Effect of multidimensional physiotherapy on non-specific chronic low back pain: a randomized controlled trial.

IF 2 4区医学 Q3 RHEUMATOLOGY Advances in Rheumatology Pub Date : 2023-12-04 DOI:10.1186/s42358-023-00329-9

Sanaz Bemani, Javad Sarrafzadeh, Shohreh Noorizadeh Dehkordi, Saeed Talebian, Reza Salehi, Jamileh Zarei

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Abstract

Background: Many people with non-specific chronic low back pain (NSCLBP) do not recover with current conventional management. Systematic reviews show multidimensional treatment improves pain better than usual active interventions. It is unclear whether multidimensional physiotherapy improves pain better than usual physiotherapy. This study determines the effectiveness of this treatment to reduce pain and disability and improve quality of life, pain cognitions, and electroencephalographic pattern in individuals with NSCLBP.

Methods: 70 eligible participants aged 18 to 50 years with NSCLBP were randomized into either the experimental group (multidimensional physiotherapy) or the active control group (usual physiotherapy). Pain intensity was measured as the primary outcome. Disability, quality of life, pain Catastrophizing, kinesiophobia, fear Avoidance Beliefs, active lumbar range of motion, and brain function were measured as secondary outcomes. The outcomes were measured at pre-treatment, post-treatment, 10, and 22 weeks. Data were analyzed using intention-to-treat approaches.

Results: There were 17 men and 18 women in the experimental group (mean [SD] age, 34.57 [6.98] years) and 18 men and 17 women in the active control group (mean [SD] age, 35.94 [7.51] years). Multidimensional physiotherapy was not more effective than usual physiotherapy at reducing pain intensity at the end of treatment. At the 10 weeks and 22 weeks follow-up, there were statistically significant differences between multidimensional physiotherapy and usual physiotherapy (mean difference at 10 weeks, -1.54; 95% CI, -2.59 to -0.49 and mean difference at 22 weeks, -2.20; 95% CI, - 3.25 to - 1.15). The standardized mean difference and their 95% confidence intervals (Cohen's d) revealed a large effect of pain at 22 weeks: (Cohen's d, -0.89; 95% CI (-1.38 to-0.39)). There were no statistically significant differences in secondary outcomes.

Conclusions: In this randomized controlled trial, multidimensional physiotherapy resulted in statistically and clinically significant improvements in pain compared to usual physiotherapy in individuals with NSCLBP at 10 and 22 weeks.

Trial registration: ClinicalTrials.gov NCT04270422; IRCT IRCT20140810018754N11.

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多维物理治疗对非特异性慢性腰痛的影响:一项随机对照试验。

背景:许多非特异性慢性腰痛(NSCLBP)患者在目前的常规治疗下无法康复。系统评价显示，多维治疗比通常的积极干预更能改善疼痛。目前尚不清楚多维物理治疗是否比常规物理治疗更能改善疼痛。本研究确定了这种治疗在减轻NSCLBP患者疼痛和残疾、改善生活质量、疼痛认知和脑电图模式方面的有效性。方法:70例年龄在18 ~ 50岁的NSCLBP患者随机分为实验组(多维物理治疗)和积极对照组(常规物理治疗)。疼痛强度作为主要观察指标。残疾、生活质量、疼痛灾难化、运动恐惧症、恐惧回避信念、腰椎活动度和脑功能作为次要结果进行测量。在治疗前、治疗后、10周和22周测量结果。使用意向治疗方法分析数据。结果:实验组男性17例，女性18例，平均[SD]年龄34.57[6.98]岁;积极对照组男性18例，女性17例，平均[SD]年龄35.94[7.51]岁。在治疗结束时，多维物理治疗在减轻疼痛强度方面并不比常规物理治疗更有效。在随访10周和22周时，多维物理治疗与常规物理治疗的差异有统计学意义(10周时平均差异为-1.54;95% CI， -2.59至-0.49,22周时的平均差异为-2.20;95% CI， - 3.25至- 1.15)。标准化平均差及其95%置信区间(Cohen’s d)显示，疼痛在22周时的影响很大:(Cohen’s d， -0.89;95% CI(-1.38 -0.39))。在次要结局方面没有统计学上的显著差异。结论:在这项随机对照试验中，与常规物理治疗相比，多维物理治疗在10周和22周时对非小细胞bp患者的疼痛有统计学和临床显著的改善。试验注册:ClinicalTrials.gov NCT04270422;IRCT IRCT20140810018754N11。

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来源期刊

Advances in Rheumatology Medicine-Rheumatology

CiteScore

4.00

自引率

4.30%

发文量

审稿时长

53 weeks

期刊介绍： Formerly named Revista Brasileira de Reumatologia, the journal is celebrating its 60th year of publication. Advances in Rheumatology is an international, open access journal publishing pre-clinical, translational and clinical studies on all aspects of paediatric and adult rheumatic diseases, including degenerative, inflammatory and autoimmune conditions. The journal is the official publication of the Brazilian Society of Rheumatology and welcomes original research (including systematic reviews and meta-analyses), literature reviews, guidelines and letters arising from published material.