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A randomized controlled trial of the effects of muscle stretching, manual therapy and steroid injections in addition to 'stay-active' care on health-related quality of life in acute and sub-acute low back pain
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
Karolinska Institutet, Institutionen för neurobiologi, vårdvetenskap och samhälle, Department of Neurobiology, Care Science and Society.
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2011 (Engelska)Ingår i: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 25, nr 11, s. 999-1010Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Objective: To evaluate the health-related quality of life effects of muscle stretching, manual therapy and steroid injections in addition to 'stay active' care in acute or subacute low back pain patients.

Study design: A randomized, controlled trial during 10 weeks with four treatment groups.

Setting: Nine primary health care and one outpatient orthopaedic hospital department.

Subjects: One hundred and sixty patients with acute or subacute low back pain.

Interventions: Ten weeks of 'stay active' care only (group 1), or 'stay active' and muscle stretching (group 2), or 'stay active', muscle stretching and manual therapy (group 3), or 'stay active', muscle stretching, manual therapy and steroid injections (group 4).

Main measures: The Gothenburg Quality of Life instrument subscales Well-being score and Complaint score.

Results: In a multivariate analysis adjusted for possible outcome affecting variables other than the treatment given Well-being score was 68.4 (12.5), 72.1 (12.4), 72,3 (12.4) and 72.7 (12.5) in groups 1-4, respectively (P for trend <0.05). There were significant trends for the well-being components patience (P < 0.005), energy (P < 0.05), mood (P < 0.05) and family situation (P < 0.05). The remaining two components and Complaint score showed a non-significant trend towards improvement.

Conclusion: The effects on health-related quality of life were greater the larger the number of treatment modalities available. The 'stay active' treatment group, with the most restricted number of modalities, had the most modest health-related quality of life improvement, while group 4 with the most generous choice of treatment modalities, had the greatest improvement.

Ort, förlag, år, upplaga, sidor
2011. Vol. 25, nr 11, s. 999-1010
Nationell ämneskategori
Medicin och hälsovetenskap
Identifikatorer
URN: urn:nbn:se:uu:diva-156551DOI: 10.1177/0269215511403512ISI: 000296747400005PubMedID: 21831926OAI: oai:DiVA.org:uu-156551DiVA, id: diva2:433098
Tillgänglig från: 2011-08-08 Skapad: 2011-08-02 Senast uppdaterad: 2017-12-08Bibliografiskt granskad
Ingår i avhandling
1. Low Back Pain: With Special Reference to Manual Therapy, Outcome and its Prognosis
Öppna denna publikation i ny flik eller fönster >>Low Back Pain: With Special Reference to Manual Therapy, Outcome and its Prognosis
2011 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Objectives. To assess outcome of manual therapy in addition to stay-active care in sub-acute low back pain patients and to investigate the predictive power of pain drawing sketch variables for return to work.

Materials and methods. The study was designed as a randomised controlled trial with a factorial design, and included 160 patients with acute or sub-acute low back pain allocated to one of the four treatment groups during 10 weeks. Group 1 received stay-active care only, Group 2 the same treatment as in Group 1 + muscle stretching, Group 3 the same treatment as in Group 2 plus manual therapy, and Group 4 the same treatment as Group 3 plus steroid injections. Outcome included pain intensity, pain extension, functional and health related quality of life variables and return to work.

Results. Pain intensity and disability rating improved faster in Groups 3 and 4 than in Groups 1 and 2 (p<0.05 and p<0.05). Also health related quality of life was affected by the treatments given; the more treatment options the better the effect (trend across the groups p<0.05). Pain extension as described on a pain drawing sketch decreased in all groups across the study period. The pain modality ‘numbness’ was the most painful one among patients with no pain radiation. Pain radiation according to the pain drawing sketch was the strongest predictor for return to work (p=0.03, Wald χ2=4.56).

Conclusions. The manual therapy concept used in this study reduced pain intensity and disability rating better than the stay active concept. The effects on health related quality of life were greater the larger the number of treatment modalities available. Pain drawing information was significantly correlated with pain and functional variables. Pain radiation according to the pain drawing adds significant information to the prediction of return to work.

Ort, förlag, år, upplaga, sidor
Uppsala: Acta Universitatis Upsaliensis, 2011. s. 79
Serie
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 691
Nyckelord
Low Back Pain, Manual therapy, Stay active care, Mobilisation, Manipulation, Pain drawing, Return to work, Prognosis, Disability rating, Pain
Nationell ämneskategori
Allmänmedicin
Forskningsämne
Allmänmedicin
Identifikatorer
urn:nbn:se:uu:diva-156739 (URN)978-91-554-8122-3 (ISBN)
Disputation
2011-09-30, Rudbecksalen, Rudbecklaboratoriet, Dag Hammarskölds väg 20, Uppsala Science Park, Uppsala, 13:15 (Svenska)
Opponent
Handledare
Tillgänglig från: 2011-09-09 Skapad: 2011-08-08 Senast uppdaterad: 2018-01-12Bibliografiskt granskad

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Grunnesjö, Marie IBogefeldt, Johan PBlomberg, Stefan I ESvärdsudd, Kurt F
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