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Pain and functional outcomes after outpatient physiotherapy in patients with low back pain

Schmerz und funktionelle Ergebnisse nach ambulanter Physiotherapie bei Patienten mit Kreuzschmerzen

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Abstract

Background

Physiotherapy treatment programs are recommended in the rehabilitation of low back pain (LBP). Rehabilitation institutions are increasingly asked to demonstrate the outcomes of their intensive physiotherapy services.

Aim

To describe pain and functional outcome measures following a 6-month outpatient physiotherapy treatment program in patients with LBP.

Methods

A total of 85 patients were analysed after being treated with a combination of physiotherapeutic treatment modalities 2–3 days weekly. Pain and disability were measured before, 3 and 6 months after the onset of treatment. Isometric trunk muscle strength for flexion and extension and flexibility of dorsal trunk and thigh structures were measured before and 6 months after treatment.

Results

After 6 months, pain at rest decreased from a median of 4.0 to 0.0 (p < 0.01) and pain during activity from a median of 5.5 to 2.0 on the numeric rating scale (p < 0.001). The Roland–Morris Disability (RMDQ) score decreased from a median of 7.0 to 3.0 (p < 0.001). Mean trunk muscle flexion strength increased from 133.7 to 156.0 Nm and for extension from 235.5 to 278.3 Nm (p < 0.001). Flexibility was improved from a mean of −5.9 to −1.4 cm (p < 0.001). A moderate correlation between pain at rest and RMDQ score was found after 3 (r = 0.532, p < 0.01) and 6 months (r = 0.508, p < 0.01).

Conclusions

Patients with LBP who were treated with the physiotherapeutic treatment program showed a clinically relevant reduction of pain and disability with improved trunk muscle strength and flexibility. Reductions in pain and disability do not seem to correlate with increased trunk muscle strength and flexibility. No conclusions can be declared about long-term changes after the intervention.

Zusammenfassung

Hintergrund

Physiotherapeutische Behandlungsprogramme werden in der Rehabilitation von Kreuzschmerzen empfohlen. Von Rehabilitationseinrichtungen wird zunehmend erwartet, die Ergebnisse ihrer intensiven physiotherapeutischen Leistungen darzulegen.

Ziel

Darstellung von Schmerz und Funktion nach Ablauf eines 6‑monatigen ambulanten physiotherapeutischen Behandlungsprogramms bei Patienten mit Kreuzschmerzen.

Methodik

Es wurden 85 Patienten analysiert, die an einem aus mehreren Behandlungsmodalitäten bestehenden physiotherapeutischen Behandlungsprogramm teilgenommen hatten (2–3 Tage pro Woche). Schmerz und schmerzbedingte Behinderung wurden vor sowie 3 und 6 Monate nach Beginn der Intervention gemessen. Die isometrische Muskelkraft der Rumpfmuskulatur für die Flexion und Extension sowie die Beweglichkeit der dorsalen Strukturen des Rumpfs und des Oberschenkels wurden vor der Therapie und 6 Monate danach gemessen.

Ergebnisse

Nach 6 Monaten reduzierte sich der Ruheschmerz von einem Median von 4,0 auf 0,0 (p < 0,01) und der Schmerz während körperlicher Aktivität von einem Median von 5,5 auf 2,0 auf der numerischen Rating-Skala (p < 0,001). Der Roland-Morris-Disability-Questionnaire(RMDQ)-Score verringerte sich von einem Median von 7,0 auf 3,0 (p < 0,001). Die durchschnittliche Muskelkraft des Rumpfs für die Flexion steigerte sich von 133,7 auf 156,0 Nm, bezüglich der Extension nahm sie von 235,5 auf 278,3 Nm zu (p < 0,001). Die Beweglichkeit verbesserte sich von einem Mittelwert von −5,9 auf −1,4 cm (p < 0,001). Eine moderate Korrelation bestand zwischen dem Ruheschmerz und dem RMDQ-Score nach 3 Monaten (r = 0,532, p < 0,01) und nach 6 Monaten (r = 0,508, p < 0,01).

Schlussfolgerung

Patienten mit Kreuzschmerzen, die mit dem physiotherapeutischen Programm behandelt wurden, zeigten nach 6 Monaten eine klinisch relevante Reduzierung des Schmerzes und der schmerzbedingten Behinderung bei verbesserter Muskelkraft der Rumpfmuskulatur und besserer Beweglichkeit. Die Reduzierungen des Schmerzes und der schmerzbedingten Behinderung scheinen nicht mit den Steigerungen der Muskelkraft der Rumpfmuskulatur und der Beweglichkeit in Zusammenhang zu stehen. Die Ergebnisse geben keinen Aufschluss über die Nachhaltigkeit der Veränderungen.

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References

  1. American Physical Therapy Association (2001) Guide to physical therapist practice. Second edition. Phys Ther 81:9–746

    Google Scholar 

  2. Arnold B, Brinkschmidt T, Casser HR et al (2014) Multimodal pain therapy for treatment of chronic pain syndrome. Consensus paper of the ad hoc commission on multimodal interdisciplinary pain management of the German Pain Society on treatment contents. Schmerz 28:459–472

    Article  CAS  PubMed  Google Scholar 

  3. Baltaci G, Un N, Tunay V et al (2003) Comparison of three different sit and reach tests for measurement of hamstring flexibility in female university students. Br J Sports Med 37:59–61

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Bendix T, Bendix A, Labriola M et al (2000) Functional restoration versus outpatient physical training in chronic low back pain: a randomized comparative study. Spine 25:2494–2500

    Article  CAS  PubMed  Google Scholar 

  5. Borkan JM, Koes B, Reis S et al (1998) A report from the Second International Forum for Primary Care Research on Low Back Pain. Reexamining priorities. Spine 23:1992–1996

    Article  CAS  PubMed  Google Scholar 

  6. Bouter LM, Van Tulder MW, Koes BW (1998) Methodologic issues in low back pain research in primary care. Spine 23:2014–2020

    Article  CAS  PubMed  Google Scholar 

  7. Bredow J, Bloess K, Oppermann J et al (2016) Conservative treatment of nonspecific, chronic low back pain: evidence of the efficacy – a systematic literature review. Orthopade 45:573–578

    Article  CAS  PubMed  Google Scholar 

  8. Cohen J (1988) Statistical power analysis for the behavioral sciences, 2nd edn. Erlbaum, New York

    Google Scholar 

  9. Cypress BK (1983) Characteristics of physician visits for back symptoms: a national perspective. Am J Public Health 73:389–395

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Del Pozo-Cruz B, Gusi N, Adsuar JC et al (2013) Musculoskeletal fitness and health-related quality of life characteristics among sedentary office workers affected by sub-acute, non-specific low back pain: a cross-sectional study. Physiotherapy 99:194–200

    Article  PubMed  Google Scholar 

  11. Durmus D, Unal M, Kuru O (2014) How effective is a modified exercise program on its own or with back school in chronic low back pain? A randomized-controlled clinical trial. J Back Musculoskelet Rehabil 27:553–561

    Article  PubMed  Google Scholar 

  12. Farrar JT, Young JP Jr., Lamoreaux L et al (2001) Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain 94:149–158

    Article  CAS  PubMed  Google Scholar 

  13. Ferraz MB, Quaresma MR, Aquino LR et al (1990) Reliability of pain scales in the assessment of literate and illiterate patients with rheumatoid arthritis. J Rheumatol 17:1022–1024

    CAS  PubMed  Google Scholar 

  14. Fritz JM, Irrgang JJ (2001) A comparison of a modified Oswestry Low Back Pain Disability Questionnaire and the Quebec Back Pain Disability Scale. Phys Ther 81:776–788

    Article  CAS  PubMed  Google Scholar 

  15. Fritz JM, Magel JS, Mcfadden M et al (2015) Early physical therapy vs usual care in patients with recent-onset low back pain: A randomized clinical trial. JAMA 314:1459–1467

    Article  CAS  PubMed  Google Scholar 

  16. Giesche F, Streicher H, Maiwald M et al (2016) Inpatient multimodal pain therapy: Additive value of neuromuscular core stability exercises for chronic back pain. Schmerz. doi:10.1007/s00482-016-0178-6

    Google Scholar 

  17. Gruther W, Wick F, Paul B et al (2009) Diagnostic accuracy and reliability of muscle strength and endurance measurements in patients with chronic low back pain. J Rehabil Med 41:613–619

    Article  PubMed  Google Scholar 

  18. Hansen FR, Bendix T, Skov P et al (1993) Intensive, dynamic back-muscle exercises, conventional physiotherapy, or placebo-control treatment of low-back pain. A randomized, observer-blind trial. Spine 18:98–108

    Article  CAS  PubMed  Google Scholar 

  19. Harts CC, Helmhout PH, De Bie RA et al (2008) A high-intensity lumbar extensor strengthening program is little better than a low-intensity program or a waiting list control group for chronic low back pain: a randomised clinical trial. Aust J Physiother 54:23–31

    Article  PubMed  Google Scholar 

  20. Heitz CA, Hilfiker R, Bachmann LM et al (2009) Comparison of risk factors predicting return to work between patients with subacute and chronic non-specific low back pain: systematic review. Eur Spine J 18:1829–1835

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Jackson JK, Shepherd TR, Kell RT (2011) The influence of periodized resistance training on recreationally active males with chronic nonspecific low back pain. J Strength Cond Res 25:242–251

    Article  PubMed  Google Scholar 

  22. Kaapa EH, Frantsi K, Sarna S et al (2006) Multidisciplinary group rehabilitation versus individual physiotherapy for chronic nonspecific low back pain: a randomized trial. Spine 31:371–376

    Article  PubMed  Google Scholar 

  23. Keller S, Ehrhardt-Schmelzer S, Herda C et al (1997) Multidisciplinary rehabilitation for chronic back pain in an outpatient setting: a controlled randomized trial. Eur J Pain 1:279–292

    Article  CAS  PubMed  Google Scholar 

  24. Kool JP, Oesch PR, De Bie RA (2002) Predictive tests for non-return to work in patients with chronic low back pain. Eur Spine J 11:258–266

    Article  CAS  PubMed  Google Scholar 

  25. Krämer JF (1991) Bandscheiben-Operation – was dann? Dtsch Arztebl 88:39–45

    Google Scholar 

  26. Kumar S, Negi MP, Sharma VP et al (2009) Efficacy of two multimodal treatments on physical strength of occupationally subgrouped male with low back pain. J Back Musculoskelet Rehabil 22:179–188

    Article  CAS  PubMed  Google Scholar 

  27. Leboeuf-Yde C, Lauritsen JM, Lauritzen T (1997) Why has the search for causes of low back pain largely been nonconclusive? Spine 22:877–881

    Article  CAS  PubMed  Google Scholar 

  28. Macedo LG, Latimer J, Maher CG et al (2012) Effect of motor control exercises versus graded activity in patients with chronic nonspecific low back pain: a randomized controlled trial. Phys Ther 92:363–377

    Article  PubMed  Google Scholar 

  29. Maier A, Weh L, Klein A et al (2009) Exercise therapy in the treatment of chronic back pain. An integral part of interdisciplinary therapy. Orthopade 38:920 (922–924, 926–927)

    Article  CAS  PubMed  Google Scholar 

  30. Mikkelsson LO, Nupponen H, Kaprio J et al (2006) Adolescent flexibility, endurance strength, and physical activity as predictors of adult tension neck, low back pain, and knee injury: a 25 year follow up study. Br J Sports Med 40:107–113

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Moseley L (2002) Combined physiotherapy and education is efficacious for chronic low back pain. Aust J Physiother 48:297–302

    Article  PubMed  Google Scholar 

  32. Pieber K, Herceg M, Quittan M et al (2014) Long-term effects of an outpatient rehabilitation program in patients with chronic recurrent low back pain. Eur Spine J 23:779–785

    Article  PubMed  PubMed Central  Google Scholar 

  33. Resnik L, Dobrzykowski E (2003) Guide to outcomes measurement for patients with low back pain syndromes. J Orthop Sports Phys Ther 33:307–316 (discussion 317–308)

    Article  PubMed  Google Scholar 

  34. Roche-Leboucher G, Petit-Lemanac’h A, Bontoux L et al (2011) Multidisciplinary intensive functional restoration versus outpatient active physiotherapy in chronic low back pain: a randomized controlled trial. Spine 36:2235–2242

    Article  PubMed  Google Scholar 

  35. Ruhe A, Fejer R, Walker B (2012) Pain relief is associated with decreasing postural sway in patients with non-specific low back pain. BMC Musculoskelet Disord 13:39

    Article  PubMed  PubMed Central  Google Scholar 

  36. Sackett DL, Rosenberg WM, Gray JA et al (1996) Evidence based medicine: what it is and what it isn’t. BMJ 312:71–72

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Sahin N, Albayrak I, Durmus B et al (2011) Effectiveness of back school for treatment of pain and functional disability in patients with chronic low back pain: a randomized controlled trial. J Rehabil Med 43:224–229

    Article  PubMed  Google Scholar 

  38. Salaffi F, Stancati A, Silvestri CA et al (2004) Minimal clinically important changes in chronic musculoskeletal pain intensity measured on a numerical rating scale. Eur J Pain 8:283–291

    Article  PubMed  Google Scholar 

  39. Schafer A, Gartner-Tschacher N, Schottker-Koniger T (2013) Subgroup-specific therapy of low back pain: description and validity of two classification systems. Orthopade 42:90–99

    Article  CAS  PubMed  Google Scholar 

  40. Simpson AK, Cholewicki J, Grauer J (2006) Chronic low back pain. Curr Pain Headache Rep 10:431–436

    Article  PubMed  Google Scholar 

  41. Stratford PW, Binkley JM, Riddle DL et al (1998) Sensitivity to change of the Roland-Morris Back Pain Questionnaire: part 1. Phys Ther 78:1186–1196

    Article  CAS  PubMed  Google Scholar 

  42. Unsgaard-Tondel M, Fladmark AM, Salvesen O et al (2010) Motor control exercises, sling exercises, and general exercises for patients with chronic low back pain: a randomized controlled trial with 1‑year follow-up. Phys Ther 90:1426–1440

    Article  PubMed  Google Scholar 

  43. Van Middelkoop M, Rubinstein SM, Kuijpers T et al (2011) A systematic review on the effectiveness of physical and rehabilitation interventions for chronic non-specific low back pain. Eur Spine J 20:19–39

    Article  PubMed  Google Scholar 

  44. Von Korff M, Ormel J, Keefe FJ et al (1992) Grading the severity of chronic pain. Pain 50:133–149

    Article  Google Scholar 

  45. Wiesinger GF, Nuhr M, Quittan M et al (1999) Cross-cultural adaptation of the Roland-Morris questionnaire for German-speaking patients with low back pain. Spine 24:1099–1103

    Article  CAS  PubMed  Google Scholar 

  46. Woolf AD, Pfleger B (2003) Burden of major musculoskeletal conditions. Bull World Health Organ 81:646–656

    PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The authors would like to thank Petra Geißler, Mara Kozan and Rüdiger Hübbers-Lücking for assistance with the study.

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Authors and Affiliations

  1. Faculty of Health Care (Therapeutic Sciences), Niederrhein University of Applied Sciences, Reinarzstr. 49, 47805, Krefeld, Germany

    Martin Alfuth

  2. medicoreha Welsink Rehabilitation GmbH, Ambulante Fachkliniken für Rehabilitation, Preußenstr. 84a, 41464, Neuss, Germany

    Dieter W. Welsink

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  1. Martin Alfuth
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Correspondence to Martin Alfuth.

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Conflict of interest

D.W. Welsink is executive manager of medicoreha Welsink Rehabilitation GmbH. M. Alfuth declares that he has no competing interests.

The study was completed in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form). It was reviewed by the “Ethik-Kommission des Deutschen Verbands für Physiotherapie an der Physio-Akademie gGmbH, Wremen”. It was approved that this investigation evaluates rehabilitation practice with the aim of enhancing patients’ medical care and that no ethical approval is required. All patients included in the study gave written informed consent.

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Alfuth, M., Welsink, D.W. Pain and functional outcomes after outpatient physiotherapy in patients with low back pain. Orthopäde 46, 522–529 (2017). https://doi.org/10.1007/s00132-017-3390-x

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