The Effectiveness of Physical Therapy and Rehabilitation Approaches in Low Back Pain on Pain Severity and Disability; A Systematic Review

Year 2024, Volume: 10 Issue: 4, 341 - 355, 30.11.2024

Cansu Dal , Banu Bayar

https://doi.org/10.19127/mbsjohs.1492701

Abstract

The objective of this study was to review the efficacy of physical therapy and rehabilitation approaches for low back pain, focusing on pain intensity and disability.
A survey of the literature was done in PubMed and Web of Science databases up to January 30, 2024. English studies were required, using keywords: “low back pain,” “pain intensity,” “pain severity,” “disability,” and “physical therapy.” Pain intensity was measured using the Visual Analog Scale and Numeric Rating Scale, including the 11-point Pain Intensity Numerical Rating Scale. Disability was assessed using Activities of Daily Living, Instrumental Activities of Daily Living scales, Roland Morris Disability Questionnaire, and Oswestry Disability Index. Seven studies met the inclusion criteria from 665 initial records. Interventions included osteopathic manipulative treatment, core muscle exercise with interferential current, cognitive functional therapy, dry cupping therapy, high-intensity machine-based core muscle resistance training,heat therapy, transcutaneous electrical nerve stimulation, pelvic traction, Reiki, dynamic muscular stabilization technique, and McGill Big 3. Sample sizes ranged from 30 to 1090 participants. Interferential current combined with core muscle exercises significantly reduced pain intensity compared to each method alone, though not statistically significant (p > 0.05). The high-intensity machine-based core muscle resistance training program group had greater pain relief (P<.001) and reduced disability (P=.002) compared to online integrated multidisciplinary therapy. No significant differences were found between dynamic muscular stabilization technique and McGill Big 3 groups (p >0.05). Dry cupping did not outperform sham cupping. Cognitive functional therapy reduced absenteeism in the first two years but not later. Reiki showed significant improvement in pain and Activities of Daily Living compared to drug therapy, but not to physiotherapy. Physical therapy interventions effectively alleviate symptoms and enhance results for low back pain. However, variability in interventions and outcome measures necessitates cautious interpretation. Further research with standardized protocols is essential to understand the effectiveness and optimal duration of physical therapy for Low Back Pain.

Keywords

low back pain, pain intensity, pain severity, disability, physical therapy

Ethical Statement

Since the research is a review, ethical permission was not required.

Supporting Institution

No supporting institution

References

• Knezevic NN, Candido KD, Vlaeyen JWS, Van Zundert J, Cohen SP. Low back pain. Lancet. 2021;398(10294):78-92. doi:10.1016/S0140-6736(21)00733-9
• Lidgren L. The bone and joint decade 2000-2010. Bull World Health Organ. 2003;81(9):629.
• Steenstra IA, Verbeek JH, Heymans MW, Bongers PM. Prognostic factors for duration of sick leave in patients sick listed with acute low back pain: a systematic review of the literature. Occup Environ Med. 2005;62(12):851-860. doi:10.1136/oem.2004.015842
• Thelin A, Holmberg S, Thelin N. Functioning in neck and low back pain from a 12-year perspective: a prospective population-based study. J Rehabil Med. 2008;40(7):555-561. doi:10.2340/16501977-0205
• Linton SJ, Shaw WS. Impact of psychological factors in the experience of pain. Phys Ther. 2011;91(5):700-711. doi:10.2522/ptj.20100330
• Christe G, Crombez G, Edd S, Opsommer E, Jolles BM, Favre J. Relationship between psychological factors and spinal motor behaviour in low back pain: a systematic review and meta-analysis. Pain. 2021;162(3):672-686. doi:10.1097/j.pain.0000000000002065
• Gardner T, Refshauge K, Smith L, McAuley J, Hübscher M, Goodall S. Physiotherapists' beliefs and attitudes influence clinical practice in chronic low back pain: a systematic review of quantitative and qualitative studies. J Physiother. 2017;63(3):132-143. doi:10.1016/j.jphys.2017.05.017
• Foster NE, Anema JR, Cherkin D, et al. Prevention and treatment of low back pain: evidence, challenges, and promising directions. Lancet. 2018;391(10137):2368-2383. doi:10.1016/S0140-6736(18)30489-6
• Buchbinder R, van Tulder M, Öberg B, et al. Low back pain: a call for action. Lancet. 2018;391(10137):2384-2388. doi:10.1016/S0140-6736(18)30488-4
• Delitto A, George SZ, Van Dillen L, et al. Low back pain. J Orthop Sports Phys Ther. 2012;42(4):A1-A57. doi:10.2519/jospt.2012.42.4.A1
• Will JS, Bury DC, Miller JA. Mechanical Low Back Pain. Am Fam Physician. 2018;98(7):421-428.
• Last AR, Hulbert K. Chronic low back pain: evaluation and management. Am Fam Physician. 2009;79(12):1067-1074.
• Moseley AM, Herbert RD, Sherrington C, Maher CG. Evidence for physiotherapy practice: a survey of the Physiotherapy Evidence Database (PEDro). Aust J Physiother. 2002;48(1):43-49. doi:10.1016/s0004-9514(14)60281-6
• Cooley D, Bailey J, Jermyn R. Cost comparison of osteopathic manipulative treatment for patients with chronic low back pain. J Osteopath Med. 2021;121(7):635-642. Published 2021 Apr 15. doi:10.1515/jom-2020-0238
• Zuo C, Zheng Z, Ma X, et al. Efficacy of Core Muscle Exercise Combined with Interferential Therapy in Alleviating Chronic Low Back Pain in High-Performance Fighter Pilots: A Randomized Controlled Trial. BMC Public Health. 2024;24(1):700. Published 2024 Mar 5. doi:10.1186/s12889-024-18177-7
• Van Hoof W, O'Sullivan K, Verschueren S, O'Sullivan P, Dankaerts W. Evaluation of Absenteeism, Pain, and Disability in Nurses With Persistent Low Back Pain Following Cognitive Functional Therapy: A Case Series Pilot Study With 3-Year Follow-Up. Phys Ther. 2021;101(1):pzaa164. doi:10.1093/ptj/pzaa164
• Kovacs FM, Fernández C, Cordero A, et al. Non-specific low back pain in primary care in the Spanish National Health Service: a prospective study on clinical outcomes and determinants of management. BMC Health Serv Res. 2006;6:57. Published 2006 May 17. doi:10.1186/1472-6963-6-57
• Almeida Silva HJ, Barbosa GM, Scattone Silva R, et al. Dry cupping therapy is not superior to sham cupping to improve clinical outcomes in people with non-specific chronic low back pain: a randomised trial. J Physiother. 2021;67(2):132-139. doi:10.1016/j.jphys.2021.02.013
• Raiszadeh K, Tapicer J, Taitano L, Wu J, Shahidi B. In-Clinic Versus Web-Based Multidisciplinary Exercise-Based Rehabilitation for Treatment of Low Back Pain: Prospective Clinical Trial in an Integrated Practice Unit Model. J Med Internet Res. 2021;23(3):e22548. Published 2021 Mar 18. doi:10.2196/22548
• Jahantiqh F, Abdollahimohammad A, Firouzkouhi M, Ebrahiminejad V. Effects of Reiki Versus Physiotherapy on Relieving Lower Back Pain and Improving Activities Daily Living of Patients With Intervertebral Disc Hernia. J Evid Based Integr Med. 2018;23:2515690X18762745. doi:10.1177/2515690X18762745
• Salik Sengul Y, Yilmaz A, Kirmizi M, Kahraman T, Kalemci O. Effects of stabilization exercises on disability, pain, and core stability in patients with non-specific low back pain: A randomized controlled trial. Work. 2021;70(1):99-107. doi:10.3233/WOR-213557
• Kim B, Yim J. Core Stability and Hip Exercises Improve Physical Function and Activity in Patients with Non-Specific Low Back Pain: A Randomized Controlled Trial. Tohoku J Exp Med. 2020;251(3):193-206. doi:10.1620/tjem.251.193
• Tella BA, Oghumu SN, Gbiri CAO. Efficacy of Transcutaneous Electrical Nerve Stimulation and Interferential Current on Tactile Acuity of Individuals With Nonspecific Chronic Low Back Pain. Neuromodulation. 2022;25(8):1403-1409. doi:10.1111/ner.13522
• Facci LM, Nowotny JP, Tormem F, Trevisani VF. Effects of transcutaneous electrical nerve stimulation (TENS) and interferential currents (IFC) in patients with nonspecific chronic low back pain: randomized clinical trial. Sao Paulo Med J. 2011;129(4):206-216. doi:10.1590/s1516-31802011000400003
• Dissanayaka TD, Pallegama RW, Suraweera HJ, Johnson MI, Kariyawasam AP. Comparison of the Effectiveness of Transcutaneous Electrical Nerve Stimulation and Interferential Therapy on the Upper Trapezius in Myofascial Pain Syndrome: A Randomized Controlled Study. Am J Phys Med Rehabil. 2016;95(9):663-672. doi:10.1097/PHM.0000000000000461
• O'Sullivan P. It's time for change with the management of non-specific chronic low back pain. Br J Sports Med. 2012;46(4):224-227. doi:10.1136/bjsm.2010.081638
• Dankaerts W, O'Sullivan P, Burnett A, Straker L, Davey P, Gupta R. Discriminating healthy controls and two clinical subgroups of nonspecific chronic low back pain patients using trunk muscle activation and lumbosacral kinematics of postures and movements: a statistical classification model. Spine (Phila Pa 1976). 2009;34(15):1610-1618. doi:10.1097/BRS.0b013e3181aa6175
• Vibe Fersum K, O'Sullivan P, Skouen JS, Smith A, Kvåle A. Efficacy of classification-based cognitive functional therapy in patients with non-specific chronic low back pain: a randomized controlled trial. Eur J Pain. 2013;17(6):916-928. doi:10.1002/j.1532-2149.2012.00252.x
• O'Sullivan K, Dankaerts W, O'Sullivan L, O'Sullivan PB. Cognitive Functional Therapy for Disabling Nonspecific Chronic Low Back Pain: Multiple Case-Cohort Study. Phys Ther. 2015;95(11):1478-1488. doi:10.2522/ptj.20140406
• Murthy V, Sibbritt DW, Adams J. An integrative review of complementary and alternative medicine use for back pain: a focus on prevalence, reasons for use, influential factors, self-perceived effectiveness, and communication. Spine J. 2015;15(8):1870-1883. doi:10.1016/j.spinee.2015.04.049
• Thrane S, Cohen SM. Effect of Reiki therapy on pain and anxiety in adults: an in-depth literature review of randomized trials with effect size calculations. Pain Manag Nurs. 2014;15(4):897-908. doi:10.1016/j.pmn.2013.07.008
• Fazzino DL, Griffin MT, McNulty RS, Fitzpatrick JJ. Energy healing and pain: a review of the literature. Holist Nurs Pract. 2010;24(2):79-88. doi:10.1097/HNP.0b013e3181d39718
• Aust MP. Complementary and Alternative Therapies in Nursing. 7th ed. New York, NY: Springer; 2014.
• DiGiovanna EL, Schiowitz S, Dowling DJ: An Osteopathic Approach to Diagnosis &Treatment.3rd edition. Philadelphia: Lippincott William & Wilkins; 2005.
• Vaughan B, Morrison T, Buttigieg D, Macfarlane C, Fryer G. Approach to low back pain - osteopathy. Aust Fam Physician. 2014;43(4):197-198.
• Licciardone JC, Brimhall AK, King LN. Osteopathic manipulative treatment for low back pain: a systematic review and meta-analysis of randomized controlled trials. BMC Musculoskelet Disord. 2005;6:43. Published 2005 Aug 4. doi:10.1186/1471-2474-6-43