Annals of Clinical and Experimental NeurologyAnnals of Clinical and Experimental NeurologyАнналы клинической и экспериментальной неврологии2075-54732409-2533Eco-Vector75910.54101/ACEN.2021.3.4Original articlesОригинальные статьиResearch ArticleEffectiveness of kinesiotherapy in chronic non-specific low back painЭффективность кинезитерапии при хронической неспецифической люмбалгииhttps://orcid.org/0000-0002-1992-7960ParfenovVladimir A.ПарфеновВладимир Анатольевич
Russian Federation

D. Sci. (Med.), Professor, Head, Department of nervous diseases and neurosurgery

д.м.н., проф., зав. каф. нервных болезней и нейрохирургии

vladimirparfenov@mail.ruhttps://orcid.org/0000-0003-0392-9037LamkovaIrina A.ЛамковаИрина Асламбиевна
Russian Federation

postgraduate student, Department of nervous diseases and neurosurgery

аспирант каф. нервных болезней и нейрохирургии

vladimirparfenov@mail.ruSechenov First Moscow State Medical University (Sechenov University)ФГАОУ ВО «Первый Московский государственный медицинский университет имени И.М. Сеченова» (Сеченовский Университет)0410202115335420310202103102021Copyright ©; 2021, Parfenov V.A., Lamkova I.A.Copyright ©; 2021, Парфенов В.А., Ламкова И.А.2021Parfenov V.A., Lamkova I.A.Парфенов В.А., Ламкова И.А.https://creativecommons.org/licenses/by/4.0https://annaly-nevrologii.com/pathID/article/view/759

The aim of this study was to evaluate the effectiveness of physical therapy (kinesiotherapy or KT) for chronic non-specific low back pain (CNSLBP) in managing pain, improving functional and emotional state, and overall physical activity.

Materials and methods. The study included 71 patients (17 men and 54 women) aged 18–75 years (mean age 55.09 ± 13.0 years) with CNSLBP, of whom 34 patients received standard KT and 37 patients received enhanced KT. Patients were asked to complete the Numeric Pain Rating Scale (NPRS), the Oswestry Low Back Pain Disability Questionnaire, the Hospital Anxiety and Depression Scale (HADS), and the International Physical Activity Questionnaire (IPAQ-SF) at baseline, after 7 days and 90 days.

Results. In patients who received treatment, we observed a reduction in pain intensity as measured by the NPRS, from a score of 8 at baseline (6–8) to 3 (2–4) points after 7 days and down to 2 (0–4) after 3 months (p < 0.0001). Depression severity decreased from 7 (5–9) points to 5 (3–7) after 7 days (p = 0.002) and 4 (3–6) points after 90 days (p = 0.002). Anxiety decreased from 7 (5–10) to 6 (4–8) after 7 days (p = 0.0003) and 5 (3–7) points after 90 days (p = 0.0003). The Oswestry Low Back Pain Disability Questionnaire score decreased from 46% (34–57.77) to 28% (12–35.55) after 7 days (p < 0.0001), and then to 11.11% (4.44–26) after 90 days (p < 0.0001). Physical activity as measured by the IPAQ-SF increased from 11 (7–16) to 16 (13–19) points after 7 days (p = 0.001) and to 23 (15–26) points after 90 days (p = 0.0002).

The patient group receiving enhanced KT had a more significant reduction in pain as measured by the NPRS after 7 days and 3 months (p = 0.02 and p = 0.055, respectively), depression as measured by the HADS (p < 0.05), and disability as measured by the Oswestry Questionnaire (p = 0.015), accompanied by an increase in physical activity as measured by the IPAQ-SF after 90 days (p = 0.0002), as compared to the patient group receiving standard KT.

Conclusion. KT not only reduces pain but also improves the functional and emotional state, and increases physical activity in patients with CNSLBP. Enhancing KT by using a personalized approach and educational programmes improves long-term treatment outcomes.

Цель работы — изучение эффективности физической терапии (кинезитерапии, КТ) при хронической неспецифической люмбалгии (ХНЛ) в отношении боли, функционального и эмоционального состояния пациентов, их общей физической активности.

Материалы и методы. Наблюдали 71 пациента (17 мужчин и 54 женщин) в возрасте 18–75 лет (средний возраст 55,09 ± 13,0 лет) с ХНЛ, из которых 34 пациента получали стандартную КТ, 37 пациентов — расширенную КТ. Исходно, через 7 и 90 дней проводили анкетирование с использованием цифровой рейтинговой шкалы (ЦРШ) боли, опросника оценки степени нарушения жизнедеятельности (Освестри), госпитальной шкалы тревоги и депрессии (HADS) и опросника физической активности (IPAQ-SF).

Результаты. На фоне лечения наблюдались снижение интенсивности боли по ЦРШ с исходного 8 (6–8) до 3 (2–4) баллов через 7 дней и до 2 (0–4) баллов через 3 мес (р < 0,0001), выраженность депрессии уменьшалась с 7 (5–9) до 5 (3–7) баллов через 7 дней (р = 0,002) и до 4 (3–6) баллов через 90 дней (р = 0,002), выраженность тревоги — с 7 (5–10) до 6 (4–8) баллов через 7 дней (р = 0,0003) и до 5 (3–7) баллов через 90 дней (р = 0,0003), нарушения жизнедеятельности по опроснику Освестри — с 46% (34–57,77%) до 28% (12–35,55%) через 7 дней (р < 0,0001) и до 11,11% (4,44–26%) через 90 дней (р < 0,0001). Физическая активность по IPAQ-SF повысилась с 11 (7–16) до 16 (13–19) баллов через 7 дней (р = 0,001) и до 23 (15–26) баллов через 90 дней (р = 0,0002).

В группе пациентов с расширенной КТ в сравнении с группой со стандартной КТ отмечено более значительное снижение боли по ЦРШ через 7 дней и 3 мес (р = 0,02 и p = 0,055 соответственно), уменьшение выраженности депрессии по HADS (p < 0,05), уменьшение функциональных нарушений по опроснику Освестри (р = 0,015), повышение физической активности по IPAQ через 90 дней (р = 0,0002).

Заключение. КТ при ХНЛ не только уменьшает боль, но и улучшает функциональное и эмоциональное состояние пациентов, повышает их физическую активность. Расширение программы КТ с использованием персонализированного подхода и образовательных программ улучшает отдалённые результаты лечения.

chronic nonspecific low back painkinesitherapydepressionanxietyхроническая неспецифическая боль в нижней части спиныкинезитерапиядепрессиятревожностьGlobal Burden of Disease Study 2013 Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;386:743–800. DOI: 10.1016/S0140­6736(15)60692­4. PMID: 26063472.Maher C., Underwood M., Buchbinder R. Non­specific low back pain. Lancet Neurol. 2017;389(10070):736­747. DOI: 10.1016/S0140­6736(16)309709. PMID: 27745712.Parfenov V.A., Yakhno N.N., Davydov O.S. et al. [Chronic nonspecific (musculoskeletal) low back pain. Guidelines of the Russian Society for the Study of Pain (RSSP)]. Neurology, Neuropsychiatry, Psychosomatics. 2019;11(2S):7–16. DOI: 10.14412/2074­2711­2019­2S­7­16. (In Russ.)Парфенов В.А., Яхно Н.Н., Давыдов О.С. и др. Хроническая неспецифическая (скелетно­мышечная) поясничная боль. Рекомендации Российского общества по изучению боли (РОИБ). Неврология, нейропсихиатрия, психосоматика. 2019;11(2S):7–16. DOI: 10.14412/2074­2711­2019­2S­7­16.Kamper S.J., Apeldoorn A.T., Chiarotto A. et al. Multidisciplinary biopsychosocial rehabilitation for chronic low back pain. Cochrane Database Syst Rev. 2014;(9):CD000963. DOI: 10.1002/14651858.CD000963.pub3. PMID: 25180773.Byström M.G., Rasmussen­Barr E., Grooten W.J. Motor сontrol exercises reduces pain and disability in chronic and recurrent low back pain. Spine (Phila Pa 1976). 2013;38(6):E350–Е358. DOI: 10.1097/BRS.0b013e31828435fb. PMID: 23492976.Airaksinen O., Brox J.I., Cedraschi C. et al. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J. 2006;15(Suppl 2): S192–S300. DOI: 10.1007/s00586­006­1072­1. PMID: 16550448.Cherepanov E.A. [Russian version of the Oswestry Disability Index: cross­cultural adaptation and validity]. Hirurgiya pozvonochnika (Spine Surgery). 2009;3:93–98. DOI: 10.14531/ss2009.3.93­98. (In Russ.)Черепанов Е.А. Русская версия опросника Освестри: культурная адаптация и валидность. Хирургия позвоночника. 2009;3:93–98. DOI: 10.14531/ss2009.3.93­98.Zigmond A.S., Snaith R.P. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361–370. DOI: 10.1111/j.1600­0447.1983.tb09716.x.Craig C.L., Marshall A.L., Sjostrom M. et al. International physical activity questionnaire: 12­country reliability and validity. Med Sci Sports Exerc. 2003;35(8):1381–1395. DOI: 10.1249/01.MSS.0000078924.61453.FB. PMID: 12900694.Guidelines for data processing and analysis of the International Physical Activity Questionnaire (IPAQ) — short and long forms. November 2005. URL: https://docs.google.com/viewer?a=v&pid=sites&srcid=ZGVmYXVsdGRvbWFpbnx0aGVpcGFxfGd4OjE0NDgxMDk3NDU1YWRlZTM (дата обращения 30.06.2021).Koes B.W., van Tulder M., Lin C.W. et al. An updated overview of clinical guidelines for the management of non­specific low back pain in primary care. Eur Spine J. 2010;19(12):2075–2094. DOI: 10.1007/s00586­010­1502­y. PMID: 20602122.Low back pain and sciatica in over 16s: assessment and management. Clinical Guidelines. London: National Institute for Health and Care Excellence (UK); 2016. URL: https://www.nice.org.uk/guidance/ng59.Wong J.J., Côté P., Sutton D.A. et al. Clinical practice guidelines for the noninvasive management of low back pain: а systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Eur J Pain. 2017;21(2):201–216. DOI: 10.1002/ejp.931. PMID: 27712027.Sletten C.D., Kurklinsky S., Chinburapa V., Ghazi S. Economic analysis of a comprehensive pain rehabilitation program: a collaboration between Florida Blue and Mayo Clinic Florida. Pain Med. 2015;16(5):898–904. DOI: 10.1111/pme.12679. PMID: 25645237.Takahashi N., Omata J.I., Iwabuchi M. et al. Therapeutic efficacy of nonsteroidal anti­inflammatory drug therapy versus exercise therapy in patients with chronic nonspecific low back pain: a prospective study. Fukushima J Med Sci. 2017;63(1):8–15. DOI: 10.5387/fms.2016­12. PMID: 28331155.Magalhães M.O., Comachio J., Ferreira P.H. et al. Effectiveness of graded activity versus physiotherapy in patients with chronic nonspecific low back pain: midterm follow up results of a randomized controlled trial. Braz J Phys Ther. 2018;22(1):82–91. DOI: 10.1016/j.bjpt.2017.07.002. PMID: 28803704.Paolucci T., Attanasi C., Cecchini W. et al. Chronic low back pain and postural rehabilitation exercise: a literature review. J Pain Res. 2018;12:95–107. DOI: 10.2147/JPR.S171729. PMID: 30588084.Sitthipornvorakul E., Klinsophon T., Sihawong R., Janwantanakul P. The effects of walking intervention in patients with chronic low back pain: A meta­analysis of randomized controlled trials. Musculoskelet Sci Pract. 2018;34:38–46. DOI: 10.1016/j.msksp.2017.12.003. PMID: 29257996.Stochkendahl M.J., Kjaer P., Hartvigsen J. et al. National Clinical Guidelines for non­surgical treatment of patients with recent onset low back pain or lumbar radiculopathy. Eur Spine J. 2018;27(1):60–75. DOI: 10.1007/s00586­017­5099­2. PMID: 28429142.Qaseem A., Wilt T.J., McLean R.M., Forciea M.A. Clinical Guidelines Committee of the American College of Physicians. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline from the American College of Physicians. Ann Intern Med. 2017;166(7):514–530. DOI: 10.7326/M16­2367. PMID: 28192789.DePalma M.J., Ketchum J.M., Saullo T.R. Multivariable analyses of the relationships between age, gender, and body mass index and the source of chronic low back pain. Pain Med. 2012;13(4):498–506. DOI: 10.1111/j.1526­4637.2012.01339.x. PMID: 22390231.Jin P., Tseng L.A., Zhang Y. Chronic low back pain: improving approach to diagnosis and treatment. In: Mao J. (ed.) Spine Pain Care. Springer, 2020. DOI: 10.1007/978­3­030­27447­4_39.Niederer D., Mueller J. Sustainability effects of motor control stabilisation exercises on pain and function in chronic nonspecific low back pain patients: a systematic review with meta­analysis and meta­regression. PLoS One. 2020;15(1):e0227423. DOI: 10.1371/journal.pone.0227423. PMID: 31940397.Hayden J.A., Wilson M.N., Stewart S. et al. Exercise treatment effect modifiers in persistent low back pain: an individual participant data meta­analysis of 3,514 participants from 27 randomised controlled trials. Br J Sports Med. 2020;54(21):1277–1278. DOI: 10.1136/bjsports­2019­101205. PMID: 31780447.Saner J., Bergman E.M., de Bie R.A., Sieben J.M. Low back pain patients’ perspectives on long­term adherence to home­based exercise programmes in physiotherapy. Musculoskelet Sci Pract. 2018;38:77–82. DOI: 10.1016/j.msksp.2018.09.002. PMID: 30317015.Saragiotto B.T., Maher C.G., Yamato T.P. et al. Motor control exercise for nonspecific low back pain: a Cochrane review. Spine (Phila Pa 1976). 2016;41(16):1284–1295. DOI: 10.1097/BRS.0000000000001645. PMID: 27128390.Owen P.J., Miller C.T., Mundell N.L. et al. Which specific modes of exercise training are most effective for treating low back pain? Network meta­analysis. Br J Sports Med. 2020;54(21):1279–1287. DOI: 10.1136/bjsports­2019­100886. PMID: 31666220.Erdal E.S., Demirgüç A., Kabalcı M., Demirtaş H. Evaluation of physi­cal activity level and exercise capacity in patients with varicose veins and chronic venous insufficiency. Phlebology. 2021:2683555211002339. DOI: 10.1177/02683555211002339. PMID: 33745365.Pedersen B.K., Saltin B. Exercise as medicine — evidence for prescribing exercise as therapy in 26 different chronic diseases. Scand J Med Sci Sports. 2015;25(Suppl 3):1–72. DOI: 10.1111/sms.12581. PMID: 26606383.Wewege M.A., Booth J., Parmenter B.J. Aerobic vs. resistance exercise for chronic non­specific low back pain: a systematic review and meta­analysis. J Back Musculoskelet Rehabil. 2018;31(5):889–899. DOI: 10.3233/BMR­170920. PMID: 29889056.Yamato T.P., Maher C.G., Saragiotto B.T. et al. Pilates for low back pain: complete republication of a Cochrane review. Spine (Phila Pa 1976). 2016;41(12):1013–1021. DOI: 10.1097/BRS.0000000000001398. PMID: 26679894.Searle A., Spink M., Ho A., Chuter V. Exercise interventions for the treatment of chronic low back pain: a systematic review and meta­analysis of randomised controlled trials. Clin Rehabil. 2015;29(12):1155–1167. DOI: 10.1177/0269215515570379. PMID: 25681408.O’Connor S.R., Tully M.A., Ryan B. et al. Walking exercise for chronic musculoskeletal pain: systematic review and meta­analysis [published correction appears in Arch Phys Med Rehabil. 2015;96(6):1182]. Arch Phys Med Rehabil. 2015;96(4):724–734.e3. DOI: 10.1016/j.apmr.2014.12.003. PMID: 25529265.Vanti C., Andreatta S., Borghi S. et al. The effectiveness of walking versus exercise on pain and function in chronic low back pain: a systematic review and meta­analysis of randomized trials. Disabil Rehabil. 2019;41(6):622–632. DOI: 10.1080/09638288.2017.1410730. PMID: 29207885.White N.T., Delitto A., Manal T.J., Miller S. The American Physical Therapy Association’s top five choosing wisely recommendations. Phys Ther. 2015;95(1):9–24. DOI: 10.2522/ptj.20140287. PMID: 25223237.