PHILADELPHIA, PA – September 2005 - A strengthening and exercise program can help lessen the pain and improve the functional capabilities of disabled workers with long-standing back pain, according to a new study presented on Wednesday, September 28, at the 20th annual meeting of the North American Spine Society in Philadelphia.
The 8- to 15-week program combined progressive resistance training with exercises designed to improve flexibility and coordination. It eschewed passive modalities such as ultrasound, electrical stimulation, and hot packs.
“Restorative exercise was effective in improving self-reported functional ability and reducing pain intensity in a sample of patients with spinal complaints,” said Vert Mooney, MD, of the Spine and Sport Foundation in San Diego. Mooney reported the findings at the 20th annual meeting of the North American Spine Society in Philadelphia.
Mooney and his colleagues reviewed the records of 314 consecutive patients who participated in the program. The majority of the workers had chronic back pain attributed to work-related causes. Many of them were receiving workers’ compensation. Some had previously undergone spine surgery.
The researchers quantified the patients’ spinal disability using a touch-screen computerized tool called the Multidimensional Task Ability Profile (MTAP). The MTAP displays a sequence of captioned drawings depicting people performing normal daily activities of increasing physical demand—for example, picking up paper clips, vacuuming a floor, and wheeling a wheelbarrow loaded with cement up an incline. Patients self-score their ability to perform each task on a five-point Likert scale. The test takes about 10 minutes to complete.
The researchers also gauged functional abilities using a government work classification system that rates the physical demands of various types of labor.
After finishing the rehabilitation program, the workers demonstrated modest but significant functional gains (a 13% improvement over baseline). Mooney says these may be sufficient to return them to productive lives in the workforce.
Two-thirds of workers who were deemed “unemployable” (worse than sedentary) before the beginning of the program improved enough after the program to become theoretically “employable.” In addition, pain scores significantly improved by 18 points on a scale of 0-100 (dropping to 33 points from 55 at baseline).
“Most people reduce their activity when they’re in pain. By increasing their strength with guidance and progressive exercise, the pain goes down,” said Mooney.
There is a growing body of evidence to support the role of functional rehabilitation in patients with chronic low back pain. The literature suggests that more-intensive training yield greater improvements than less-intensive regimens, according to a recent Cochrane review. (See Hayden JA et al., Ann Intern Med, 2005; 142:776-85.)
“Exercise therapy that consists of individually designed programs, including stretching or strengthening, and is delivered with supervision may improve pain and function in chronic nonspecific low back pain,” the Cochrane review authors concluded. “High-dose exercise programs fared better than low-dose exercise programs.”
Mooney said clinicians should ask themselves, “What sort of treatment serves the societal interest of returning a person to normal function?” The literature shows that “usual physical therapy using hot packs, ultrasound, and [other modalities] makes no difference.”
Mooney acknowledges that the new study does not measure psychological or social risk factors that may be at play in disabled workers with back pain. Many patients who seek care for back pain have additional problems, such as low education levels, low job satisfaction, and depression that have a profound effect on their functional abilities and the resolution of their back pain.
The study’s design also leaves unanswered other questions often raised by spine rehabilitation programs. Are all of the components of the rehabilitation protocol necessary for a good result—or just one or two? How much of the improvement might be due to the attention and encouragement patients receive from enthusiastic clinicians? Would the addition of a psychological component—for example, a cognitive behavioral therapy program—accrue even greater gains in these patients?
Spine specialists are actively pursuing the answers to these and other questions in a broad, ongoing research effort.
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NASS is a multidisciplinary medical organization dedicated to fostering the highest quality, evidence-based, and ethical spine care by promoting education, research, and advocacy. Since its start in 1985, NASS has grown to nearly 4,000 members in 22 spine-related specialties. NASS members are MDs, DOs, and PhDs, including orthopedics, neurosurgery, physiatry, pain management, and other disciplines. Nurse practitioners, physician’s assistants, chiropractors, physical therapists, practice administrators, and other allied health care professionals involved in spine care are also represented as affiliate members.
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