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)?
Sim = 1
Incerto = 0,5
Não relevante = 0
Não = 0
A Avaliação dos Critérios de Relato avalia a transparência com que os autores relatam as caraterísticas metodológicas e do ensaio na publicação. A avaliação está dividida em cinco categorias que são apresentadas de seguida.
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
O Índice de Fragilidade é uma ferramenta que auxilia na interpretação de achados significativos, fornecendo uma medida de força para um resultado. O Índice de Fragilidade representa o número de eventos consecutivos que precisam de ser adicionados a um resultado dicotómico para que o resultado deixe de ser significativo. Um número pequeno representa um resultado mais fraco e um número grande representa um resultado mais forte.
Porque é que este estudo era necessário agora?
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 a principal questão de investigação?
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
De que é que me devo lembrar mais?
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.
Como é que isto afectará o tratamento dos meus doentes?
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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