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Al-Banawi LAA, Youssef EF, Shanb AA, Shanb BE. Effects of the Addition of Hands-on Procedures to McKenzie Exercises on Pain, Functional Disability and Back Mobility in Patients with Low Back Pain: A Randomised Clinical Trial. Malays J Med Sci 2023; 30:122-134. [PMID: 37425389 PMCID: PMC10325135 DOI: 10.21315/mjms2023.30.3.11] [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: 06/07/2022] [Accepted: 09/25/2022] [Indexed: 07/11/2023] Open
Abstract
Background Low back pain (LBP) is a common musculoskeletal disorder that affects people of all ages. This study investigates the effects of the addition of hands-on procedures to McKenzie exercises on patients with LBP and derangement syndrome. Methods Forty-eight female patients were randomly assigned to either the experimental group or control group. All the patients in both groups underwent McKenzie exercises, transcutaneous electrical nerve stimulation (TENS) and education for 35 min/session-45 min/ session, with three sessions/week for 2 weeks. Hands-on procedures were added to the McKenzie extension exercises only for the patients in the experimental group. A visual analogue scale (VAS), the Oswestry disability index (ODI), back range of motion (BROM) and body diagrams were used to measure pain, functional disability, BROM and the centralisation of symptoms, respectively. Results The mean values of VAS, ODI and BROM significantly improved after the interventions in both groups (P < 0.05), whereas the results of repeated measures ANOVA and Mann-Whitney U tests showed statistically non-significant differences between the two groups (P > 0.05). Conclusion The addition of hands-on procedures to McKenzie exercises, TENS and education significantly alleviated back pain and functional disability and improved the back mobility and centralisation of symptoms in patients with LBP and derangement syndrome; however, these measures did not result in any significant additional benefits for such patients.
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Affiliation(s)
| | - Enas Fawzy Youssef
- Orthopedic Physical Therapy Department, Faculty of Physical Therapy, Cairo University, Egypt
| | - Alsayed Abdelhameed Shanb
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Kingdom of Saudi Arabia
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Garcia AN, Costa LOP, Costa LDCM, Hancock M, Cook C. Do prognostic variables predict a set of outcomes for patients with chronic low back pain: a long-term follow-up secondary analysis of a randomized control trial. J Man Manip Ther 2019; 27:197-207. [PMID: 30946005 DOI: 10.1080/10669817.2019.1597435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2022] Open
Abstract
Objective: The objective was to explore for universal prognostic variables, or predictors, across three different outcome measures in patients with chronic low back pain (LBP). We hypothesized that selected prognostic variables would be 'universal' prognostic variables, regardless of the outcome measures used. Methods: This study was a secondary analysis of data from a previous randomized controlled trial comparing the McKenzie treatment approach with placebo in patients with chronic LBP. Ten baseline prognostic variables were explored in predictive models for three outcomes: pain intensity, disability, and global perceived effect, at 6 and 12 months. Predictive models were created using backward stepwise logistic and linear multivariate regression analyses. Results: Several predictors were present including age, expectancy of improvement, global perceived effect; however, we only identified baseline disability as a universal predictor of outcomes at 6 months. The second most represented universal predictor was baseline pain intensity for outcomes at 12 months. Discussion: Only two predictors demonstrated an association with more than one outcome measure. High baseline disability predicts multidimensional outcome measures at 6 months in patients with chronic LBP while baseline pain intensity can best predict the outcome at 12 months. Nevertheless, other predictors seem to be unique to the outcome used. Level of evidence: 2c.
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Affiliation(s)
- Alessandra Narciso Garcia
- a Doctor of Physical Therapy Division, Department of Orthopaedic Surgery, Duke University , Durham , NC , USA
| | - Leonardo O P Costa
- b Physical Therapy, University Cidade de Sao Paulo , Sao Paulo , Brazil.,c School of Public Health, Sydney Medical School, The University of Sydney, Ashleigh Provest , Sydney , Australia
| | | | - Mark Hancock
- e Discipline of Physiotherapy, Faculty of Human Sciences, Macquarie University , Sydney , Australia
| | - Chad Cook
- f Doctor of Physical Therapy Division, Duke Clinical Research Institute, Duke University , Durham , NC , USA
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Paolucci T, Attanasi C, Cecchini W, Marazzi A, Capobianco SV, Santilli V. Chronic low back pain and postural rehabilitation exercise: a literature review. J Pain Res 2018; 12:95-107. [PMID: 30588084 PMCID: PMC6305160 DOI: 10.2147/jpr.s171729] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Chronic low back represents one of the major causes of disability worldwide. Our narrative review has the purpose of highlighting the evidence supporting the different rehabilitative techniques described for its management. In total, 26 studies were found suitable to be included in the review (14 articles about pilates, six about McKenzie (MK), one article about Feldenkrais, three about Global Postural Rehabilitation (GPR) and two about Proprioceptive Neuromuscular Facilitation). The effect of exercise therapy was examined for each single study through changes in the main clinical outcomes (pain, disability,) quality of life (QoL) and psychological aspects and the targeted aspects of physical function (muscle strength, mobility, muscular activity and flexibility). All the techniques are effective for the study groups with respect to the control groups in reducing pain and disability and improving the QoL and maintaining benefits at follow-up; pilates, Back School, MK and Feldenkrais methods reduce pain and are more efficient than a pharmacological or instrumental approach in reducing disability and improving all psychological aspects also. GPR shows long lasting results for the last outcome. To date, it is difficult to affirm the superiority of one approach over another. Further high quality research is needed to confirm the effect of these techniques, together with the use of more appropriate evaluation measures.
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Affiliation(s)
- Teresa Paolucci
- Department of Physical Medicine and Rehabilitation, Policlinico Universitario Umberto I, Sapienza University, Rome, Italy,
| | - Carmine Attanasi
- Department of Physical Medicine and Rehabilitation, Policlinico Universitario Umberto I, Sapienza University, Rome, Italy,
| | - Walter Cecchini
- Physical Medicine and Rehabilitation Unit, S. Filippo Neri Hospital, Rome, Italy
| | - Alessandra Marazzi
- Physical Medicine and Rehabilitation Unit, S. Filippo Neri Hospital, Rome, Italy
| | - Serena V Capobianco
- Department of Physical Medicine and Rehabilitation, Policlinico Universitario Umberto I, Sapienza University, Rome, Italy,
| | - Valter Santilli
- Department of Physical Medicine and Rehabilitation, Policlinico Universitario Umberto I, Sapienza University, Rome, Italy,
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Reliability of the Mechanical Diagnosis and Therapy System in Patients With Spinal Pain: A Systematic Review. J Orthop Sports Phys Ther 2018; 48:923-933. [PMID: 29932871 DOI: 10.2519/jospt.2018.7876] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND An updated summary of the evidence for the reliability of the Mechanical Diagnosis and Therapy (MDT) system in patients with spinal pain is needed. OBJECTIVE To investigate the evidence on the intrarater and interrater reliability of MDT in patients with spinal pain. METHODS Searches in MEDLINE, CINAHL, Embase, PEDro, and Scopus were conducted for this systematic review. We included any study design as long as reliability of the MDT method was tested in patients with spinal pain. We collected data on the reliability of MDT to identify main and subsyndromes, directional preference, the centralization phenomenon, and lateral shift. The methodological quality of studies was assessed using the Quality Appraisal of Diagnostic Reliability and the Guidelines for Reporting Reliability and Agreement Studies checklists. RESULTS Twelve studies were included (8 studies on back pain, pooled n = 2160 patients; 3 studies on neck pain, pooled n = 45 patients; and 3 studies recruited mixed spinal conditions, pooled n = 389 patients). Studies investigating patients with back pain reported kappa estimates ranging from 0.26 to 1.00 (main and subsyndromes), 0.27 to 0.90 (directional preference), and 0.11 to 0.70 (centralization phenomenon). Kappa estimates for studies investigating neck pain ranged from 0.47 to 0.84 (main and subsyndromes) and 0.46 (directional preference). In mixed populations, kappa estimates ranged from 0.56 to 0.96 (main and subsyndromes). CONCLUSION The MDT system appears to have acceptable interrater reliability for classifying patients with back pain into main and subsyndromes when applied by therapists who have completed the credentialing examination, but unacceptable reliability in other therapists. We found conflicting evidence regarding the reliability of the MDT system in patients with neck pain or mixed pain locations. J Orthop Sports Phys Ther 2018;48(12):923-933. Epub 22 Jun 2018. doi:10.2519/jospt.2018.7876.
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Description of low back pain clinical trials in physical therapy: a cross sectional study. Braz J Phys Ther 2018; 23:448-457. [PMID: 30237058 DOI: 10.1016/j.bjpt.2018.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 08/27/2018] [Accepted: 09/04/2018] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE To describe the main characteristics of low back pain randomized controlled trials on the Physiotherapy Evidence Database, and to rank the journals where these trials were published according to their Impact Factor. METHODS This is a cross sectional study based on a collection of randomized controlled trials. A random sample of 200 low back pain trials published between 2010 and 2015 were selected from Physiotherapy Evidence Database in February 2016. We collected the following main characteristics of trials: 2015 journal Impact Factor; if the paper was published as open access; CONSORT recommendations endorsement by the journal; methodological quality and statistical reporting measured by the 0-10 items Physiotherapy Evidence Database scale. Data was analyzed descriptively. RESULTS Trials were published in journals with a mean Impact Factor of 2.5 (SD 2.5), from which 55.5% endorsed the CONSORT recommendations. The methodological quality was moderate with 5.8 points (SD 1.6). The top 3 journals according to Impact Factor were: (1) British Medical Journal; (2) Annals of Internal Medicine; and (3) BMC Medicine. Only 6 out of 97 journals publishing low back pain trials combined the following factors: journal Impact Factor higher than 2.0, mean trial methodological quality higher than 6.0 points, endorse CONSORT recommendations and offering papers as open access. CONCLUSION Clinicians interested in low back pain trials must look for a wide variety of healthcare journals. A substantial number of low back pain randomized controlled trials did not follow adequate reporting and methodological recommendations.
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Shariat A, Cleland JA, Danaee M, Kargarfard M, Sangelaji B, Tamrin SBM. Effects of stretching exercise training and ergonomic modifications on musculoskeletal discomforts of office workers: a randomized controlled trial. Braz J Phys Ther 2018; 22:144-153. [PMID: 28939263 PMCID: PMC5883995 DOI: 10.1016/j.bjpt.2017.09.003] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 05/30/2017] [Accepted: 07/27/2017] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE To evaluate the effectiveness of exercise, ergonomic modification, and a combination of training exercise and ergonomic modification on the scores of pain in office workers with neck, shoulders, and lower back pain. METHODS Participants (N=142) in this randomized controlled trial were office workers aged 20-50 years old with neck, shoulders, and lower back pain. They were randomly assigned to either the ergonomic modification group, the exercise group, the combined exercise and ergonomic modification group, or the control group (no-treatment). The exercise training group performed a series of stretching exercises, while the ergonomic group received some modification in the working place. Outcome measures were assessed by the Cornell Musculoskeletal Disorders Questionnaire at baseline, after 2, 4, and 6 months of intervention. RESULTS There was significant differences in pain scores for neck (MD -10.55; 95%CI -14.36 to -6.74), right shoulder (MD -12.17; 95%CI -16.87 to -7.47), left shoulder (MD -11.1; 95%CI -15.1 to -7.09) and lower back (MD -7.8; 95%CI -11.08 to -4.53) between the exercise and control groups. Also, significant differences were seen in pain scores for neck (MD -9.99; 95%CI -13.63 to -6.36), right shoulder (MD -11.12; 95%CI -15.59 to -6.65), left shoulder (MD -10.67; 95%CI -14.49 to -6.85) and lower back (MD -6.87; 95%CI -10 to -3.74) between the combined exercise and ergonomic modification and control groups. The significant improvement from month 4 to 6, was only seen in exercise group (p<0.05). CONCLUSION To have a long term effective on MSDs, physical therapists and occupational therapists should use stretching exercises in their treatment programs rather than solely rely on ergonomic modification. CLINICAL TRIAL ID NCT02874950 - https://www.clinicaltrials.gov/ct2/show/NCT02874950.
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Affiliation(s)
- Ardalan Shariat
- Department of Occupational Health, Faculty of Medicine and Health Sciences, University Putra Malaysia, Serdang, Malaysia; Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | | | - Mahmoud Danaee
- Academic Development Center, University of Malaya, Kuala Lumpur, Malaysia
| | - Mehdi Kargarfard
- Department of Exercise Physiology, Faculty of Sport Sciences, University of Isfahan, Isfahan, Iran
| | | | - Shamsul Bahri Mohd Tamrin
- Department of Occupational Health, Faculty of Medicine and Health Sciences, University Putra Malaysia, Serdang, Malaysia
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Tomazoni SS, Costa LDCM, Guimarães LDS, Araujo AC, Nascimento DP, Medeiros FCD, Avanzi MA, Costa LOP. Effects of photobiomodulation therapy in patients with chronic non-specific low back pain: protocol for a randomised placebo-controlled trial. BMJ Open 2017; 7:e017202. [PMID: 29070637 PMCID: PMC5665327 DOI: 10.1136/bmjopen-2017-017202] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 08/04/2017] [Accepted: 08/17/2017] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Low back pain (LBP) is one of the largest and most frequent public health problems worldwide. Photobiomodulation therapy (PBMT) is a frequently used non-pharmacological therapy for the treatment of musculoskeletal disorders. However, there is little high-quality scientific evidence that demonstrates the effectiveness of PBMT in the treatment of patients with chronic LBP in the short, medium and long term. Therefore, the objective of this clinical trial is to evaluate the effects of PBMT in patients with chronic non-specific LBP in the short, medium and long term. METHODS AND ANALYSES This is a prospectively registered, two-arm randomised placebo-controlled trial with blinded patients, assessors and treatment providers. One hundred and forty-eight patients with chronic non-specific LBP will be recruited. Treatment sessions will be provided three times a week for 4 weeks (totaling 12 sessions) with patients receiving either placebo or active PBMT. For ethical reasons, all patients, regardless of treatment allocation, will also receive an information booklet based on 'The Back Book'. Clinical outcomes will be measured at baseline, at the end of treatment, as well as 3, 6 and 12 months after randomisation. The primary outcomes will be pain intensity and disability measured after 12 sessions of treatment. The secondary outcomes will be pain intensity and disability measured at 3, 6 and 12 months after randomisation, in addition to specific disability and global perceived effect in all time points. ETHICS AND DISSEMINATION The study was approved by the Research Ethics Committee of Universidade Cidade de São Paulo. The results will be disseminated through scientific publications and presentations at national and international scientific meetings. TRIAL REGISTRATION NUMBER NCT03089424.
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Affiliation(s)
- Shaiane Silva Tomazoni
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, Brazil
| | | | | | - Amanda Costa Araujo
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, Brazil
| | - Dafne Port Nascimento
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, Brazil
| | | | - Marina Athayde Avanzi
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, Brazil
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Garcia AN, Costa LDCM, Hancock MJ, Souza FSD, Gomes GVFDO, Almeida MOD, Costa LOP. McKenzie Method of Mechanical Diagnosis and Therapy was slightly more effective than placebo for pain, but not for disability, in patients with chronic non-specific low back pain: a randomised placebo controlled trial with short and longer term follow-up. Br J Sports Med 2017; 52:594-600. [DOI: 10.1136/bjsports-2016-097327] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2017] [Indexed: 11/04/2022]
Abstract
BackgroundThe McKenzie Method of Mechanical Diagnosis and Therapy (MDT) is one of the exercise approaches recommended by low back pain (LBP) guidelines. We investigated the efficacy of MDT compared with placebo in patients with chronic LBP.MethodsThis was a prospectively registered, two-arm randomised placebo controlled trial, with a blinded assessor. A total of 148 patients seeking care for chronic LBP were randomly allocated to either MDT (n=74) or placebo (n=74). Patients from both groups received 10 treatment sessions over 5 weeks. Patients from both groups also received an educational booklet. Clinical outcomes were obtained at the end of treatment (5 weeks) and 3, 6 and 12 months after randomisation. Primary outcomes were pain intensity and disability at the end of treatment (5 weeks). We also conducted a subgroup analysis to identify potential treatment effect modifiers that could predict a better response to MDT treatment.ResultsThe MDT group had greater improvements in pain intensity at the end of treatment (mean difference (MD) −1.00, 95% CI −2.09 to −0.01) but not for disability (MD −0.84, 95% CI −2.62 to 0.93). We did not detect between-group differences for any secondary outcomes, nor were any treatment effect modifiers identified. Patients did not report any adverse events.ConclusionWe found a small and likely not clinically relevant difference in pain intensity favouring the MDT method immediately at the end of 5 weeks of treatment but not for disability. No other difference was found for any of the primary or secondary outcomes at any follow-up times.Trial registration numberClinicalTrials.gov (NCT02123394)
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Szulc P, Wendt M, Waszak M, Tomczak M, Cieślik K, Trzaska T. Impact of McKenzie Method Therapy Enriched by Muscular Energy Techniques on Subjective and Objective Parameters Related to Spine Function in Patients with Chronic Low Back Pain. Med Sci Monit 2015; 21:2918-32. [PMID: 26418868 PMCID: PMC4596425 DOI: 10.12659/msm.894261] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background The high incidence and inconsistencies in diagnostic and therapeutic process of low back pain (LBP) stimulate the continuing search for more efficient treatment modalities. Integration of the information obtained with various therapeutic methods and a holistic approach to the patient seem to be associated with positive outcomes. The aim of this study was to analyze the efficacy of combined treatment with McKenzie method and Muscle Energy Technique (MET), and to compare it with the outcomes of treatment with McKenzie method or standard physiotherapy in specific chronic lumbar pain. Material/Methods The study included 60 men and women with LBP (mean age 44 years). The patients were randomly assigned to 1 of 3 therapeutic groups, which were further treated with: 1) McKenzie method and MET, 2) McKenzie method alone, or 3) standard physiotherapy for 10 days. The extent of spinal movements (electrogoniometry), level of experienced pain (Visual Analogue Scale and Revised Oswestry Pain Questionnaire), and structure of the spinal discs (MRI) were examined prior to the intervention, immediately thereafter, and 3 months after the intervention. Results McKenzie method enriched with MET had the best therapeutic outcomes. The mobility of cervical, thoracic, and lumbar spine normalized at levels corresponding to 87.1%, 66.7%, and 95% of respective average normative values. Implementation of McKenzie method, both alone and combined with MET, was associated with a significant decrease in Oswestry Disability Index, significant alleviation of pain (VAS), and significantly reduced size of spinal disc herniation. Conclusions The combined method can be effectively used in the treatment of chronic LBP.
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Affiliation(s)
- Paweł Szulc
- Department of Functional Anatomy, University School of Physical Education, Poznań, Poland
| | - Michał Wendt
- Department of Sports Medicine and Traumatology, University School of Physical Education, Poznań, Poland
| | - Małgorzata Waszak
- Department of Functional Anatomy, University School of Physical Education, Poznań, Poland
| | - Maciej Tomczak
- Department of Psychology, University School of Physical Education, Poznań, Poland
| | - Krystyna Cieślik
- Department of Functional Anatomy, University School of Physical Education, Poznań, Poland
| | - Tadeusz Trzaska
- Department of Sports Medicine and Traumatology, University School of Physical Education, Poznań, Poland
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