Arthrokinematic Approach-Hakata Method effective in chronic nonspecific low back pain .
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2016;4(9):27 PLoS One. 2015 Dec 8;10(12):e0144325186 patients diagnosed with chronic nonspecific low back pain were randomized to receive either the Arthrokinematic approach-Hakata (AKA-H) method (manual therapy) or a sham treatment, once a month for 6 months. The purpose of the study was to determine if the AKA-H method positively affected pain, disability and quality of life after 6 months of treatment. The results suggested that patients in the AKA-H group displayed significant improvements compared to the sham group in pain scores, disability, and quality of life that generally began after 3 months and lasted for the remainder of the 6 month study period.
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
Sí = 1
Incierto = 0,5
No relevante = 0
No = 0
La evaluación de los criterios de información evalúa la transparencia con la que los autores informan de las características metodológicas y del ensayo dentro de la publicación. La evaluación se divide en cinco categorías que se presentan a continuación.
2/4
Randomization
2/4
Outcome Measurements
4/4
Inclusion / Exclusion
4/4
Therapy Description
4/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
El Índice de Fragilidad es una herramienta que ayuda en la interpretación de hallazgos significativos, proporcionando una medida de fuerza para un resultado. El Índice de Fragilidad representa el número de eventos consecutivos que es necesario añadir a un resultado dicotómico para que el hallazgo deje de ser significativo. Un número pequeño representa un hallazgo más débil y un número grande un hallazgo más fuerte.
¿Por qué se necesitaba ahora este estudio?
Chronic nonspecific low back pain is very common in the general population and is associated with a reduced quality of life. While this condition is prevalent in the general population a gold standard for effective management has yet to be defined. Various conservative therapies exist; however, these treatments vary in effectiveness from patient to patient. The Arthrokinematic Approach-Hakata (AKA-H) method is a manual procedure for treating abnormalities of intraarticular movement of the synovial joint and guides movement on the joint surface. Although not indicated for a specific pathology, the efficacy of the AKA-H method in the treatment of low back pain warranted examination.
¿Cuál era la pregunta principal de la investigación?
In adults with chronic low back pain, how did the Arthrokinematic approach-Hakata method affect pain and quality of life in comparison to sham treatment when assessed over 6 months?
- The mean VAS pain score at 6 months was significantly lower in the AFA-H group when compared to the sham group (31.2 +/- 18.8 vs. 45.5 +/- 22.0; p<0.0016). This difference was also observed at months 3-5 (all p<0.0016), however, no significant differences between groups were noted at months 1 and 2 (both p>0.05)
- RDQ scores were similar between groups from months 1-3 (p>0.05), however, the AFA-H group displayed significantly greater improvements at months 4 (p<0.008), 5 (p<0.0016) and 6 (AFA-H: 49.3 +/- 9.3 vs. Sham: 42.6 +/- 9.9; p<0.0016)
- SF-36 subscores were significantly better in the AFA-H group in terms of bodily pain and mental health from months 2-6, in physical functioning, social functioning, general health perception, vitality, and emotional role functioning from months 3-6, and in physical role functioning from months 4-6 (p<0.008)
- Mild side effects, including muscle weakness and lower leg numbness, were comparable between groups
¿Qué es lo que más debo recordar?
For patients with nonspecific low back pain, management using the Arthrokinematic approach-Hakata method displayed significant improvements in VAS pain scores after 3 months which were sustained until final follow-up at 6 months when compared to sham treatment. Additionally, the AKA-H patients displayed significantly greater improvements in disability and quality of life, generally beginning after the third month of treatment, and lasting for the remainder of the study period.
¿Cómo afectará esto al cuidado de mis pacientes?
The results of this randomized controlled trial suggest that the Arthrokinematic approach-Hakata method, for the treatment of patients with chronic low back pain, may improve pain, disability, and quality of life after 6 months of monthly treatment when compared to a sham treatment. However, further trials using a double-blind methodology that include a more gender-balanced population are required to further elucidate the efficacy of this treatment.
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