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)?
Sì = 1
Incerto = 0,5
Non rilevante = 0
No = 0
La valutazione dei criteri di segnalazione valuta la trasparenza con cui gli autori riportano le caratteristiche metodologiche e sperimentali dello studio all'interno della pubblicazione. La valutazione è suddivisa in cinque categorie che vengono presentate di seguito.
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
L'Indice di Fragilità è uno strumento che aiuta l'interpretazione dei risultati significativi, fornendo una misura della forza di un risultato. L'Indice di Fragilità rappresenta il numero di eventi consecutivi che devono essere aggiunti a un risultato dicotomico per rendere il risultato non più significativo. Un numero piccolo rappresenta un risultato più debole, mentre un numero grande rappresenta un risultato più forte.
Perché questo studio era necessario ora?
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.
Qual era la domanda di ricerca principale?
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
Che cosa devo ricordare di più?
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.
Come influenzerà l'assistenza ai miei pazienti?
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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