PNF and Movement

Korea Proprioceptive Neuromuscular Facilitation Association (대한고유수용성신경근촉진법학회)
권호 표지
DOI QR코드

DOI QR Code

Effects of Multimodal vs. Stabilization Exercises on Pain Intensity, Disability, and Pain-induced Fear in People with Chronic Low Back Pain: A Randomized Controlled Trial

만성요통 대상자의 통증 강도, 장애, 통증 관련 두려움에 대한 복합운동과 안정화운동의 효과 비교: 무작위 대조시험

  • Won, Jong-Im (Dept. of Physical Therapy, College of Medical Science, Jeonju University)
  • 원종임 (전주대학교 의과학대학 물리치료학과)
  • Received : 2022.07.06
  • Accepted : 2022.08.01
  • Published : 2022.08.31
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: We investigated the effects of multimodal vs. stabilization exercises on chronic low back pain. Methods: Study participants were randomly assigned to a multimodal exercise (n = 20) or a stabilization exercise group (n = 20). Participants in the multimodal exercise group performed stabilization, stretching, and endurance exercises, whereas those in the stabilization exercise group performed only stabilization exercises. Participants in both groups performed the exercises for 1 hour thrice a week for 5 weeks. The following outcomes were evaluated: pain intensity (numeric rating scale), disability (the Oswestry Disability Index [ODI] and the Roland-Morris Disability Questionnaire [RMDQ]), pain-induced fear (the Fear of Daily Activities Questionnaire [FDAQ], the Fear-Avoidance Belief Questionnaire [FABQ], and the Tampa scale for kinesiophobia-11 [TSK-11]). Outcome measures were evaluated at baseline and after intervention. Results: Significant post-intervention improvement was observed in pain intensity and the RMDQ and FDAQ scores in both groups (p < 0.01). The post-intervention ODI, FABQ, and TSK-11 scores were improved in the multimodal exercise group (p < 0.01). Additionally, significant differences were observed in pain intensity, as well as in the ODI, FDAQ, and FABQ scores in the multimodal exercise group compared with these findings in the stabilization exercise group (p < 0.01). Conclusion: The multimodal and stabilization exercise programs reduced pain intensity, disability, and pain-induced fear. Compared with stabilization exercises, multimodal exercises more effectively reduced pain intensity, disability, and pain-induced fear. This study highlights that musculoskeletal rehabilitation for people with chronic low back pain should include a multimodal exercise program.

Keywords

References

  1. Adnan R, Van Oosterwijck J, Cagnie B, et al. Determining predictive outcome factors for a multimodal treatment program in low back pain patients: a retrospective cohort study. Journal of Manipulative & Physiological Therapeutics. 2017;40(9):659-667. https://doi.org/10.1016/j.jmpt.2017.09.001
  2. Badke MB, Boissonnault WG. Changes in disability following physical therapy intervention for patients with low back pain: dependence on symptom duration. Archives of Physical Medicine and Rehabilitation. 2006;87(6):749-756. https://doi.org/10.1016/j.apmr.2006.02.033
  3. Coste J, Lefrancois G, Guillemin F, et al. French study group for quality of life in rheumatology: prognosis and quality of life in patients with acute low back pain: insights from a comprehensive inception cohort study. Arthritis and Rheumatism. 2004;51(2):168-176. https://doi.org/10.1002/art.20235
  4. Deyo RA, Phillips WR. Low back pain: a primary care challenge. Spine. 1996;21(24):2826-2832. https://doi.org/10.1097/00007632-199612150-00003
  5. Edwert T, Limm H, Wessels T et al. The Comparative effectiveness of a multimodal program versus exercise alone for the secondary prevention of chronic low back pain and disability. Physical Medicine and Rehabilitation. 2009;1(9):798-808.
  6. George SZ, Valencia C, Zeppieri G Jr, et al. Development of a self-report measure of fearful activities for patients with low back pain: the fear of daily activities questionnaire. Physical Therapy. 2009;89(9):969-979. https://doi.org/10.2522/ptj.20090032
  7. Gomes-Neto M, Lopes JM, Conceicao CS et al. Stabilization exercise compared to general exercises or manual therapy for the management of low back pain: a systematic review and meta-analysis. Physical Therapy in Sport. 2017;23:136-142. https://doi.org/10.1016/j.ptsp.2016.08.004
  8. Hall H and McIntosh G. Low back pain (chronic). BMJ Clinical Evidence. 2008;10(1116):1-28.
  9. Hebert JJ, Fritz JM, Thackeray A et al. Early multimodal rehabilitation following lumbar disc surgery: a randomised clinical trial comparing the effects of two exercise programmes on clinical outcome and lumbar multifidus muscle function. British Journal of Sports Medicine. 2015;49(2):100-106. https://doi.org/10.1136/bjsports-2013-092402
  10. Hayden JA, van Tulder MW, Malmivaara A, et al. Exercise therapy for treatment of non-specific low back pain. Cochrane Database of Systematic Reviews. 2005a. CD000335.
  11. Hayden JA, van Tulder MW, Tomlinson G. Systematic review: strategies for using exercise therapy to improve outcomes in chronic low back pain. Annals of Internal Medicine. 2005b;142(9):776-785. https://doi.org/10.7326/0003-4819-142-9-200505030-00014
  12. Hodges PW, Richardson CA. Inefficient muscular stabilization of the lumbar spine associated with low back pain. a motor control evaluation of transversus abdominis. Spine. 1996;21(22):2640-2650. https://doi.org/10.1097/00007632-199611150-00014
  13. Hwangbo G, Lee CW, Kim SG et al. The effects of trunk stability exercise and a combined exercise program on pain, flexibility, and static balance in chronic low back pain patients. Journal of Physical Therapy Science. 2015;27(4):1153-1155. https://doi.org/10.1589/jpts.27.1153
  14. Joo MK, Kim TY, Kim JT, et al. Reliability and validity of the korean version of the fear-avoidance beliefs questionnaire. Physical Therapy Korea. 2009;16(2);24-30.
  15. Kankaanpaa M, Taimela S, Laaksonen D, et al. Back and hip extensor fatigability in chronic low back pain patients and controls. Archives of Physical Medicine and Rehabilitation. 1998;79(4):412-417. https://doi.org/10.1016/S0003-9993(98)90142-3
  16. Kim CR, Park DK, Lee ST, et al. Electromyographic changes in trunk muscles during graded lumbar stabilization exercises. Physical Medicine and Rehabilitation. 2016;8(10):979-989.
  17. Kim KE, Lim JY. Cross-cultural adaptation and validation of the korean version of the roland-morris disability questionnaire for use in low back pain. Journal of Back and Musculoskeletal Rehabilitation.2011;24(2):83-88. https://doi.org/10.3233/BMR-2011-0278
  18. Koumantakis GA, Watson PJ, Oldham JA. Trunk muscle stabilization training plus general exercise versus general exercise only: randomized controlled trial of patients with recurrent low back pain. Physical Therapy. 2005;85(3):209-225. https://doi.org/10.1093/ptj/85.3.209
  19. Krismer M, van Tulder M. Strategies for prevention and management of musculoskeletal conditions. low back pain (non-specific). Best Practice & Research Clinical Rheumatology. 2007;21(1):77-91 https://doi.org/10.1016/j.berh.2006.08.004
  20. Leeuw M, Goossens ME, Linton SJ, et al. The fear-avoidance model of musculoskeletal pain: current state of scientific evidence. Journal of Behavioral Medicine. 2007;30(1):77-94. https://doi.org/10.1007/s10865-006-9085-0
  21. Leung AS, Lam TH, Hedley AJ et al. Psychometric properties of a generic health measure in chinese patients with low back pain in Hong Kong. Manual Therapy. 2003;8(3):151-160. https://doi.org/10.1016/S1356-689X(03)00006-7
  22. Macedo LG, Latimer J, Maher CG, et al. Effect of motor control exercises versus graded activity in patients with chronic nonspecific low back pain: a randomized controlled trial. Physical Therapy. 2012;92(3):363-377. https://doi.org/10.2522/ptj.20110290
  23. Moseley L. Combined physiotherapy and education is efficacious for chronic low back pain. Australian Journal of Physiotherapy. 2002;48(4):297-302. https://doi.org/10.1016/S0004-9514(14)60169-0
  24. Motallebi L, Mohseni Bandpei MA, Rahmani N. Effects of stabilization exercises on pain intensity, functional disability and cross sectional area of multifidus muscle in women with non-specific chronic low back pain. Journal of Mazandaran University of Medical Sciences. 2003;23(100):11-19.
  25. Muller-Schwefe G, Morlion B, Ahlbeck K et al., Treatment for chronic low back pain: the focus should change to multimodal management that reflects the underlying pain mechanisms. Current Medical Research and Opinion, 2017;33(7):1199-1210. https://doi.org/10.1080/03007995.2017.1298521
  26. Nabavi N, Bandpei MAM, Mosallanezhad Z, et al. The effect of 2 different exercise programs on pain intensity and muscle dimensions in patients with chronic low back pain: a randomized controlled trial. Journal of Manipulative & Physiological Therapeutics. 2018;41(2):102-110. https://doi.org/10.1016/j.jmpt.2017.03.011
  27. Nagar VR, Hooper TL, Dedrick GS, et al. The Effect of current low back pain on volitional preemptive abdominal activation during a loaded forward reach activity. Physical Medicine and Rehabilitation. 2017;9(2):127-135.
  28. Niemisto L, Lahtinen-Suopanki T, Rissanen P et al. A randomized trial of combined manipulation, stabilizing exercises, and physician consultation compared to physician consultation alone for chronic low back pain. Spine.2003;28(19):2185-2191. https://doi.org/10.1097/01.BRS.0000085096.62603.61
  29. Pengel LH, Herbert RD, Maher CG, et al. Acute low back pain: systematic review of its prognosis. British Medical Journal. 2003;327(7410):323. https://doi.org/10.1136/bmj.327.7410.323
  30. Rasmussen-Barr E, Ang B, Arvidsson I, et al. Graded exercise for recurrent low-back pain: a randomized, controlled trial with 6-, 12-, and 36-month follow-ups. Spine. 2009;34(3):221-228. https://doi.org/10.1097/BRS.0b013e318191e7cb
  31. Roland M, Morris R. A study of the natural history of back pain, partI: the development of a reliable and sensitive measure of disability in low back pain. Spine. 1983;8(2):141-144. https://doi.org/10.1097/00007632-198303000-00004
  32. Saliba SA, Croy T, Guthrie R, et al. Differences in transverse abdominis activation with stable and unstable bridging exercises in individuals with low back pain. North American Journal of Sports Physical Therapy. 2010;5(2):63-73.
  33. Schellenberg KL, Lang JM, Chan KM, et al. A clinical tool for office assessment of lumbar spine stabilization endurance: prone and supine bridge maneuvers. American Journal of Physical Medicine & Rehabilitation. 2007;86(5):380-386. https://doi.org/10.1097/PHM.0b013e318032156a
  34. Searle A, Spink M, Ho A, et al. Exercise interventions for the treatment of chronic low back pain: a systematic review and meta-analysis of randomised controlled trials. Clinical Rehabilitation. 2015;29(12):1155-1167. https://doi.org/10.1177/0269215515570379
  35. Stevens VK, Coorevits PL, Bouche KG, et al. The influence of specific training on trunk muscle recruitment patterns in healthy subjects during stabilization exercises. Manual Therapy. 2007;12(3):271-279. https://doi.org/10.1016/j.math.2006.07.009
  36. Stratford PW, Binkley JM. Applying the results of self-report measures to individual patients: an example using the roland-morris questionnaire. The Journal of Orthopaedic and Sports Physical Therapy. 1999;29(4):232-239. https://doi.org/10.2519/jospt.1999.29.4.232
  37. Tkachuk GA, Harris CA. Psychometric properties of the tampa scale for kinesiophobia-11 (tsk-11). The Journal of Pain, 2012;13(10):970-977. https://doi.org/10.1016/j.jpain.2012.07.001
  38. van Middelkoop M, Rubinstein SM, Verhagen AP, et al. Exercise therapy for chronic nonspecific low-back pain. Best Practice and Research Clinical Rheumatology. 2010;24(2):193-204. https://doi.org/10.1016/j.berh.2010.01.002
  39. Vianin M. Psychometric properties and clinical usefulness of the oswestry disability index. Journal of Chiropractic Medicine. 2008;7(4):161-163. https://doi.org/10.1016/j.jcm.2008.07.001
  40. Waddell G, Newton M, Henderson I et al. A fear-avoidance beliefs questionnaire(FABQ) and the role of fearavoidance beliefs in chronic low back pain and disability. Pain. 1993;52(2):157-168. https://doi.org/10.1016/0304-3959(93)90127-B
  41. Woby SR, Roach NK, Urmston M, et al. Psychometric properties of the TSK-11: a shortened version of the tampa scale for kinesiophobia. Pain. 2005;117(1-2):137-144. https://doi.org/10.1016/j.pain.2005.05.029