The aim of this trial is to investigate and compare the effects of phonophoresis (PP) and ultrasound (US) therapy on pain, disability, trunk muscle strength, walking performance, spinal mobility, quality of life (QOL), and depression in the patients with chronic low back pain (CLBP). A total of 60 patients with definite CLBP were included in this study. The patients were randomized into three groups. Group 1 (n = 20) was accepted as the control group and was given only exercises. Group 2 (n = 20) received US treatment and exercises. Group 3 (n = 20) received PP and exercises. All of the programs were performed 3 days a week, for 6 weeks. The pain (visual analog scale, VAS), disability (Oswestry Disability Questionnaire, ODQ and pain disability index, PDI), walking performance (6 min walking test, 6MWT), depression (Beck Depression Inventory scores, BDI), and QOL (Short Form 36, SF-36) of all participants were evaluated. The trunk muscle strength was measured with a handheld dynamometer. All of the groups showed statistically significant improvements in pain, disability, muscle strength, endurance, 6MWT, mobility, QOL, and depression. The intergroup comparison showed significant differences in VAS pain, 6MWT, and EMS, among three groups. These differences were statistically significant in groups 2 and 3 compared with the group 1. The intergroup comparison showed significant difference in pain, physical function, and energy subgroups of SF-36. The differences were statistically in group 3 compared with group 1 and 2. We observed that US and PP treatments were effective in the treatment of patients with CLBP but PP was not found to be superior over ultrasound therapy.
BACKGROUND: Non-specific chronic low back pain (NSCLBP) is one of the most common musculoskeletal disorders around the world including Iran. One of the most widely used modalities in the field of physiotherapy is therapeutic ultrasound (US). Despite its common use, there is still inconclusive evidence to support its effectiveness in patients with NSCLBP. The objective of this study was to evaluate the effect of continuous US compared with placebo US additional to exercise therapy for patients with NSCLBP.
METHODS: In this single blind placebo controlled study, 50 patients with NSCLBP were randomized into two treatment groups: 1) continuous US (1 MHz &1.5 W/cm2) plus exercise 2) placebo US plus exercise. Patients received treatments for 4 weeks, 10 treatment sessions, 3 times per week, every other day. Treatment effects were assessed in terms of primary outcome measures: 1) functional disability, measured by Functional Rating Index, and 2) global pain, measured by a visual analog scale. Secondary outcome measures were lumbar flexion and extension range of motion (ROM), endurance time and rate of decline in median frequency of electromyography spectrum during a Biering Sorensen test. All outcome variables were measured before, after treatment, and after one-month follow-up. An intention to treat analysis was performed. Main effects of Time and Group as well as their interaction effect on outcome measures were investigated using repeated measure ANOVA.
RESULTS: Analysis showed that both groups had improved regarding function (FRI) and global pain (VAS) (P < .001). Lumbar ROM as well as holding time during the Sorensen test and median frequency slope of all measured paravertebral muscles did not change significantly in either group (P > .05). Improvement in function and lumbar ROM as well as endurance time were significantly greater in the group receiving continuous US (P < .05).
CONCLUSIONS: The study showed that adding continuous US to a semi supervised exercise program significantly improved function, lumbar ROM and endurance time. Further studies including a third group of only exercise and no US can establish the possible effects of placebo US.
TRIAL REGISTRATION: NTR2251.
OBJECTIVE: The aim of the current study was to evaluate the effects of therapeutic ultrasound on pain, disability, walking performance, quality of life (QOL) and depression in patients with chronic low back pain (CLBP). MATERIALS AND METHODS: Forty-two patients with CLBP were randomly allocated into two groups. Patients in group 1 received therapeutic ultrasound, exercise, and hot packs, while patients in group 2 received sham ultrasound, exercise, and hot packs. All treatment programs (ultrasound, sham ultrasound, hot packs, and exercise) were performed 5 days a week for 3 weeks. Patients were evaluated by the following parameters: pain (visual analog scale [VAS]), disability (Modified Oswestry Low Back Pain Disability Questionnaire and Pain Disability Index), functional performance (6-Minute Walk Test [6MWT]), QOL (Short Form 36 [SF-36]), and depression (Beck Depression Inventory [BDI]). RESULTS: A significant improvement was noted in both groups in pain, disability, walking performance, QOL and depression after treatment. Significantly greater improvement was observed in group 1 compared to group 2 in pain, emotional and physical role functioning, functional performance, and depression. CONCLUSION: Therapeutic ultrasound was shown to be effective on pain, some particular parameters of QOL, functional performance, and depression in patients with CLBP. (Turk J Rheumatol 2010; 25: 82-7) Key words: chronic low back pain, therapeutic ultrasound, pain, walking performance, quality of life Received: 29.12.2008 Accepted: 30.03.2009 Amac: Bu calismanin amaci, kronik bel agrisi (KBA) olan hastalarda tedavide kullanilan ultrasonun (US) agri, fonksiyon, yasam kalitesi ve depresyona olan etkisini degerlendirmektir. Yontem ve Gerecler: KBA'si olan 42 hasta rastgele iki gruba dagitildi. Grup 1 sicak paket, US ve egzersiz tedavisi aldi, grup 2 kontrol grubu olarak kabul edildi (sicak paket, plasebo US ve egzersiz tedavisi). Butun tedaviler (US, plasebo US, sicak paket ve egzersiz) 3 hafta sureyle haftada 5 gun uygulandi. Hastalarin agrisi visual analog skala (VAS), disabilitesi Duzeltilmis Oswestry Ozurluluk Sorgulama formu (DOOS) ve Agri Ozurluluk Indeksi (AOI), fonksiyonu 6 dakika yurume testi (6DYT), yasam kalitesi kisa form-36 (SF-36) ve depresyon Beck Depresyon Olcegi (BDO) ile degerlendirilmistir. Bulgular: Tedavi sonrasinda her iki grupta agri, disabilite, yurume performansi, yasam kalitesi ve depresyonda cok anlamli gelisme tespit edildi. Iki grup karsilastirildiginda VAS agri, 6DYT, SF-36'nin fiziksel rol ve emosyonel roldeki kisitlilik parametrelerini iceren alt gruplari ve BDO degerlerinde grup 1'de grup 2'ye gore daha anlamli gelisme bulundu. Sonuc: Bu calismada tedavide kullanilan US'nin KBA'li hastalarda agriya, yasam kalitesinin bazi parametrelerine, fonksiyonel performansa ve depresyona etkili oldugunu tespit ettik.
The purpose was to determine the efficacy of therapeutic ultrasound in patients with chronic low back pain. Thirty-one patients, age 38-77, with low back pain lasting more than three months and the intensity of pain on visual analogue scale at least 50 mm, are randomly divided in two groups. Ultrasound is applied on the lumbar paravertebral muscle in 16 patients and in 15 patients the machine was not switched on. All patients also underwent kinesitherapy. Pharmacological treatment was not changed during the research (except the possibility of using paracetamol as the "rescue drug"). Following parameters were measured at the beginning and at the end of the research: pain intensity on the visual analogue scale/mm, modified Schober measure/cm, patient's and physician's global assessment of treatment efficacy (1-5 scale). The intensity of pain in the ultrasound group before the treatment was 82,7+/-14,0 and after the treatment 79,8+/-12,2 (p<0,05). The intensity of pain in the placebo group before the treatment was 81,7+/-12,1 and at the end of the treatment 78,9+/-12,1 (p>0,05). The value of the modified Schober measure for the ultrasound group were 5,7+0,8 cm vs. 5,8+/-0,9 cm (p>0,05) and in the placebo group were 5,4+/-0,9 cm vs. 5,6+/-1,0 cm (p>0,05). There was no significant statistical difference between ultrasound and placebo group regarding the efficacy of the treatment (patients p>0,05, physicians p>0,05). Therapeutic ultrasound was effective in decreasing the pain intensity in this research, but showed no improvement regarding the functional ability of the lumbar spine in patients with chronic low back pain.
Low back pain (LBP) is a very common problem in primary care and a major cause of disability. There is no evidence for the efficacy of therapeutic modalities such as ultrasound in LBP In a randomized, single blind placebo controlled clinical trial, we aimed to evaluate the effect of continuous ultrasound (US) in patients with non specific LBP Of the fifty eight patients recruited, 10 patients (8 women and 2 men) randomly allocated to ultrasound (n=5) or placebo controlled (n=5) groups. The patients were treated by either US or sham-US for ten sessions, three days per week, every other day. The outcome measures were Functional Rating Index (FRI), Hmax/Mmax ratio and range of motion (ROM), which were measured at baseline, after 5 treatment sessions and at the end of treatment. To analyze the data, The Mann Whitney U test and Wilcoxon Signed Rank test were used. After treatment, both US and placebo groups showed statistically significant decrease in FRI scores indicating improvement in functional ability (p = 0.042 and p = 0.043, respectively). The mean changes of FRI during the second five treatment sessions and after the end of treatment was significantly better in the US group than in the placebo group (p = 0.016 and p = 0.032, respectively). Before and after treatment, the mean H reflex latency and Hmax/Mmax ratio, right and left side were similar in the groups (p > 0.05), and no significant changes were observed in the treatment groups (p > 0.05). After treatment, the extension and lateral flexion range of motion significantly increased in the US group (p = 0.04), but the back movements in the placebo group did not show significant changes (p > 0.05). The present study supports the significant effect of US on LBP, and suggests that US may improve the functional ability of patients with non specific low back pain.
The aim of this trial is to investigate and compare the effects of phonophoresis (PP) and ultrasound (US) therapy on pain, disability, trunk muscle strength, walking performance, spinal mobility, quality of life (QOL), and depression in the patients with chronic low back pain (CLBP). A total of 60 patients with definite CLBP were included in this study. The patients were randomized into three groups. Group 1 (n = 20) was accepted as the control group and was given only exercises. Group 2 (n = 20) received US treatment and exercises. Group 3 (n = 20) received PP and exercises. All of the programs were performed 3 days a week, for 6 weeks. The pain (visual analog scale, VAS), disability (Oswestry Disability Questionnaire, ODQ and pain disability index, PDI), walking performance (6 min walking test, 6MWT), depression (Beck Depression Inventory scores, BDI), and QOL (Short Form 36, SF-36) of all participants were evaluated. The trunk muscle strength was measured with a handheld dynamometer. All of the groups showed statistically significant improvements in pain, disability, muscle strength, endurance, 6MWT, mobility, QOL, and depression. The intergroup comparison showed significant differences in VAS pain, 6MWT, and EMS, among three groups. These differences were statistically significant in groups 2 and 3 compared with the group 1. The intergroup comparison showed significant difference in pain, physical function, and energy subgroups of SF-36. The differences were statistically in group 3 compared with group 1 and 2. We observed that US and PP treatments were effective in the treatment of patients with CLBP but PP was not found to be superior over ultrasound therapy.
