Benefit of specific vs general exercise for low back pain with movement control impairment .
This report has been verified
by one or more authors of the
original publication.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2016;4(17):11 BMC Musculoskelet Disord. 2016 Mar 22;17(1):13570 patients with sub-acute low back pain (LBP) and movement control impairment were randomized to receive either specific movement control exercise or general exercise (control) in combination with manual therapy. The purpose of this study was to determine if there is a significant difference in clinical outcomes between general and specified therapies for improving disability. The findings of this study indicated a significantly greater improvement in disability form baseline, assessed by the Roland-Morris Disability Questionnaire, and significantly less need for pain medications in the specific movement control exercise group compared to the control group after 12 months. Patient-specific functional scale scores demonstrated a significantly greater improvement from baseline values in the specific movement control exercise group compared to the Control group at 12 months, but not at 3 months. The Oswestry Disability Index, need for other treatment methods, the number of absences from work, and patient satisfaction were comparable between groups.
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.
4/4
Randomization
3/4
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?
Low back pain is a common disorder in the general population that can often lead to disability and a decreased quality of life. The etiology of low back pain varies greatly and frequently results in unidentifiable pain symptoms. It is often recommended that patients with low back pain be divided into sub-groups as guided by the O'Sullivan system to allow for tailored treatment. One such subgroup is movement control impairment, which is characterized by patients that provoke pain through maladaptive physical compensation. While sub-acute low back pain is traditionally managed with exercise regimens, there is limited evidence evaluating the comparative effectiveness of general and specific exercise treatments for low back pain patients with movement control impairment, thus warranting the present study.
Qual era a principal questão de investigação?
In the treatment of sub-acute low back pain with movement control impairment, is there a difference between general and specific exercise therapy when assessed over a 12-month period using pain, function, and disability outcome measures?
- Significantly greater improvement in change from baseline was reported in the specific movement control exercise group compared to the Control group for the Roland-Morris Disability Questionnaire at 3 months (-2.4 [95% CI -4.5, -1.1]; p<0.01) and 12 months (-1.7 [95% CI -3.9, -0.5]; p<0.01)
- Both groups demonstrated a significant improvement from baseline on the Patient-specific functional scale, however, no significant difference in the change from baseline was reported between treatment groups at 3 months (p=0.13). At 12 months a significantly greater improvement in change from baseline was reported in the specific movement control exercise group compared to the Control group (3.1 [95% CI 0.2, 6.0]; p=0.03)
- Both groups significantly improved from baseline on the Oswestry Disability Index; however, no significant differences in change from baseline were reported between treatment groups for the Oswestry Disability Index at 3 months (p=0.35) or at 12 months (p=0.35)
- Pain medication was needed significantly less in the specific movement control exercise group compared to the control group at 12 months
- No significant differences were reported between groups for the number of absences from work, need for other treatments, or patient satisfaction
De que é que me devo lembrar mais?
In the treatment of recurring low back pain with movement control impairment, the use of a specific movement control exercise regimen was associated with significantly greater reduction disability scores from baseline and a reduced need for medication when compared to a general exercise regimen at 3 and 12 months. Additionally, a significantly greater improvement from baseline in the patient-specific functional scale was observed in the specific movement control exercise group at 12 months. The Oswestry Disability Index, the number of absence from work, need for other treatment modalities, and patient satisfaction remained similar between groups throughout the study duration.
Como é que isto afectará o tratamento dos meus doentes?
The findings of this study suggest that specific movement control exercise in combination with manual therapy may provide a more beneficial outcome compared to general exercise programs for patients with sub-acute LBP and movement control impairment. Future trials should compare the benefits of specific movement control exercise with various other types of general exercise programs to confirm the specific efficacy of this treatment modality in this patient population.
AVISO LEGAL
O conteúdo desta página destina-se apenas a fins informativos e não pretende substituir o aconselhamento, diagnóstico ou tratamento médico profissional. Se necessitar de tratamento médico, procure sempre o conselho do seu médico ou dirija-se ao serviço de urgência mais próximo. As opiniões, crenças e pontos de vista expressos pelos indivíduos no conteúdo encontrado nesta página não reflectem as opiniões, crenças e pontos de vista da OrthoEvidence.
0 de 4 artigos mensais GRATUITOS desbloqueados
