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Active Care Research for Doctors
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Low Back Pain
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1. Kwon, MA et al. A Correlation between Low Back Pain and Associated Factors: A Study Involving 772 Patients who had Undergone General Physical Examination. J Korean Med Sci. Dec; 21 (6): 1086-91 (2006)
Many factors are associated with the development of low back pain. Among them, exercise, obesity, smoking, age, educational level and stress are the most common. This study examined the association of these factors with low back pain. An additional aim was to determine a procedure for preventing low back pain.
This study analyzed the responses to a questionnaire sent to 772 individuals who had undergone a medical examination at a hospital in 2003 and excluded the individuals who had shown symptoms or their test results indicated a particular disease.
RESULTS:
- Individuals who exercised regularly 3-4 times per week would have a lower chance of having low back pain than those who did not exercise regularly.
- Individuals with a college degree or higher education have a lower chance of experiencing low back pain than those with only a high school education or even college drop-outs. When the other variables were constant, age, extent of obesity (body mass index), smoking and level of stress were not found to affect the development of low back pain.
- Regular exercise 3-4 times per week or more would be most effective in reducing the incidence and duration of low back pain.
2. Goldby, LJ. A randomized controlled trial investigating the efficiency of musculoskeletal physiotherapy on chronic low back disorder. Spine. May 1:31 (10): 1083-93 (2006).
A Randomized, single blind, controlled trial was performed to determine the efficacy of 2 components of musculoskeletal physiotherapy on chronic low back disorder. A total of 346 subjects were randomized to manual therapy, a 10-week spinal stabilization rehabilitation program, or a minimal intervention control group. Data was collected at baseline, and 3, 6, 12, and 24 months after intervention. Outcome measures recorded intensity of low back pain, disability, handicap, medication, and quality of life. There were 4 main variables combined in a primary component analysis to form a single outcome measure (i.e., a measure of dysfunction).
RESULTS:
The results indicated statistically significant improvements in favor of the spinal stabilization group:
- In pain (65.9% reduction in symptoms) at the 6-month stage
- In dysfunction (combined mean reduction of 134, standard error 23.84),
- In dysfunction (combined mean reduction of 134, standard error 18.2), and disability (mean difference in change 15.71 Oswestry Disability Index, 95% confidence interval).
- In medication consumption (34.3% reduction in medication) at the 1-year stage
CONCLUSIONS:
As a component of musculoskeletal physiotherapy, the spinal stabilization program is more effective than manually applied therapy or an education booklet in treating chronic low back disorder over time.
Both manual therapy and the spinal stabilization program are significantly effective in pain reduction in comparison to an active control.
3. Hayden, JA et al. Meta-analysis: exercise therapy for nonspecific low back pain. Ann Intern Med. 2005 May 3; 142 (9):765-75.
Exercise therapy is widely used as an intervention in low back pain.
The objective of this meta-analysis was to evaluate the effectiveness of exercise therapy in adult nonspecific acute, subacute, and chronic low back pain versus no treatment and other conservative treatments.
Randomized, controlled trials evaluating exercise therapy for adult nonspecific low back pain and measuring pain, function, return to work or absenteeism, and global improvement outcomes were utilized.
61 randomized, controlled trials (6390 participants) met inclusion criteria: acute (11 trials), subacute (6 trials), and chronic (43 trials) low back pain (1 trial was unclear).
RESULTS:
- Evidence suggests that exercise therapy is effective in chronic back pain relative to comparisons at all follow-up periods.
Pooled mean improvement (of 100 points) was 7.3 points for pain and 2.5 points for function at earliest follow-up.
- In studies investigating patients (people seeking care for back pain), mean improvement was 13.3 points for pain and 6.9 points for function.
- Some evidence suggests effectiveness of a graded-activity exercise program in subacute low back pain in occupational settings.
- In acute low back pain, exercise therapy and other programs were equally effective
CONCLUSIONS:
Exercise therapy seems to be slightly effective at decreasing pain and improving function in adults with chronic low back pain, particularly in health care populations.
In subacute low back pain populations, some evidence suggests that a graded-activity program improves absenteeism outcomes.
In acute low back pain populations, exercise therapy is as effective as either no treatment or other conservative treatments.
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