Back school vs idrokinesiterapia in pazienti affetti da lombalgia cronica: studio controllato (original) (raw)
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Acta bio-medica : Atenei Parmensis, 2014
Chronic low back pain (CLBP) is a major cause of disability, for which clinical practice guidelines suggest exercise programs, such as Back School program (stretching and selective muscle reinforcement techniques) and Hydrotherapy technique, as an effective treatment to reduce pain intensity and disability. We enrolled 56 elderly individuals, affected by non-specific CLBP, whose pain had worsened in the last three months, which were randomly allocated to Back School (group A) or to Hydrotherapy program (group B). Each group underwent two one-hour-treatment sessions per week, over a 12-week period. Each patient was evaluated using the Roland Morris Disability Questionnaire (RMDQ) and the 36-Item Short Form Health Survey (SF-36) V2.0 at the beginning (T0), at the end of treatment (T1) and at the 3-month follow-up (T2). At T1 and T2 we observed a highly significant statistical difference in the values measured in both groups: at T1 in group A RMDQ improvement of 3.26±1.02 (p<0.001)...
Study Design. This study was a prospective, random-ized, controlled study. Objective. To compare the effectiveness of aquatic exercise interventions with land-based exercises in the treatment of chronic low back pain (CLBP). Summary of Background Data. Land-based exercise and physiotherapy are the main treatment tools used for CLBP. Clinical experience indicates that aquatic exercise may have advantages for patients with musculoskeletal disorders. Methods. A total of 65 patients with CLBP were included in this study. Patients were randomly assigned to receive aquatic exercise or land-based exercise treatment protocol. Aquatic exercise program consisted of 20 sessions , 5 ϫ per week for 4 weeks in a swimming pool at 33°C. Land-based exercise (home-based exercise) program were demonstrated by a physiotherapist on one occasion and then they were given written advice The patients were assessed for spinal mobility, pain, disability, and quality of life. Evaluations were performed before treatment (week 0) and after treatment (week 4 and week 12). Results. In both groups, statistically significant improvements were detected in all outcome measures (ex-cept modified Schober test) compared with baseline. However, improvement in modified Oswestry Low Back Pain Disability questionnaire and physical function and role limitations due to physical functioning subpart of Short-Form 36 Health Survey were better in aquatic exercise group (P Ͻ 0.05). Conclusion. It is concluded that a water-based exercises produced better improvement in disability and quality of life of the patients with CLBP than land-based exercise. Water-based exercise may have value in various muscu-loskeletal conditions. Movement in water is often less painful than similar movement on land. Sensory input from water pressure and temperature may decrease feelings of pain. A desired exercise intensity can be achieved by adjusting the velocity of movement in the water. 1-3 Water-based physical activity enhances balance and coordination , while stimulating, visual, vestibular, and perceptual systems. Buoyancy reduces stress on joints and muscles and enables greater range of movement via supporting the weight of the body, changing depth allows for progression of resistance, and warm water increases muscle efficiency. 4 These findings suggest the potential benefits of aquatic exercise for people with chronic low back pain (CLBP); however, only a few published studies have examined the effects of aquatic exercise on people with low back pain (LBP). The recent guidelines for the management of patients with CLBP recommend supervised exercise therapy as a first-line treatment for the reduction of pain and disability. 5 The aim of this study is to compare the effectiveness of aquatic exercise interventions with land-based exercises in the treatment of CLBP. Materials and Methods This study was a prospective, randomized, controlled study. The criteria for inclusion were LBP without leg pain for more than 3 months and age of 20 to 50 years. The exclusion criteria were, (a) symptoms or signs that might suggest serious medical illness, 6 (b) pregnancy or recent childbirth, (c) major rheumatologic, neurologic, neoplastic, or other conditions that may prevent full participation in the intervention, (d) previous spinal surgery , (e) inflammatory, infectious, or malignant diseases of the vertebra, (f) the presence of the psychiatric disorder, which might affect the compliance and the assessment of symptoms, and (g) presence of severe cardiovascular disease. A total of 69 patients with CLBP without leg pain referred to our study. Two patients with symptoms or signs that might suggest serious medical illness, and another 2 patients with history of previous spinal surgery were excluded from the study. The number of excluded patient was the same (2 for aquatic therapy group and 2 for land-based exercise group) in both groups. After a physical examination, routine laboratory investigations, including full blood count, erythrocyte sedimen-tation rate, and biochemical markers (serum glucose, calcium, phosphorous, alkaline phosphatase, and also renal function tests and liver function tests), were evaluated. All patients underwent plain radiographs of lumbosacral spines. They were instructed not to take nonsteroidal anti-inflammatory drugs or any other analgesic during the treatment and control periods. Treatment Sixty-five patients from the outpatient physical medicine and rehabilitation clinic of our university hospital were randomized into 2 groups. The every first person on a list of names of 65 patients were assigned to the land-based exercise group, every
Treatment of Chronic Low-Back Pain
Clinical Orthopaedics and Related Research, 1984
Study Design. A stratified randomized single-blinded clinical trial. Objective. To compare the efficacies of 2 active therapies for chronic low back pain (CLBP). Summary of Background Data. Both a multidisciplinary biopsychosocial rehabilitation program and an intensive individual therapist-assisted back muscle strengthening exercise program used in Denmark have been reported to be effective for the treatment of CLBP. Methods. A total of 286 patients with CLBP were randomized to either a group-based 12-week program comprising 73 hours of therapist exposure (approximately 12 h/patient): 35 hours of hard physical exercise, 22 hours of light exercise/occupational therapy, and 16 hours of education (group A) or a 12-week program comprising 1 hour of personal training twice a week, i.e., therapist exposure 24 h/patient (group B). At baseline and at 3, 6, 12, and 24 months, patients filled out questionnaires on pain (visual analogue scale [VAS]-pain average, which was the primary outcome measure), Roland-Morris disability questionnaire, global perceived outcome, and 36-Item Short-Form General Health Survey. Data were analyzed using the intention-to-treat principle. Results. Of the 286 patients, 14 patients did not start treatment. Of the remaining patients, 25 (9%) dropped out of therapy. The 2 groups were comparable regarding baseline characteristic. After treatment, significant improvements were observed with regard to pain, disability, and most of the quality of life dimensions. These effects were sustained over the 24-month follow-up period. There were some statistically significant differences between the 2 groups relating to secondary end points, Roland-Morris disability questionnaire, and in the MOS 36-Item Short-Form Health Survey the "physical functioning" dimension and the "physical component summary." Conclusion. Both groups showed long-term improvements in pain and disability scores, with only minor statistically significant differences between the 2 groups. The minor outcome difference in favor of the group-based multidisciplinary rehabilitation program is hardly of clinical interest for individual patients.
Journal of spine research and surgery, 2022
Objective: This study aims to evaluate the effectiveness of Dynamic Back Strengthening exercise along with conventional physiotherapy for chronic non-specific low back pain (LBP) patients over a conventional rehabilitation protocol for chronic non-specific LBP patients. Methods: Between October to December 2021 to a total of 8 patients with nonspecific LBP (5 males, 3 females; mean age: 41.12± years; ranged, 25 to 55 years) were included in this randomized-controlled pilot study. The patients were randomly assigned to experimental (n=4) and control (n=4) group. The treatment period was 3 days in a week for four consecutive weeks where pre & post assessment were done. Data were collected by using structured questionnaires related to CLBP and disability, sociodemographic data were collected through a semi-structured questionnaire including the Dallas Pain Questionnaire & Oswestry disability index (ODI). Results: In Mann Whitney 'U', the level of significance is greater than p = > 0.05, and there is no significant difference in between group analysis for all traits of the Dallas pain questionnaire and the Oswestry disability questionnaire. Conclusion: Effectiveness of Dynamic Strengthening Exercise along with conventional physiotherapy was the same in comparison to the conventional physiotherapy treatment for patients with CLBP. In these limited sessions, it has been found that the strengthening program could be started earlier but not for all kinds of patients. As the disability level has been improved by both groups, so it can be introduced earlier with the patients. A complete study should be done with a larger sample size to find out the effectiveness of the dynamic strengthening exercise along with the conventional physiotherapy treatment approach for CLBP patients.
Effect of Aquatic Versus Conventional Therapy in Treatment of Chronic Low Back Pain
International Journal of Physiotherapy, 2018
Background: Chronic LBP a frequent sign of back dysfunction. The recent literature recorded that up to 90% of the world's population complain from LBP which cause disability in people. This study conducted to compare the efficacy of aquatic and conventional therapy on pain level, functional limitation and lumbar ROM in subjects with CLBP. Methods: Forty CLBP were divided into two groups (A) control 20 subjects received conventional therapy. (B) experimental received 20 subjects received aquatic therapy the treatment was given for six weeks. Results: Mixed MANOVA test showed statistically significant enhancement in values of post-treatment in either group compared with pre-treatment in pain enhancement for group A was 54.86% and 57.74% for group B (P=0.0001), functional limitation enhancement for group A was 55.46% and 58.95% for group B (p=0.0001), and lumbar ROM enhancement for group A was 46.63%, 18.79%, for lumbar flexion, and extension, and for group B was 46.96%, 22.85% (p=0.0001). Conclusion: It is concluded that aquatic and conventional therapies have a similar result in reducing pain severity, functional limitation, and enhancing lumbar ROM in CLBP patients.
European Spine Journal, 2011
Low back pain (LBP) is a common and disabling disorder in western society. The management of LBP comprises a range of different intervention strategies including surgery, drug therapy, and non-medical interventions. The objective of the present study is to determine the effectiveness of physical and rehabilitation interventions (i.e. exercise therapy, back school, transcutaneous electrical nerve stimulation (TENS), low level laser therapy, education, massage, behavioural treatment, traction, multidisciplinary treatment, lumbar supports, and heat/cold therapy) for chronic LBP. The primary search was conducted in MEDLINE, EMBASE, CINAHL, CENTRAL, and PEDro up to 22 December 2008. Existing Cochrane reviews for the individual interventions were screened for studies fulfilling the inclusion criteria. The search strategy outlined by the Cochrane Back Review Groups (CBRG) was followed. The following were included for selection criteria: (1) randomized controlled trials, (2) adult (C18 years) population with chronic (C12 weeks) nonspecific LBP, and (3) evaluation of at least one of the main clinically relevant outcome measures (pain, functional status, perceived recovery, or return to work). Two reviewers independently selected studies and extracted data on study characteristics, risk of bias, and outcomes at short, intermediate, and long-term follow-up. The GRADE approach was used to determine the quality of evidence. In total 83 randomized controlled trials met the inclusion criteria: exercise therapy (n = 37), back school (n = 5), TENS (n = 6), low level laser therapy (n = 3), behavioural treatment (n = 21), patient education (n = 1), traction (n = 1), and multidisciplinary treatment (n = 6). Compared to usual care, exercise therapy improved post-treatment pain intensity and disability, and long-term function. Behavioural treatment was found to be effective in reducing pain intensity at short-term follow-up compared to no treatment/waiting list controls. Finally, multidisciplinary treatment was found to reduce pain intensity and disability at short-term follow-up compared to no treatment/waiting list controls. Overall, the level of evidence was low. Evidence from randomized controlled trials demonstrates that there is low quality evidence for the effectiveness of exercise therapy compared to usual care, there is low evidence for the effectiveness of behavioural therapy compared to no treatment and there is moderate evidence for the Electronic supplementary material The online version of this article (
A randomized controlled trial, pretest-posttest design, with a 3-, 6-, and 12-month follow-up. Objectives: To investigate the efficacy of a therapeutic exercise approach in a population with chronic low back pain (LBP). Background: Therapeutic approaches developed from the Pilates method are becoming increasingly popular; however, there have been no reports on their efficacy. Methods and Measures: Thirty-nine physically active subjects between 20 and 55 years old with chronic LBP were randomly assigned to 1 of 2 groups. The specific-exercise-training group participated in a 4-week program consisting of training on specialized (Pilates) exercise equipment, while the control group received the usual care, defined as consultation with a physician and other specialists and healthcare professionals, as necessary. Treatment sessions were designed to train the activation of specific muscles thought to stabilize the lumbar-pelvic region. Functional disability outcomes were measured with The Roland Morris Disability Questionnaire (RMQ/RMDQ-HK) and average pain intensity using a 101-point numerical rating scale. Results: There was a significantly lower level of functional disability (P = .023) and average pain intensity (P = .002) in the specific-exercise-training group than in the control group following the treatment intervention period. The posttest adjusted mean in functional disability level in the specific-exercise-training group was 2.0 (95% CI, 1.3 to 2.7) RMQ/RMDQ-HK points compared to a posttest adjusted mean in the control group of 3.2 (95% CI, 2.5 to 4.0) RMQ/RMDQ-HK points. The posttest adjusted mean in pain intensity in the specific-exercise-training group was 18.3 (95% CI, 11.8 to 24.8), as compared to 33.9 (95% CI, 26.9 to 41.0) in the control group. Improved disability scores in the specific-exercise-training group were maintained for up to 12 months following treatment intervention. Conclusions: The individuals in the specific-exercise-training group reported a significant decrease in LBP and disability, which was maintained over a 12-month follow-up period. Treatment with a 1 Graduate student (at time of study), modified Pilates-based approach was more efficacious than usual care in a population with chronic, unresolved LBP.
Comparative Study of Physiotherapy Modalities and Exercise in Low Back Pain
Objectives: Comparative study of physiotherapy modalities and exercise in Low back pain. Design: Randomized Control Trial. Methodology: 20 Participants with a history of Chronic low back pain (CLBP) were randomly assigned into 5 groups; control group G1 (n = 4) that receive exercises only and 4 experimental groups (each with n = 4). The experimental groups are G2 (Ultrasound + exercise), G3 (IR + exercise), G4 (TENS with hot pack + exercise), and G5 (vibration massage + exercise). Each participant was treated 3 times weekly, for two weeks and each exercise repeated (10 × 5) along the period of study (2 weeks). The outcome measures used in this study were the Oswestry Disability Questionnaire (ODQ) and the Visual Analogue Scale (VAS) both of which were scored by all participants. Results: The VAS readings indicated a significant difference at the 1% level (p = 0.003) between the control group and the experimental groups, and showed highly significant in participants that treated with electric stimulation, then TENS with hot bag for 15 min. and followed by stretching and strengthening exercises as compared with the control group that received only the exercises. Also, ODQ readings showed significant difference (p = 0.123) between the control and treated groups. Results showed an improvement across experimental groups in pain and disability scores. Conclusion: The results of this study showed that TENS and hot pack with exercises have a better effect on improving pain and disability in participants suffering from CLBP. Interestingly, the control group who had postural re-education did improve as well as the core stability group. Age was not considered to be a factor when allocating participants into 5 groups. However, the younger age group showed marked improvement with posture re-education and exercise.
Exercise Therapy and Low Back Pain
Spine, 2008
Low back pain (LBP) can be defined as any form of pain, muscle tension, or stiffness localized between the costal margins and the inferior gluteal folds, with or without radiation into the lower limbs. 1 Any deformation of (functional-) anatomic structures of the spine may cause LBP, such as vertebrae, intervertebral discs, joints, ligaments, nerves, and muscles. The abnormality can be of mechanical origin (e.g., disc prolapse, spinal stenosis) or can have an underlying malignant or inflammatory disease (e.g., spinal tumor, ankylosing spondylitis). 2 These, mostly serious, forms of spinal pathology are referred to as "specific" LBP and can cause a great personal burden for those affected.