Physical therapy for the treatment of Unspecific Chronic Low Back Pain: A systematic review and meta-analysis of randomized controlled trials

Physical therapy for the treatment of Unspecific Chronic Low Back Pain

: A systematic review and meta-analysis of randomized controlled trials

Background:

 Unspecific chronic low back pain (UCLBP) is a common disease worldwide with increasing prevalence in an aging population. Physical therapy is a treatment in which Korean medicine doctor utilizes the devices newly developed in modern times based on Korean medicine. It is used in the UCLBP to reduce pain, inflammation, or tissue restriction, and increase movement and symptom relief through vasodilation and neurostimulation. However evidence for physical therapy on UCLBP has been insufficient and indefinitive. This review evaluate the effectiveness of physical therapy on UCLBP.

Purpose/Objectives: The purpose of this study was to search for evidence on the use of physical therapy for non-specific chronic low back pain, and to synthesize and review the results.

Method:

 Eight databases(PUBMED, CENTRAL, EMBASE, CNKI, KMBASE, KISS, NDSL, OASIS) were searched from January 2016 to September 2022. Randomized controlled trial studies using physical therapy for unspecific chronic low back pain were selected. There were restrictions according to publication status which under 18 years of age and failure to meet the criteria of unspecific chronic low back pain. Data from the selected studies were extracted using a formal extraction tool. Primary outcome measurements were Visual Analogue Scale(VAS) for pain intensity, Roland Morris Disability Questionnaire(RMDQ) and Oswestry Disability Index(ODI) for functional status. The risk of bias of each of the selected studies was assessed using the Cochrane risk of bias tool. For continuous data, standardized mean difference was calculated with 95% confidence intervals in a random effect model. Heterogeneity between the selected studies was assessed using the forest plot and Chi-square test.

Results:

 2764 records were verified from the searched databases. After screening the records, 28 studies were finally included in the systematic review, and 21 of them were included in meta-analysis. Physical therapy as add-on treatment, showed a significant effect on improving pain relief, and ICT also showed a significant improvement in alone treatment.

Conclusions: This systematic review suggests that physical therapy have beneficial effects as add-on treatment for unspecific chronic low back pain. However there were insignificant results of improving function in some physical therapy, which lacks the number of studies. Therefore, large number of further well designed studies are necessary to obtain conclusive evidence that physical therapy treatment is effective in reducing pain and improving function of unspecific chronic low back pain.

References: 1. Jaechul Park. “Comparison of the Effects of Scrambler and Transcutaneous Electrical Nerve Stimulation Therapy on Pain, Functional Disability, and Depression in Patients with Chronic Low Back Pain”. 2021;19(3):383-90.
2. Aguilar Ferrándiz ME, Nijs J, Gidron Y, Roussel N, Vanderstraeten R, Van Dyck D, et al. Auto-Targeted Neurostimulation Is Not Superior to Placebo in Chronic Low Back Pain: A Fourfold Blind Randomized Clinical Trial. Pain Physician. 2016;19(5):E707-19.
3. Aguilar-Ferrándiz ME, Matarán-Peñarrocha GA, Tapia-Haro RM, Castellote-Caballero Y, Martí-García C, Castro-Sánchez AM. Effects of a supervised exercise program in addition to electrical stimulation or kinesio taping in low back pain: a randomized controlled trial. Sci Rep. 2022;12(1):11430.
4. Caldas VVA, Maciel DG, Cerqueira MS, Barboza JAM, Neto JBV, Dantas G, et al. Effect of Pain Education, Cryotherapy, and Transcutaneous Electrical Nerve Stimulation on the Pain, Functional Capacity, and Quality of Life in Patients With Nonspecific Chronic Low Back Pain: A Single-Blind Randomized Controlled Trial. Am J Phys Med Rehabil. 2021;100(3):243-9.
5.Dias LV, Cordeiro MA, Schmidt de Sales R, Dos Santos M, Korelo RIG, Vojciechowski AS, et al. Immediate analgesic effect of transcutaneous electrical nerve stimulation (TENS) and interferential current (IFC) on chronic low back pain: Randomised placebo-controlled trial. J Bodyw Mov Ther. 2021;27:181-90.
6. Ferreira PML, Fernanda G, de MRM, Guarda KRI, César GL, Eloin LR, et al. Immediate analgesic effect of two modes of transcutaneous electrical nerve stimulation on patients with chronic low back pain: a randomized controlled trial. Einstein (Sao Paulo, Brazil). 2021;19.
7. Jalalvandi F, Ghasemi R, Mirzaei M, Shamsi M. Effects of back exercises versus transcutaneous electric nerve stimulation on relief of pain and disability in operating room nurses with chronic Unspecific LBP: a randomized clinical trial. BMC Musculoskelet Disord. 2022;23(1):291.
8. KİBar S, Konak HE, V SA, DoĞAnay ErdoĞAn B, EvcİK D. The Effectiveness of Combined Transcutaneous Electrical Nerve Stimulation and Interferential Current Therapy on Chronic Low Back Pain: a Randomized, Double-Blind, Sham-Controlled Study. Journal of physical medicine & rehabilitation sciences / fiziksel tup ve rehabilitasyon bilimleri dergisi. 2020;23(1):32‐40.
9. Kim YK, Cho SY, Lee KH. Effects of transcutaneous electrical nerve stimulation and instrument-assisted soft tissue mobilization combined treatment on chronic low back pain: A randomized controlled trial. J Back Musculoskelet Rehabil. 2021;34(5):895-902.
10. Leemans L, Elma Ö, Nijs J, Wideman TH, Siffain C, den Bandt H, et al. Transcutaneous electrical nerve stimulation and heat to reduce pain in a chronic low back pain population: a randomized controlled clinical trial. Braz J Phys Ther. 2021;25(1):86-96.
11. 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. 2021. https://doi.org/10.1111/ner.13522.
12. Sayilir S, Yildizgoren MT. The medium-term effects of diadynamic currents in chronic low back pain; TENS versus diadynamic currents: A randomised, follow-up study. Complement Ther Clin Pract. 2017;29:16-9.
13. Yurdakul OV, Beydogan E, Yalcinkaya EY. Effects of physical therapy agents on pain, disability, quality of life, and lumbar paravertebral muscle stiffness via elastography in patients with chronic low back pain. Turkish journal of physical medicine and rehabilitation. 2019;65(1):30‐9.
14. Albornoz-Cabello M, Maya-Martín J, Domínguez-Maldonado G, Espejo-Antúnez L, Heredia-Rizo AM. Effect of interferential current therapy on pain perception and disability level in subjects with chronic low back pain: a randomized controlled trial. Clin Rehabil. 2017;31(2):242-9.
15. Almeida N, Paladini LH, Korelo RG, Liebano RE, de Macedo ACB. Immediate Effects of the Combination of Interferential Therapy Parameters on Chronic Low Back Pain: A Randomized Controlled Trial. Pain Pract. 2020;20(6):615-25.
16. Corrêa JB, Costa LOP, Oliveira NTB, Lima WP, Sluka KA, Liebano RE. Effects of the carrier frequency of interferential current on pain modulation and central hypersensitivity in people with chronic nonspecific low back pain: A randomized placebo-controlled trial. European Journal of Pain (United Kingdom). 2016;20(10):1653-66
17. Kyoung-sim J, Tae-sung I. Effects of Interferential Current Treatment on Pain, Disability, and Balance in Patients with Chronic Low Back Pain: A Randomized Controlled Study. Journal of the Korean society of Physical Medicine. 2020;15(3):21-7.
18. Tantawy SA, Kamel DM, Abdelbasset WK, Nambi G. A randomized controlled trial investigating the impact of interferential therapy on pain, range of motion and quality of life in patients with chronic Unspecific low back pain. Archives of the balkan medical union. 2020;55(1):47‐54.
19. Çelik A, Altan L, Ökmen BM. The Effects Of Extracorporeal Shock Wave Therapy On Pain, Disability And Life Quality Of Chronic Low Back Pain Patients. Altern Ther Health Med. 2020;26(2):54-60.