Comparison of 2 Multimodal Interventions With and Without Whole Body Vibration Therapy Plus Traction on Pain and Disability in Patients With Nonspecific Chronic Low Back Pain

Gianni F Maddalozzo, Brian Kuo, Walker A Maddalozzo, Conner D Maddalozzo, Johnny W Galver, Gianni F Maddalozzo, Brian Kuo, Walker A Maddalozzo, Conner D Maddalozzo, Johnny W Galver

Abstract

Objective: The purpose of this secondary data analysis was to compare the effect of 2 multimodal exercise-based physical therapy interventions (one with and one without whole-body vibration [WBV] therapy plus traction) on pain and disability in patients with nonspecific chronic low back pain (NSCLBP).

Methods: We conducted a secondary analysis of data from 2 distinct samples. One sample was from the Focus on Therapeutic Outcomes Inc. (FOTO) group (n = 55, age 55.1 ± 19.0 years), and the other was the Illinois Back Institute (IBI) (n = 70, age 47.5 ± 13.4 years). Both groups of patients had NSCLBP for more than 3 months and a pain numeric rating scale (NRS) score of ≥7. Both groups received treatment consisting of flexibility or stretching exercises, core stability training, functional training, and postural exercises and strengthening exercises. However, the IBI group also received WBV plus traction. NSCLBP was measured before and after therapeutic trials using the NRS for pain and Oswestry Disability Index (ODI).

Results: The NRS scores were significantly improved in both groups, decreasing by 2 points in the FOTO group and by 5 points in the IBI group. The ODI scores were significantly improved in both groups; the FOTO group score improved by 9 points and the IBI group improved by 22 points.

Conclusions: The results of this preliminary study suggest that NPS and ODI scores statistically improved for both NSCLBP groups receiving multimodal care. However, the group that included WBV therapy plus traction in combination with multimodal care had greater clinical results. This study had several limitations making it difficult to generalize the results from this study sample to the entire population.

Keywords: Exercise Therapy; Low Back Pain.

Figures

Fig 1
Fig 1
Flow diagram. FOTO, Focus on Therapeutic Outcomes; IBI, Illinois Back Institute.

References

    1. Institute of Medicine (US) Committee on Advancing Pain Research, Care, and Education . National Academies Press; Washington, DC: 2011. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research.
    1. National Institutes of Health, National Institute of Neurological Disorders and Stroke . NIH Publication No. 15-5161. National Institutes of Health; Bethesda, MD: 2014. Low Back Pain Fact Sheet.
    1. Steglitz J, Buscemi J, Ferguson MJ. The future of pain research, education, and treatment: a summary of the IOM report “Relieving pain in America: a blueprint for transforming prevention, care, education, and research". Transl Behav Med. 2012;2(1):6–8.
    1. Chou R. Low back pain (chronic) Am Fam Physician. 2011;84(4):437–438.
    1. Centers for Disease Control and Prevention Policy impact: prescription painkiller overdoses. Available at: Accessed April 15, 2015.
    1. Nguyen TH, Randolph DC, Talmage J, Succop P, Travis R. Long-term outcomes of lumbar fusion among workers' compensation subjects: a historical cohort study. Spine (Phila Pa 1976) 2011;36(4):320–331.
    1. Rueda S, Chambers L, Wilson M. Association of returning to work with better health in working-aged adults: a systematic review. Am J Public Health. 2012;102(3):541–556.
    1. Bogduk N, Jull G. Manual therapy produces greater relief of neck pain than physiotherapy or general practitioner care. Aust J Physiother. 2002;48(3):240–241.
    1. Bogduk N. Management of chronic low back pain. Med J Aust. 2004;180(2):79–83.
    1. Koes BW, van Tulder MW, Thomas S. Diagnosis and treatment of low back pain. BMJ. 2006;332(7555):1430–1434.
    1. Merriman H, Jackson K. The effects of whole-body vibration training in aging adults: a systematic review. J Geriatr Phys Ther. 2009;32(3):134–145.
    1. Rittweger J. Vibration as an exercise modality: how it may work, and what its potential might be. Eur J Appl Physiol. 2010;108(5):877–904.
    1. Alentorn-Geli E, Padilla J, Moras G, Lázaro Haro C, Fernández-Solà J. Six weeks of whole-body vibration exercise improves pain and fatigue in women with fibromyalgia. J Altern Complement Med. 2008;14(8):975–981.
    1. Iwamoto J, Takeda T, Sato Y, Uzawa M. Effect of whole-body vibration exercise on lumbar bone mineral density, bone turnover, and chronic back pain in post-menopausal osteoporotic women treated with alendronate. Aging Clin Exp Res. 2005;17(2):157–163.
    1. Woolf CJ, Mannion RJ. Neuropathic pain: aetiology, symptoms, mechanisms, and management. Lancet. 1999;353(9168):1959–1964.
    1. Iezzoni LI. Risk adjusting rehabilitation outcomes: an overview of methodologic issues. Am J Phys Med Rehabil. 2004;83(4):316–326.
    1. Resnik L, Hart DL. Predictors of physical therapy clinic performance in the treatment of patients with low back pain syndromes—author response. Phys Ther. 2008;88(9):1009–1011.
    1. Resnik L, Liu D, Hart D, Mor V. Benchmarking physical therapy clinic performance: Statistical methods to enhance internal validity when using observational data. Phys Ther. 2008;88(9):1078–1087.
    1. Resnik L, Liu D, Mor V, Hart D. Predictors of physical therapy clinic performance in the treatment of patients with low back pain syndromes. Phys Ther. 2008;88(9):989–1004.
    1. Dobrzykowski EA, Nance T. The Focus on Therapeutic Outcomes (FOTO) Outpatient Orthopedic Rehabilitation Database: results of 1994–1996. J Rehabil Outcomes Meas. 1997;1(1):56–60.
    1. Swinkels IC, Hart D, Deutscher D. Comparing patient characteristics and treatment processes in patients receiving physical therapy in the United States, Israel and the Netherlands: cross sectional analyses of data from three clinical databases. BMC Health Serv Res. 2008;8:163.
    1. Swinkels IC, van den Ende CH, de Bakker D. Clinical databases in physical therapy. Physiother Theory Pract. 2007;23(3):153–167.
    1. Freburger JK, Carey TS, Holmes GM. Physician referrals to physical therapists for the treatment of spine disorders. Spine J. 2005;5(5):530–541.
    1. Hart LG, Deyo RA, Cherkin DC. Physician office visits for low back pain. Frequency, clinical evaluation, and treatment patterns from a U.S. national survey. Spine (Phila Pa 1976) 1995;20(1):11–19.
    1. Iezzoni LI. An introduction to risk adjustment. Am J Med Qual. 1996;11(1):S8–11.
    1. Zimmerman DR. Improving nursing home quality of care through outcomes data: the MDS quality indicators. Int J Geriatr Psychiatry. 2003;18(3):250–257.
    1. McKenzie R, May S. Spinal Publications; Waikanae, NZ: 2003. The Lumbar Spine Mechanical Diagnosis & Therapy.
    1. Nesser TW, Huxel KC, Tincher JL, Okada T. The relationship between core stability and performance in division I football players. J Strength Cond Res. 2008;22(6):1750–1754.
    1. Okada T, Huxel KC, Nesser TW. Relationship between core stability, functional movement, and performance. J Strength Cond Res. 2011;25(1):252–261.
    1. Key J, Clift A, Condie F, Harley C. A model of movement dysfunction provides a classification system guiding diagnosis and therapeutic care in spinal pain and related musculoskeletal syndromes: a paradigm shift—Part 2. J Bodyw Mov Ther. 2008;12(2):105–120.
    1. Key J, Clift A, Condie F, Harley C. A model of movement dysfunction provides a classification system guiding diagnosis and therapeutic care in spinal pain and related musculoskeletal syndromes: a paradigm shift—Part 1. J Bodyw Mov Ther. 2008;12(1):7–21.
    1. National Institutes of Health, Warren Grant Magnuson Clinical Center Pain intensity instruments, July 2003. Available at: Accessed March 12, 2015.
    1. Turk DC, Melzack R. 3rd ed. Guilford Press; New York, NY: 2011. Handbook of Pain Assessment.
    1. Williamson A, Hoggart B. Pain: a review of three commonly used pain rating scales. J Clin Nurs. 2005;14(7):798–804.
    1. Bijur PE, Silver W, Gallagher EJ. Reliability of the visual analog scale for measurement of acute pain. Acad Emerg Med. 2001;8(12):1153–1157.
    1. Lara-Muñoz C, De Leon SP, Feinstein AR, Puente A, Wells CK. Comparison of three rating scales for measuring subjective phenomena in clinical research. I. Use of experimentally controlled auditory stimuli. Arch Med Res. 2004;35(1):43–48.
    1. Ponce de Leon S, Lara-Muñoz C, Feinstein AR, Wells CK. A comparison of three rating scales for measuring subjective phenomena in clinical research. II. Use of experimentally controlled visual stimuli. Arch Med Res. 2004;35(2):157–162.
    1. Fairbank JC, Couper J, Davies DB, O’Brien JP. The Oswestry low back pain disability questionnaire. Physiotherapy. 1980;66(8):271–273.
    1. Nordin M, Skovron ML, Hiebert R. Early predictors of delayed return to work in patients with low back pain. J Musculoskel Pain. 1997;5(2):5–27.
    1. Baena-Beato PA, Arroyo-Morales M, Delgado-Fernández M, Gatto-Cardia MC, Artero EG. Effects of different frequencies (2-3 days/week) of aquatic therapy program in adults with chronic low back pain. A non-randomized comparison trial. Pain Med. 2013;14(1):145–158.
    1. Baena-Beato PA, Delgado-Fernández M, Artero EG, Robles-Fuentes A, Gatto-Cardia MC, Arroyo-Morales M. Disability predictors in chronic low back pain after aquatic exercise. Am J Phys Med Rehabil. 2014;93(7):615–623.
    1. Henry SM, Van Dillen LR, Ouellette-Morton RH. Outcomes are not different for patient-matched versus nonmatched treatment in subjects with chronic recurrent low back pain: a randomized clinical trial. Spine J. 2014;14(12):2799–2810.
    1. Hoffman DL, Sadosky A, Dukes EM, Alvir J. How do changes in pain severity levels correspond to changes in health status and function in patients with painful diabetic peripheral neuropathy? Pain. 2010;149(2):194–201.
    1. Kumar T, Kumar S, Nezamuddin M, Sharma VP. Efficacy of core muscle strengthening exercise in chronic low back pain patients. J Back Musculoskelet Rehabil. 2015;28(4):699–707.
    1. Unsgaard-Tondel M, Fladmark AM, Salvesen O, Vasseljen O. Motor control exercises, sling exercises, and general exercises for patients with chronic low back pain: a randomized controlled trial with 1-year follow-up. Phys Ther. 2010;90(10):1426–1440.
    1. Farrar JT. What is clinically meaningful: outcome measures in pain clinical trials. Clin J Pain. 2000;16(2 Suppl):S106–S112.
    1. del Pozo-Cruz B, Hernández Mocholí MA, Adsuar JC, Parraca JA, Muro I, Gusi N. Effects of whole body vibration therapy on main outcome measures for chronic non-specific low back pain: a single-blind randomized controlled trial. J Rehabil Med. 2011;43(8):689–694.
    1. Majchrzycki M, Kocur P, Kotwicki T. Deep tissue massage and nonsteroidal anti-inflammatory drugs for low back pain: a prospective randomized trial. ScientificWorldJournal. 2014;2014:287597.
    1. McDonough SM, Tully MA, Boyd A. Pedometer-driven walking for chronic low back pain: a feasibility randomized controlled trial. Clin J Pain. 2013;29(11):972–981.
    1. Tekur P, Singphow C, Nagendra HR, Raghuram N. Effect of short-term intensive yoga program on pain, functional disability, and spinal flexibility in chronic low back pain: a randomized control study. J Altern Complement Med. 2008;14(6):637–644.
    1. Tsauo JY, Liang HW, Jang Y, Du CL. Physical therapy utilization in subjects with work-related musculoskeletal disorders: Taiwan experience. J Occup Rehabil. 2009;19(1):106–112.
    1. Davies C, Nitz AJ, Mattacola CG. Practice patterns when treating patients with low back pain: a survey of physical therapists. Physiother Theory Pract. 2014;30(6):399–408.
    1. Solberg T, Johnsen LG, Nygaard OP, Grotle M. Can we define success criteria for lumbar disc surgery?: estimates for a substantial amount of improvement in core outcome measures. Acta Orthop. 2013;84(2):196–201.
    1. Fritz JM, Hebert J, Koppenhaver S, Parent E. Beyond minimally important change defining a successful outcome of physical therapy for patients with low back pain. Spine (Phila Pa 1976) 2009;34(25):2803–2809.
    1. Gatchel RJ, Mayer TG. Testing minimal clinically important difference: consensus or conundrum? Spine J. 2010;10(4):321–327.
    1. Ostelo RWJG, Deyo RA, Stratford P. Interpreting change scores for pain and functional status in low back pain - Towards international consensus regarding minimal important change. Spine (Phila Pa 1976) 2008;33(1):90–94.
    1. Hagg O, Fritzell P, Nordwall A. The clinical importance of changes in outcome scores after treatment for chronic low back pain. Eur Spine J. 2003;12(1):12–20.
    1. Ostelo RWJG, de Vet HCW. Clinically important outcomes in low back pain. Best Pract Res Clin Rheumatol. 2005;19(4):593–607.
    1. Deyo RA, Mirza SK, Turner JA, Martin BI. Overtreating chronic back pain: time to back off? J Am Board Fam Med. 2009;22(1):62–68.
    1. Turk DC, Dworkin RH. What should be the core outcomes in chronic pain clinical trials? Arthritis Res Ther. 2004;6(4):151–154.
    1. Marchettini P, Lacerenza M, Mauri E, Marangoni C. Painful peripheral neuropathies. Curr Neuropharmacol. 2006;4(3):175–181.
    1. Maddalozzo G, Guzman RJ, Dvorak RV, Maddalozzo WA, Milroy DA, Koshinski RS. Whole body vibration: an effective treatment for painful diabetic neuropathy. J Pain Relief. 2015;4(2):1–4.
    1. Kim DH, Park JK, Jeong MK. Influences of posterior-located center of gravity on lumbar extension strength, balance, and lumbar lordosis in chronic low back pain. J Back Musculoskelet Rehabil. 2014;27(2):231–237.
    1. Sparto PJ, Parnianpour M, Marras WS, Granata KP, Reinsel TE, Simon S. Neuromuscular trunk performance and spinal loading during a fatiguing isometric trunk extension with varying torque requirements. J Spinal Disord. 1997;10(2):145–156.
    1. Abercromby AF, Amonette WE, Layne CS, McFarlin BK, Hinman MR, Paloski WH. Variation in neuromuscular responses during acute whole-body vibration exercise. Med Sci Sports Exerc. 2007;39(9):1642–1650.
    1. Cardinale M, Lim J. Electromyography activity of vastus lateralis muscle during whole-body vibrations of different frequencies. J Strength Cond Res. 2003;17(3):621–624.
    1. Cochrane DJ, Stannard SR, Firth EC, Rittweger J. Acute whole-body vibration elicits post-activation potentiation. Eur J Appl Physiol. 2010;108(2):311–319.
    1. Zaidell LN, Mileva KN, Sumners DP, Bowtell JL. Experimental evidence of the tonic vibration reflex during whole-body vibration of the loaded and unloaded leg. PLoS One. 2013;8(12)
    1. Cholewicki J, Panjabi MM, Khachatryan A. Stabilizing function of trunk flexor-extensor muscles around a neutral spine posture. Spine (Phila Pa 1976) 1997;22(19):2207–2212.
    1. Wang LZ, Zhao M, Ma J. Effect of combining traction and vibration on back muscles, heart rate and blood pressure. Med Eng Phys. 2014;36(11):1443–1448.
    1. Ahlborg L, Andersson C, Julin P. Whole-body vibration training compared with resistance training: effect on spasticity, muscle strength and motor performance in adults with cerebral palsy. J Rehabil Med. 2006;38(5):302–308.
    1. Bogaerts A, Verschueren S, Delecluse C, Claessens AL, Boonen S. Effects of whole body vibration training on postural control in older individuals: a 1 year randomized controlled trial. Gait Posture. 2007;26(2):309–316.
    1. Ebersbach G, Edler D, Kaufhold O, Wissel J. Whole body vibration versus conventional physiotherapy to improve balance and gait in Parkinson's disease. Arch Phys Med Rehabil. 2008;89(3):399–403.
    1. Ness LL, Field-Fote EC. Whole-body vibration improves walking function in individuals with spinal cord injury: a pilot study. Gait Posture. 2009;30(4):436–440.
    1. Rehn B, Lidström J, Skoglund J, Lindström B. Effects on leg muscular performance from whole-body vibration exercise: a systematic review. Scand J Med Sci Sports. 2007;17(1):2–11.
    1. Roelants M, Delecluse C, Goris M, Verschueren S. Effects of 24 weeks of whole body vibration training on body composition and muscle strength in untrained females. Int J Sports Med. 2004;25(1):1–5.
    1. van Nes IJ, Latour H, Schils F, Meijer R, van Kuijk A, Geurts AC. Long-term effects of 6-week whole-body vibration on balance recovery and activities of daily living in the postacute phase of stroke: a randomized, controlled trial. Stroke. 2006;37(9):2331–2335.
    1. Verschueren SM, Roelants M, Delecluse C, Swinnen S, Vanderschueren D, Boonen S. Effect of 6-month whole body vibration training on hip density, muscle strength, and postural control in postmenopausal women: a randomized controlled pilot study. J Bone Miner Res. 2004;19(3):352–359.
    1. Bishop MD, Horn ME, George SZ. Exercise-induced pain intensity predicted by pre-exercise fear of pain and pain sensitivity. Clin J Pain. 2011;27(5):398–404.
    1. Leeuw M, Goossens ME, Linton SJ, Crombez G, Boersma K, Vlaeyen JW. The fear-avoidance model of musculoskeletal pain: current state of scientific evidence. J Behav Med. 2007;30(1):77–94.
    1. Kirkham JJ, Dwan KM, Altman DG. The impact of outcome reporting bias in randomised controlled trials on a cohort of systematic reviews. BMJ. 2010;340

Source: PubMed

3
S'abonner