Effectiveness of Advice for Low Back Pain
Acute low back pain (ALBP) causes disability due to pain and limitation of physical activities. Persistent low back pain may lead to limitations in activities of daily living, absenteeism, and transition to chronic low back pain. This prospective, randomized trial presents an evaluation of the effects of two different treatment recommendations provided in routine care on physical activity and the course of ALBP.
After the onset of pain.
99 patients with acute severe LBP who were examined within 48 hours were randomized to the treatment advice of "continue activity despite pain" (continue activity group) or "adjust activity according to pain" (adjust activity group).
Pedometer steps and pain intensity (numerical rating scale, NRS, 0-10) were tracked daily for 7 days, and linear mixed modeling was employed for statistical analysis.
Results.
The trajectory of the step change showed a curvilinear shape, with an initial sharp increase observable in both groups, reaching a plateau after 3 days and then increasing further on day 7 only in the group that remained active.
In terms of the number of steps taken on day 1, the active group took 4560 steps, while the adjusted group took 4317 steps. (p = 0.76) Although there was no statistical difference between the two groups in terms of the parameter representing the trajectory of the change in the number of steps, the increase in the number of steps was greater in the group that remained active.
In terms of the number of steps taken on day 7, the group that remained active took 9865 steps, while the group that adjusted their activity took 6609 steps. (p = 0.008)
The trajectory of pain intensity (NRS) was similar in the two groups, decreasing linearly from 5.0 to 2.8 in the group that remained active from day 1 to day 7 (p < 0.001), and from 4.8 to 2.3 in the group that adjusted for activity (p < 0.001). (p <0.001)
In conclusion, there was no significant difference between the advice to adjust or actively encourage activity with respect to "low back pain," but the advice to actively continue moving was more significant with respect to continuing activity.
Olaya-Contreras, P., Styf, J., Arvidsson, D. et al. The effect of the stay active advice on physical activity and on the course of acute severe low back pain . BMC Sports Sci Med Rehabil 7, 19 (2015). Available at: https://doi.org/10.1186/s13102-015-0013-x
Conclusion
This study provides indicative results for those who are unsure of how to advise on acute low back pain. This advice seems appropriate as the possibility of avoiding the negative psychological effects caused by physical pain and limitation of movement due to low back pain syndrome by staying active.
However, as advice issued by a newcomer who has been in the field for one year and by an experienced medical professional, isn't there a difference? You might think so, but it seems that the conditions under which patients would comply could have been influenced by a "quick and comprehensive examination by an experienced orthopedic surgeon.
This is thought to vary depending on who is telling the patient, not only because of years of experience, but also because the attitude of the examination is a factor that influences the patient.Secondly, there are concerns about recurrence or worsening due to this advice, but we have not been able to confirm these phenomena during the research intervention.
If used clinically, the advice in this study may be useful in situations where the patient needs to practice to properly perform the examination method, and to properly understand and explain the situation to the patient.
