, University Hospital, 4031 Basel, Switzerland; (L.C.); (T.E.); (H.B.R.); (F.F.); (C.H.N.)
| | - Tanguy Espejo
- Emergency Department, University Hospital, 4031 Basel, Switzerland; (L.C.); (T.E.); (H.B.R.); (F.F.); (C.H.N.)
| | - Henk B. Riedel
- Emergency Department, University Hospital, 4031 Basel, Switzerland; (L.C.); (T.E.); (H.B.R.); (F.F.); (C.H.N.)
| | - Joris Kirchberger
- Department of Therapies, University Hospital, 4031 Basel, Switzerland; (J.K.); (J.-A.O.); (G.P.)
| | - Jan-Arie Overberg
- Department of Therapies, University Hospital, 4031 Basel, Switzerland; (J.K.); (J.-A.O.); (G.P.)
| | - Florina Felber
- Emergency Department, University Hospital, 4031 Basel, Switzerland; (L.C.); (T.E.); (H.B.R.); (F.F.); (C.H.N.)
| | - Guido Perrot
- Department of Therapies, University Hospital, 4031 Basel, Switzerland; (J.K.); (J.-A.O.); (G.P.)
| | - Christian H. Nickel
- Emergency Department, University Hospital, 4031 Basel, Switzerland; (L.C.); (T.E.); (H.B.R.); (F.F.); (C.H.N.)
| | - Roland Bingisser
- Emergency Department, University Hospital, 4031 Basel, Switzerland; (L.C.); (T.E.); (H.B.R.); (F.F.); (C.H.N.)
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He J, Tse MMY, Kwok TTO. The effectiveness, acceptability, and sustainability of non-pharmacological interventions for chronic pain management in older adults in mainland China: A systematic review. Geriatr Nurs 2024; 57:123-131. [PMID: 38640646 DOI: 10.1016/j.gerinurse.2024.04.008] [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: 12/22/2023] [Revised: 03/03/2024] [Accepted: 04/03/2024] [Indexed: 04/21/2024]
Abstract
OBJECTIVES This systematic review aims to assess the effectiveness, acceptability, and sustainability of non-pharmacological pain management interventions for older adults in mainland China. MATERIALS AND METHODS Articles searching was conducted across six databases, including MEDLINE, PubMed, PsycINFO, Web of Science, China National Knowledge Infrastructure (CNKI), and WanFangdata. Quality appraisal was performed using the revised Cochrane risk of bias tool. RESULTS A total of 26 articles met the inclusion criteria, involving 2,197 participants with a mean age of 69.19 years. The participants' ages ranged from 63.85 to 81.75 years. The evaluated non-pharmacological interventions included psychotherapy, acupuncture, exercise, massage, neurotherapy, and multidisciplinary interventions. The overall changes in pain intensity varied from -5.19 to -0.65 on a numeric rating scale ranging from zero to ten. CONCLUSIONS Non-pharmacological interventions proved effective in alleviating pain intensity among older adults in mainland China. The findings suggest that mindfulness, exercise and pain education can be promoted as viable strategies for enhancing the well-being of the elderly population.
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Affiliation(s)
- Jiafan He
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong
| | - Mimi Mun Yee Tse
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong.
| | - Tyrone Tai On Kwok
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong
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Lu J, Abd Rahman NA, Wyon M, Shaharudin S. The effects of dance interventions on physical function and quality of life among middle-aged and older adults: A systematic review. PLoS One 2024; 19:e0301236. [PMID: 38640093 PMCID: PMC11029638 DOI: 10.1371/journal.pone.0301236] [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: 10/09/2023] [Accepted: 03/12/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Fundamental physical functions such as postural control and balance are vital in preserving everyday life, affecting an individual's quality of life. Dance is a physical activity that offers health advantages across various life stages. Nevertheless, the effects of dance interventions on physical function, postural control, and quality of life among older adults have remained underexplored. The review aimed to examine the strength of evidence for dance interventions on physical function and quality of life among middle-aged and older adults. METHODS A systematic review was conducted across four databases (PubMed, Cochrane Library, Web of Science, and Medline), focusing on studies involving more than four weeks of dance interventions. MeSH terms [dance or dance intervention or dance rehabilitation or dance movement] and [motor function or functional capacity or postural control or functional mobility or mobility or postural balance or balance or flexibility or gait] and [well-being or quality of life or life satisfaction] were utilized in the search. This review was registered in the PROSPERO database (CRD42023422857). Included studies were assessed using the Cochrane Risk of Bias. RESULTS The search revealed 885 studies, and 16 met the inclusion criteria. The effects of various dance genres on physical functions and quality of life were compared. Most studies showed that dance intervention improved physical function, balance, postural control and quality of life. Dance intervention showed a high level of adherence compared to physiotherapy, self-care, conventional therapy, and aerobic and resistance exercise. CONCLUSION In terms of improving physical function and quality of life, structured dance is a safe and relatively effective alternative to exercise. Note the effect of movement selection and intensity in the dance interventions. Dance with music may increase participants' interest, encouraging more physical activity among middle-aged and older adults.
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Affiliation(s)
- Jingting Lu
- College of Physical Education, Hubei Normal University, Huangshi, China
- Exercise & Sports Science Programme, School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Nur Athirah Abd Rahman
- Exercise & Sports Science Programme, School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Matthew Wyon
- School of Sport, University of Wolverhampton, Walsall, United Kingdom
| | - Shazlin Shaharudin
- Exercise & Sports Science Programme, School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
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Khaledi A, Gheitasi M. Isometric vs Isotonic Core Stabilization Exercises to Improve Pain and Disability in Patients with Non-specific Chronic Low Back Pain: A Randomized Controlled Trial. Anesth Pain Med 2024; 14:e144046. [PMID: 38725921 PMCID: PMC11078224 DOI: 10.5812/aapm-144046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/03/2024] [Accepted: 02/06/2024] [Indexed: 05/12/2024] Open
Abstract
Background Non-specific chronic low back pain (NSCLBP) is a prevalent condition that affects 90% of individuals experiencing low back pain. Core stabilization exercises (CSE) stand out as the most commonly employed therapeutic approach for managing NSCLBP. Nevertheless, there remains uncertainty regarding the superior effectiveness between isometric (ISOM) and isotonic (ISOT) types of CSE in the treatment of NSCLBP. Objectives The primary objective of this study was to compare the efficacy of ISOM and ISOT exercises concerning pain and disability in patients with NSCLBP. Additionally, the study aimed to assess the effectiveness of both ISOM and ISOT in comparison to no intervention concerning these variables in these patients. Methods This study was a randomized controlled trial that involved 41 men and women experiencing NSCLBP. Participants were randomly allocated to three groups: ISOM CSE (n = 13), ISOT CSE (n = 14), and a waitlist control (n = 14). The exercise training was administered for 40 - 60 minutes three times a week over a period of up to 8 weeks. Pain (assessed using the Visual Analog Scale or VAS) and disability (evaluated through the Oswestry Disability Index or ODI) variables were measured before and after the interventions. Results Based on the results, there was no significant difference between the 2 exercise groups (ISOM and ISOT) regarding pain and disability. However, the ISOM group demonstrated numerically better results than the ISOT group. Both the ISOM and ISOT groups exhibited a significant decrease in pain levels, with the VAS score decreasing from 5.5 to 2.7 for ISOM and from 5.8 to 3.7 for ISOT, as compared to the control group (P < 0.001 and P = 0.001, respectively). Additionally, the average disability showed a significant improvement in both the ISOM (ODI score from 17 to 11) and ISOT (ODI score from 15.4 to 11) groups compared to the control group (P < 0.001). Conclusions Both ISOM and ISOT methods are effective in alleviating pain and disability in patients with NSCLBP. However, there is no significant difference in the benefits between them. Numerically, ISOM exercises were found to be superior. Further studies are needed to obtain a more accurate answer regarding their superiority.
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Affiliation(s)
- Arash Khaledi
- Department of Sports Science, Kish International Campus, University of Tehran, Kish, Iran
| | - Mehdi Gheitasi
- Department of Health & Sport Rehabilitation, Faculty of Sport Science & Health, University of Shahid Beheshti, Tehran, Iran
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Jiang Y, Xu Y, Kong X, Zhao E, Ma C, Lv Y, Xu H, Sun H, Gao X. How to tackle non-specific low back pain among adult patients? A systematic review with a meta-analysis to compare four interventions. J Orthop Surg Res 2024; 19:1. [PMID: 38167170 PMCID: PMC10763207 DOI: 10.1186/s13018-023-04392-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/18/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE To tackle non-specific low back pain (NSLBP) among patients and find the most effective solution and to quantitatively synthesize the overall effect of motor control training (MCT) compared with Pilates, McKenzie method, and physical therapy (PT) in pain and physical function. METHODS Randomized controlled trials (RCTs) of four types of intervention (MCT, Pilates, McKenzie method, and PT) for LBP were collected by searching PubMed, Web of Science, EBSCOhost (Cochrane Central Register of Controlled Trials), and Scopus databases from the establishment of the database to September 30, 2023. The risk of bias was evaluated for included studies using the Revised Cochrane Risk of Bias tool for randomized trials (RoB 2.0). Taking pain and physical function in the experimental and control groups as outcome indicators, subgroup analysis was performed according to the intervention method to calculate the standardized mean difference (SMD) and 95% confidence interval (CI). RESULTS A total of 25 RCTs, including 1253 patients, were included. Meta-analysis showed that MCT effectively relieved pain [SMD = -0.65, 95% CI (- 1.00, - 0.29), p < 0.01] and improved physical function [SMD = -0.76, 95% CI (- 1.22, - 0.31), p < 0.01] comparing with other 3 types of intervention. Subgroup analysis suggested that MCT could alleviate pain [SMD = -0.92, 95% CI (- 1.34, - 0.50), p < 0.01] and improve physical function [SMD = -1.15, 95% CI (- 1.72, - 0.57), p < 0.01] compared with PT, but it had no statistical significance compared with Pilates [pain: SMD = 0.13, 95% CI (- 0.56, 0.83), p = 0.71; physical function: SMD = 0.10, 95% CI (- 0.72, 0.91), p = 0.81] and the McKenzie method [pain: SMD = -0.03, 95% CI (- 0.75, 0.68), p = 0.93; physical function: SMD = -0.03, 95% CI (- 1.00, 0.94), p = 0.95]. CONCLUSIONS MCT can effectively relieve pain and improve physical function in patients with NSLBP. It is more effective compared with PT for LBP, while no differences were detected between MCT and Pilates, as well as McKenzie method. Therefore, MCT, Pilates, and the McKenzie method should be encouraged as exercise interventions for NSLBP rehabilitation.
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Affiliation(s)
- Yawen Jiang
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai, China
- School of Physical Education (Main Campus), Zhengzhou University, Zhengzhou, China
| | - Yaping Xu
- Department of Public Physical and Art Education, Zhejiang University, Hangzhou, China
| | - Xiangrui Kong
- School of Physical Education (Main Campus), Zhengzhou University, Zhengzhou, China
| | - En Zhao
- School of Physical Education (Main Campus), Zhengzhou University, Zhengzhou, China
| | - Chunxia Ma
- School of Physical Education (Main Campus), Zhengzhou University, Zhengzhou, China
| | - Yihang Lv
- School of Physical Education (Main Campus), Zhengzhou University, Zhengzhou, China
| | - Hongqi Xu
- Research Center of Sports and Health Science, School of Sports Science and Physical Education, Northeast Normal University, Changchun, China
| | - He Sun
- School of physical education, Henan university, Zhengzhou, China
| | - Xiaojuan Gao
- School of Physical Education (Main Campus), Zhengzhou University, Zhengzhou, China.
- Synergetic Innovation Center of Kinesis and Health, School of Physical Education (Main Campus), Zhengzhou University, Zhengzhou, China.
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Verville L, Ogilvie R, Hincapié CA, Southerst D, Yu H, Bussières A, Gross DP, Pereira P, Mior S, Tricco AC, Cedraschi C, Brunton G, Nordin M, Connell G, Wong JJ, Shearer HM, Lee JGB, Wang D, Hayden JA, Cancelliere C. Systematic Review to Inform a World Health Organization (WHO) Clinical Practice Guideline: Benefits and Harms of Structured Exercise Programs for Chronic Primary Low Back Pain in Adults. JOURNAL OF OCCUPATIONAL REHABILITATION 2023; 33:636-650. [PMID: 37991647 PMCID: PMC10684665 DOI: 10.1007/s10926-023-10124-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/15/2023] [Indexed: 11/23/2023]
Abstract
PURPOSE Evaluate benefits and harms of structured exercise programs for chronic primary low back pain (CPLBP) in adults to inform a World Health Organization (WHO) standard clinical guideline. METHODS We searched for randomized controlled trials (RCTs) in electronic databases (inception to 17 May 2022). Eligible RCTs targeted structured exercise programs compared to placebo/sham, usual care, or no intervention (including comparison interventions where the attributable effect of exercise could be isolated). We extracted outcomes, appraised risk of bias, conducted meta-analyses where appropriate, and assessed certainty of evidence using GRADE. RESULTS We screened 2503 records (after initial screening through Cochrane RCT Classifier and Cochrane Crowd) and 398 full text RCTs. Thirteen RCTs rated with overall low or unclear risk of bias were synthesized. Assessing individual exercise types (predominantly very low certainty evidence), pain reduction was associated with aerobic exercise and Pilates vs. no intervention, and motor control exercise vs. sham. Improved function was associated with mixed exercise vs. usual care, and Pilates vs. no intervention. Temporary increased minor pain was associated with mixed exercise vs. no intervention, and yoga vs. usual care. Little to no difference was found for other comparisons and outcomes. When pooling exercise types, exercise vs. no intervention probably reduces pain in adults (8 RCTs, SMD = - 0.33, 95% CI - 0.58 to - 0.08) and functional limitations in adults and older adults (8 RCTs, SMD = - 0.31, 95% CI - 0.57 to - 0.05) (moderate certainty evidence). CONCLUSIONS With moderate certainty, structured exercise programs probably reduce pain and functional limitations in adults and older people with CPLBP.
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Affiliation(s)
- Leslie Verville
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
| | - Rachel Ogilvie
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada
| | - Cesar A Hincapié
- EBPI-UWZH Musculoskeletal Epidemiology Research Group, University of Zurich and Balgrist University Hospital, Zurich, Switzerland.
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland.
- University Spine Centre Zurich (UWZH), Balgrist University Hospital and University of Zurich, Zurich, Switzerland.
| | - Danielle Southerst
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
| | - Hainan Yu
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
| | - André Bussières
- Département Chiropratique, Université du Québec à Trois-Rivières, Trois-Rivières (Québec), Canada
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Douglas P Gross
- Department of Physical Therapy, University of Alberta, Edmonton, Canada
| | - Paulo Pereira
- Department of Neurosurgery, Centro Hospitalar Universitário São João, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Silvano Mior
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
- Department of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, Canada
| | - Andrea C Tricco
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
- Epidemiology Division and Institute for Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Queen's Collaboration for Health Care Quality Joanna Briggs Institute Centre of Excellence, Queen's University, Kingston, Canada
| | - Christine Cedraschi
- Division of General Medical Rehabilitation, Geneva University and University Hospitals, Geneva, Switzerland
- Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Centre, Geneva University Hospitals, Geneva, Switzerland
| | - Ginny Brunton
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
- EPPI-Centre, UCL Institute of Education, University College London, London, England, UK
- McMaster Midwifery Research Centre, McMaster University, Hamilton, Canada
| | - Margareta Nordin
- Department of Orthopedic Surgery and Environmental Medicine, NYU Grossman School of Medicine, New York University, New York, United States
| | - Gaelan Connell
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
| | - Jessica J Wong
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
| | - Heather M Shearer
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
- Department of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, Canada
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Joyce G B Lee
- Department of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, Canada
| | - Dan Wang
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
| | - Jill A Hayden
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada
| | - Carol Cancelliere
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada.
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Soares Fonseca L, Pereira Silva J, Bastos Souza M, Gabrich Moraes Campos M, de Oliveira Mascarenhas R, de Jesus Silva H, Souza Máximo Pereira L, Xavier Oliveira M, Cunha Oliveira V. Effectiveness of pharmacological and non-pharmacological therapy on pain intensity and disability in older people with chronic nonspecific low back pain: a systematic review with meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:3245-3271. [PMID: 37464184 DOI: 10.1007/s00586-023-07857-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/30/2023] [Accepted: 07/04/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND AND PURPOSE The aim of the present systematic review was to investigate the effectiveness of pharmacological and non-pharmacological therapy on pain intensity and disability in older people with chronic nonspecific low back pain. METHODS Searches were conducted in the MEDLINE, COCHRANE LIBRARY, EMBASE, AMED, PSYCINFO, and PEDRO databases up to 2022. Risk of bias was appraised using the Cochrane Risk of Bias 2.0 tool. Estimated mean differences and respective 95% confidence intervals were presented for each paired comparison and the strength of the current evidence was assessed using the GRADE approach. RESULTS AND DISCUSSION Thirty-one original trials involving 2120 participants were included. All outcomes were self-rated. Pain intensity was measured using the Visual Analogue Scale or Numerical Rating Scale. Disability was evaluated using the Roland Morris Disability Questionnaire, Oswestry Disability Index or Hannover Functional Ability Questionnaire. Short-term: Moderate quality of evidence that mindfulness reduces disability compared to patient education (mean difference [MD] = - 1.38 [95% CI - 2.02 to - 0.73]); low-quality evidence that mixed exercise (MD = - 50.33 [95% CI - 57.11 to - 43.56]) reduces pain compared to no intervention, waiting list, placebo or sham; low quality of evidence that there is no effect for opioid compared to placebo (MD = - 8.26 [95% CI - 19.29 to 2.77]) with regards to reducing pain and opioid/acetaminophen reduces disability more compared to pregabalin (MD = 2.36 [95% CI] 1.86-2.86]). CONCLUSIONS The findings showed low or very low quality of evidence for non-pharmacological interventions with a large effect in short- and long-term follow-up. The two studies that provided moderate quality of evidence had a small clinical effect. Only two studies were found that investigated pharmacological therapies-both with low quality of evidence. However, the studies were methodologically weak and had small sample sizes. Given the adverse effects of low back pain and the scarce information on the effectiveness of pharmacological and non-pharmacological treatments for older people, future randomized trials should be encouraged.
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Affiliation(s)
- Letícia Soares Fonseca
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Rodovia MGT 367, Km 583, 5000, Campus JK, Diamantina, CEP 39.100-000, Brazil.
| | - Juliana Pereira Silva
- Department of Physiotherapy, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Rodovia MGT 367, Km 583, 5000, Campus JK, Diamantina, CEP 39.100-000, Brazil
| | - Mateus Bastos Souza
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Rodovia MGT 367, Km 583, 5000, Campus JK, Diamantina, CEP 39.100-000, Brazil
| | | | - Rodrigo de Oliveira Mascarenhas
- Department of Physiotherapy, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Rodovia MGT 367, Km 583, 5000, Campus JK, Diamantina, CEP 39.100-000, Brazil
| | - Hytalo de Jesus Silva
- Postgraduate Program in Health Sciences, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Rodovia MGT 367, Km 583, 5000, Campus JK, Diamantina, CEP 39.100-000, Brazil
| | - Leani Souza Máximo Pereira
- Postgraduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Murilo Xavier Oliveira
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Rodovia MGT 367, Km 583, 5000, Campus JK, Diamantina, CEP 39.100-000, Brazil
| | - Vinicius Cunha Oliveira
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Rodovia MGT 367, Km 583, 5000, Campus JK, Diamantina, CEP 39.100-000, Brazil
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Zhang SK, Gu ML, Zhang T, Xu H, Mao SJ, Zhou WS. Effects of exercise therapy on disability, mobility, and quality of life in the elderly with chronic low back pain: a systematic review and meta-analysis of randomized controlled trials. J Orthop Surg Res 2023; 18:513. [PMID: 37468931 DOI: 10.1186/s13018-023-03988-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 07/09/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Exercise is an effective treatment in chronic low back pain (CLBP), but there are few studies on CLBP in the elderly, and the intervention effect is controversial. We aimed to compare the efficacy of different exercises therapy on CLBP, dysfunction, quality of life, and mobility in the elderly. METHODS We searched Web of Science, MEDLINE, Cochrane Library, Chinese National Knowledge Infrastructure, EMBASE, and PubMed from the database inception till December 31, 2022. The publication languages were Chinese and English. Randomized controlled trials (RCTs) of exercise intervention in the elderly (≥ 60 years) with CLBP were included. Two reviewers independently extracted the data and evaluated them using the Revised Cochrane Risk of Bias Tool for Randomized Trials 2 (RoB2). The pooled effect sizes on different aspects of outcome measures were calculated. RESULTS Sixteen articles (18 RCTs) were included, comprising a total of 989 participants. The quality of included studies was relatively high. Meta-analysis results indicated that exercise therapy could improve visual analog scale (VAS) (WMD = - 1.75, 95% CI - 2.59, - 0.92, p < 0.05), Oswestry disability index (ODI) (WMD = - 9.42, 95% CI - 15.04, - 3.79, p < 0,005), short-form 36-item health survey physical composite summary (SF-36PCS) (WMD = 7.07, 95% CI 1.01, 13.14, p < 0.05), short-form 36-item health survey mental composite summary (SF-36MCS) (WMD = 7.88, 95% CI 0.09, 15.67, p < 0.05), and timed up and go test (TUG) (WMD = - 0.92, 95% CI - 2.22, 0.38, p < 0.005). CONCLUSION Exercise therapy effectively improved VAS, ODI, and SF-36 indexes in the elderly. Based on the subgroup, when designing the exercise therapy regimen, aerobics, strength, and mind-body exercise (≥ 12 weeks, ≥ 3 times/week, ≥ 60 min) should be considered carefully, to ensure the safety and effectiveness for the rehabilitation of CLBP patients. More high-quality trials are needed in future to confirm the effect of exercise on SF-36 and TUG indexes.
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Affiliation(s)
- Shi-Kun Zhang
- Department of Police Physical Education, Jiangsu Police Institute, Nanjing, Jiangsu Province, China
| | - Mei-Ling Gu
- Nanjing Tian-zheng Primary School, Nanjing, China
| | - Ting Zhang
- Nanjing Tian-zheng Primary School, Nanjing, China
| | - Hong Xu
- Department of Sport & Health Science, College of Natural Science, Sangmyung University, Seoul, Korea
| | - Su-Jie Mao
- Graduate School of Nanjing University of Physical Education, Nanjing Sport Institute, Nanjing, China
| | - Wen-Sheng Zhou
- Department of Physical Education, Nanjing Xiao-Zhuang University, Nanjing, China.
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Li C, Xiao Z, Chen L, Pan S. Efficacy and safety of extracorporeal shock wave on low back pain: A systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e32053. [PMID: 36595991 PMCID: PMC9803516 DOI: 10.1097/md.0000000000032053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Extracorporeal shock wave therapy (ESWT) is a relatively new type of treatment for many musculoskeletal disorders. However, ESWT for low back pain remains controversial as the pain relieve benefit is questionable. We performed this systematic review and meta-analysis to explore the effectiveness and safety of ESWT interventions on pain and disability in patients with low back pain (LBP). METHODS In this meta-analysis, we searched electronic databases in the Pubmed, Embase, Cochrane's library, China National Knowledge Infrastructure, and Wanfang Database to determine the equivalence of ESWT and placebo for the treatment of LBP up to April 4, 2022. A number of other outcomes were measured, including functional status, quality of life, and psychological outcomes measured by the Oswestry Disability Index. Weighted mean differences were calculated for continuous outcomes, while risk ratios were calculated for binary outcomes. Stata 12.0 software was used for statistical analysis. RESULTS Thirteen randomized controlled trials included for further analysis. Compared with control, the ESWT group showed lower pain intensity at month 1 (P < .05), as well as lower disability score at month 1 (P < .05) and at month 3 (P < .05). There was no statistically significant difference between ESWT and control groups in terms of the pain intensity at month 3 (P > .05). No serious adverse events related to treatment were reported. Sensitivity analysis demonstrates that the conclusions from this analysis were robust. CONCLUSIONS ESWT is effective in alleviating pain and improving the functional outcomes for patients with LBP. However, there remains a lack of high-level evidence to verify their effectiveness and safety and support their clinical application.
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Affiliation(s)
- Chunhong Li
- Department of Operating Room, The First Affiliated Hospital of Hainan Medical University, Hainan, China
| | - Zhibo Xiao
- Department of Anesthesiology, The First Affiliated Hospital of Hainan Medical University, Hainan, China
| | - Liuli Chen
- Department of Operating Room, The First Affiliated Hospital of Hainan Medical University, Hainan, China
| | - Songli Pan
- Department of Operating Room, The First Affiliated Hospital of Hainan Medical University, Hainan, China
- Department of Spine Surgery, The First Affiliated Hospital of Hainan Medical University, Hainan, China
- *Correspondence: Songli Pan, Department of Spine Surgery, The First Affiliated Hospital of Hainan Medical University, No. 3, Longhua Road, Longhua district, Haikou, Hainan Province, 570102, PR China (e-mail: )
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