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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Acknowledgements
The authors would like to thank Petra Geißler, Mara Kozan and Rüdiger Hübbers-Lücking for assistance with the study.
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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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DOI: https://doi.org/10.1007/s00132-017-3390-x
Keywords
- Evidence-based practice
- Physiotherapeutic treatment program
- Disability
- Trunk muscle strength
- Treatment outcome