The Role of a Multi-Step Core Stability Exercise Program in the Treatment of Nurses with Chronic Low Back Pain: A Single-Blinded Randomized Controlled Trial

Pardis Noormohammadpour, Mahla Kordi, Mohammad Ali Mansournia, Maryam Akbari-Fakhrabadi, Ramin Kordi, Pardis Noormohammadpour, Mahla Kordi, Mohammad Ali Mansournia, Maryam Akbari-Fakhrabadi, Ramin Kordi

Abstract

Study design: Single-blinded randomized controlled trial.

Purpose: To evaluate the effects of a multi-step core stability exercise program in nurses with chronic low back pain (CLBP).

Overview of literature: CLBP is a common disorder among nurses. Considering that patient-handling activities predispose nurses to CLBP, core stability exercises suggested for managing CLBP in the general population may also be helpful in nurses. However, sufficient evidence is not available on whether a multi-step core stability exercise program affects pain, disability, quality of life, and the diameter of lateral abdominal muscles in nurses with CLBP.

Methods: In this single-blinded randomized controlled trial, 36 female nurses with CLBP were recruited. The sample was divided into two groups of 18 patients (intervention and control). Nurses in the intervention group performed core stability exercises for 8 weeks, based on a progressive pattern over time. Roland-Morris Disability Questionnaire (RDQ), quality of life (36-item Short Form Health Survey [SF-36]), ultrasound assessment of the diameter of lateral abdominal muscles, and Visual Analog Scale (VAS) score for pain were evaluated in the participants before and after the trial. Sixteen nurses (eight from each group) dropped out of the study, and analysis of covariance was used to compare outcomes for the remaining nurses in the intervention (10 nurses) and control (10 nurses) groups.

Results: The results after the trial showed significant improvements in RDQ, SF-36, and VAS score in the intervention group compared with that in the control group (p <0.005). Furthermore, the ultrasound data showed a significant increase in the left and right muscle diameter of all three abdominal muscles during the abdominal drawing-in maneuver in the intervention group compared with that in the control group (p <0.05).

Conclusions: This study showed that a multi-step core stability exercise program is a helpful treatment option for improving quality of life and reducing disability and pain in female nurses with CLBP.

Keywords: Exercise therapy; Low back pain; Nurses; Quality of life.

Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1.
Fig. 1.
Flow diagram of the progress through the phases of the study.

References

    1. Hoy D, Brooks P, Blyth F, Buchbinder R. The epidemiology of low back pain. Best Pract Res Clin Rheumatol. 2010;24:769–81.
    1. Noormohammadpour P, Mansournia MA, Asadi-Lari M, Nourian R, Rostami M, Kordi R. A subtle threat to urban populations in developing countries: low back pain and its related risk factors. Spine (Phila Pa 1976) 2016;41:618–27.
    1. Vos T, Flaxman AD, Naghavi M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2163–96.
    1. Dagenais S, Caro J, Haldeman S. A systematic review of low back pain cost of illness studies in the United States and internationally. Spine J. 2008;8:8–20.
    1. Itz CJ, Geurts JW, van Kleef M, Nelemans P. Clinical course of non-specific low back pain: a systematic review of prospective cohort studies set in primary care. Eur J Pain. 2013;17:5–15.
    1. Noormohammadpour P, Mansournia MA, Koohpayehzadeh J, et al. Prevalence of chronic neck pain, low back pain, and knee pain and their related factors in community-dwelling adults in Iran: a population-based national study. Clin J Pain. 2017;33:181–7.
    1. Karahan A, Kav S, Abbasoglu A, Dogan N. Low back pain: prevalence and associated risk factors among hospital staff. J Adv Nurs. 2009;65:516–24.
    1. Holtermann A, Clausen T, Jorgensen MB, Burdorf A, Andersen LL. Patient handling and risk for developing persistent low-back pain among female healthcare workers. Scand J Work Environ Health. 2013;39:164–9.
    1. Hodges PW. Core stability exercise in chronic low back pain. Orthop Clin North Am. 2003;34:245–54.
    1. Wang XQ, Zheng JJ, Yu ZW, et al. A meta-analysis of core stability exercise versus general exercise for chronic low back pain. PLoS One. 2012;7:e52082.
    1. Kliziene I, Sipaviciene S, Klizas S, Imbrasiene D. Effects of core stability exercises on multifidus muscles in healthy women and women with chronic low-back pain. J Back Musculoskelet Rehabil. 2015;28:841–7.
    1. Leonard JH, Paungmali A, Sitilertpisan P, Pirunsan U, Uthaikhup S. Changes in transversus abdominis muscle thickness after lumbo-pelvic core stabilization training among chronic low back pain individuals. Clin Ter. 2015;166:e312–6.
    1. Brumitt J, Matheson JW, Meira EP. Core stabilization exercise prescription, part I: current concepts in assessment and intervention. Sports Health. 2013;5:504–9.
    1. Omkar SN, Vishwas S, Tech B. Yoga techniques as a means of core stability training. J Bodyw Mov Ther. 2009;13:98–103.
    1. Marshall PW, Murphy BA. Core stability exercises on and off a Swiss ball. Arch Phys Med Rehabil. 2005;86:242–9.
    1. Bayraktar D, Guclu-Gunduz A, Lambeck J, Yazici G, Aykol S, Demirci H. A comparison of water-based and land-based core stability exercises in patients with lumbar disc herniation: a pilot study. Disabil Rehabil. 2016;38:1163–71.
    1. Akuthota V, Ferreiro A, Moore T, Fredericson M. Core stability exercise principles. Curr Sports Med Rep. 2008;7:39–44.
    1. Czaprowski D, Afeltowicz A, Gebicka A, et al. Abdominal muscle EMG-activity during bridge exercises on stable and unstable surfaces. Phys Ther Sport. 2014;15:162–8.
    1. Wilk BR, Stenback JT, Gonzalez C, Jagessar C, Nau S, Muniz A. Core muscle activation during Swiss ball and traditional abdominal exercises. J Orthop Sports Phys Ther. 2010;40:538–9.
    1. Mannion AF, Pulkovski N, Toma V, Sprott H. Abdominal muscle size and symmetry at rest and during abdominal hollowing exercises in healthy control subjects. J Anat. 2008;213:173–82.
    1. Rostami M, Noormohammadpour P, Sadeghian AH, Mansournia MA, Kordi R. The effect of lumbar support on the ultrasound measurements of trunk muscles: a single-blinded randomized controlled trial. PM R. 2014;6:302–8.
    1. Kordi R, Rostami M, Noormohammadpour P, Mansournia MA. The effect of food consumption on the thickness of abdominal muscles, employing ultrasound measurements. Eur Spine J. 2011;20:1312–7.
    1. Noormohammadpour P, Ansari M, Mansournia MA, Rostami M, Nourian R, Kordi R. Reversal time of postprandial changes of the thickness of abdominal muscles employing ultrasound measurements. Man Ther. 2015;20:194–9.
    1. Norris C, Matthews M. The role of an integrated back stability program in patients with chronic low back pain. Complement Ther Clin Pract. 2008;14:255–63.
    1. Ostelo RW, Deyo RA, Stratford P, et al. Interpreting change scores for pain and functional status in low back pain: towards international consensus regarding minimal important change. Spine (Phila Pa 1976) 2008;33:90–4.
    1. Sopajareeya C, Viwatwongkasem C, Lapvongwatana P, Hong O, Kalampakorn S. Prevalence and risk factors of low back pain among nurses in a Thai public hospital. J Med Assoc Thai. 2009;92 Suppl 7:S93–9.
    1. 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. Phys Ther. 2005;85:209–25.
    1. Franca FR, Burke TN, Caffaro RR, Ramos LA, Marques AP. Effects of muscular stretching and segmental stabilization on functional disability and pain in patients with chronic low back pain: a randomized, controlled trial. J Manipulative Physiol Ther. 2012;35:279–85.
    1. Rhee HS, Kim YH, Sung PS. A randomized controlled trial to determine the effect of spinal stabilization exercise intervention based on pain level and standing balance differences in patients with low back pain. Med Sci Monit. 2012;18:CR174–81.
    1. Andrusaitis SF, Brech GC, Vitale GF, Greve JM. Trunk stabilization among women with chronic lower back pain: a randomized, controlled, and blinded pilot study. Clinics (Sao Paulo) 2011;66:1645–50.
    1. Shaughnessy M, Caulfield B. A pilot study to investigate the effect of lumbar stabilisation exercise training on functional ability and quality of life in patients with chronic low back pain. Int J Rehabil Res. 2004;27:297–301.
    1. Ota M, Kaneoka K, Hangai M, Koizumi K, Muramatsu T. Effectiveness of lumbar stabilization exercises for reducing chronic low back pain and improving quality-of-life. J Phys Ther Sci. 2011;23:679–81.
    1. Zhang Y, Tang S, Chen G, Liu Y. Chinese massage combined with core stability exercises for nonspecific low back pain: a randomized controlled trial. Complement Ther Med. 2015;23:1–6.
    1. Paungmali A, Henry LJ, Sitilertpisan P, Pirunsan U, Uthaikhup S. Improvements in tissue blood flow and lumbopelvic stability after lumbopelvic core stabilization training in patients with chronic non-specific low back pain. J Phys Ther Sci. 2016;28:635–40.
    1. Ferreira PH, Ferreira ML, Hodges PW. Changes in recruitment of the abdominal muscles in people with low back pain: ultrasound measurement of muscle activity. Spine (Phila Pa 1976) 2004;29:2560–6.
    1. Wong AY, Parent EC, Funabashi M, Kawchuk GN. Do changes in transversus abdominis and lumbar multifidus during conservative treatment explain changes in clinical outcomes related to nonspecific low back pain?: a systematic review. J Pain. 2014;15:377. e1-35.
    1. Vasseljen O, Fladmark AM. Abdominal muscle contraction thickness and function after specific and general exercises: a randomized controlled trial in chronic low back pain patients. Man Ther. 2010;15:482–9.
    1. Kim CR, Park DK, Lee ST, Ryu JS. Electromyographic changes in trunk muscles during graded lumbar stabilization exercises. PM R. 2016;8:979–89.
    1. Ferreira PH, Ferreira ML, Maher CG, Refshauge K, Herbert RD, Hodges PW. Changes in recruitment of transversus abdominis correlate with disability in people with chronic low back pain. Br J Sports Med Please add. 2010;44:1166–72.

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever