Original research
Comparison of 2 Multimodal Interventions With and Without Whole Body Vibration Therapy Plus Traction on Pain and Disability in Patients With Nonspecific Chronic Low Back Pain

https://doi.org/10.1016/j.jcm.2016.07.001Get rights and content

Abstract

Objective

The purpose of this secondary data analysis was to compare the effect of 2 multimodal exercise-based physical therapy interventions (one with and one without whole-body vibration [WBV] therapy plus traction) on pain and disability in patients with nonspecific chronic low back pain (NSCLBP).

Methods

We conducted a secondary analysis of data from 2 distinct samples. One sample was from the Focus on Therapeutic Outcomes Inc. (FOTO) group (n = 55, age 55.1 ± 19.0 years), and the other was the Illinois Back Institute (IBI) (n = 70, age 47.5 ± 13.4 years). Both groups of patients had NSCLBP for more than 3 months and a pain numeric rating scale (NRS) score of ≥7. Both groups received treatment consisting of flexibility or stretching exercises, core stability training, functional training, and postural exercises and strengthening exercises. However, the IBI group also received WBV plus traction. NSCLBP was measured before and after therapeutic trials using the NRS for pain and Oswestry Disability Index (ODI).

Results

The NRS scores were significantly improved in both groups, decreasing by 2 points in the FOTO group and by 5 points in the IBI group. The ODI scores were significantly improved in both groups; the FOTO group score improved by 9 points and the IBI group improved by 22 points.

Conclusions

The results of this preliminary study suggest that NPS and ODI scores statistically improved for both NSCLBP groups receiving multimodal care. However, the group that included WBV therapy plus traction in combination with multimodal care had greater clinical results. This study had several limitations making it difficult to generalize the results from this study sample to the entire population.

Introduction

Nonspecific chronic low back pain (NSCLBP)1 has multifactorial origins and poses a diagnostic and therapeutic challenge for a practicing physician. Americans annually spend more than $50 billion to help alleviate low back pain, and that number continues to grow, resulting in an economic burden on individuals, families, communities, industry, and governments.2 Each year, more than 149 million workdays are lost at an estimated cost of $560 billion to $635 billion dollars, of which $297 billion to $336 billion are a result of lost productivity and wages.1, 3 NSCLBP is measured by duration and is defined as persistent chronic pain that lasts for more than 3 months and significantly decreases the quality of life of the individual.4

Common treatment strategies for NSCLBP include (1) information gathering, office visit consults, laboratory tests, and imaging (radiography, ultrasound, computed tomography, or magnetic resonance imaging); (2) chiropractic treatment; (3) physical therapy (PT) treatments; (4) opioids or nonsteroidal antiinflammatory drugs; (5) intensive multidisciplinary biopsychosocial rehabilitation; and (6) physician visits for nerve blocks, surgeries, or comparable procedures. Unfortunately, a lack of consistency among measures of recovery from NSCLBP makes it extremely difficult to determine whether a treatment strategy has been successful.2

Pharmacotherapy as a treatment strategy for NSCLBP results in high cost, minimal pain reduction, side effects, and limited efficacy. According to the Centers for Disease Control and Prevention, pharmaceutical drug prescriptions such as opioid analgesics account for nearly 75% of all pharmaceutical overdose deaths, resulting in more fatalities than heroin and cocaine combined.5 Americans consume 80% of the global opioid supply and 99% of the global hydrocodone supply, and greater daily use of opioids correlates strongly with lower likelihood of the user returning to work.6 Returning to work is an important objective personal health outcome, because being out of work is associated with poor health.7

It is estimated that nearly 600,000 Americans opt for back surgeries each year, with some resulting in no significant improvement in low back pain or function. In a recent study,6 the authors reported that after 2 years, only 26% of individuals who had surgery returned to work, compared with 67% of patients who did not have surgery, and 27% had repeat surgery. Additionally, 76% of these patients were still taking opioids 90 days after surgery, with daily doses increasing by 41%, as well as experiencing reported increases in disability, prolonged work loss, and poor return to work rates.6

Few, if any, of the most commonly used interventions appear to offer any relief for patients with NSCLBP. In most patients, reductions in the number of NSCLBP-related complaints are nonsignificant while the patient continues to experience pain.8, 9, 10 The current pharmacologic and surgical approach to the treatment of NSCLBP warrants that other noninvasive approaches, without the known adverse pharmacologic and surgical side effects, need to be identified.

One such potential multimodal method that has not been widely studied is whole-body vibration (WBV) therapy in combination with traction, strengthening exercises, core stability training, functional training, flexibility or stretching exercises, and balance and postural control. WBV therapy involves the application of vibratory stimuli throughout the body by standing on a vibrating platform.11 The vibration is created by a mechanical linear or oscillating motion, which transfers energy through the body, stimulating muscles to contract.12 WBV has recently been used to reduce back pain and fibromyalgia pain in women.13, 14 Because current theory suggests that pain operates through common mechanisms and that no pain mechanism is an inevitable consequence of a particular disease process,15 it stands to reason that WBV may be effective in treating NSCLBP.

The purpose of this secondary data analysis was to assess the effect of 2 multimodal interventions to reduce pain in patients with NSCLBP, one combining WBV therapy, traction, and exercise and the other excluding WBV therapy.

Section snippets

Participants

We conducted a secondary analysis of previously collected data from the Focus on Therapeutic Outcomes, Inc. (FOTO) database (Knoxville, TN)16, 17, 18, 19, 20, 21, 22 and the Illinois Back Institute (IBI) (Chicago, IL). The platform used for outcomes data collection has previously been described.23, 24, 25 Our deidentified analytical sample was selected from 2 data sets of clinics treating patients diagnosed with confirmed chronic low back pain (FOTO, n = 616; IBI, n = 70). Participants’

Numeric Rating Scale

The NRS is an 11-point scale for patient self-reporting of pain. It is for adults and children ages 10 years and older.32 Pain was measured using the NRS33, 34 at baseline and after intervention. The NRS has a numeric range of 0 (no pain) to 10 (worst pain possible).33 Pain classifications are as follows: 0 = no pain, 1-3 = mild pain, 4-6 = moderate pain, and 7-10 = severe pain.32 Adequate validity of the NRS has been established with correlation coefficients ≥0.80 between the NRS and visual

Results

The study included 125 patients: 50 men and 75 women (Fig 1). Patients’ mean age was 51.3 ± 15.2 years for men and 50.5 ± 17.2 years for women. The means and standard deviations are presented in Table 1, Table 2, Table 3, Table 4. At baseline, no significant differences existed between FOTO and IBI for NRS and ODI scores, number of PT treatments received, BMI, and time from first onset of pain (years) (Table 1). When examining the NRS pain score differences before and after treatment (Table 2),

Discussion

The results of this study indicate that patients’ NRS and ODI scores significantly decreased regardless of therapy intervention. However, the IBI group (inclusion of vibration therapy) had better outcomes.

A strength of this study is that participants in both groups had a baseline NRS score of ≥7, a classification of severe pain. The FOTO group’s mean NRS was 7.8 and the IBI group’s NRS was 7.5, classifying all group participants with severe pain.33 The majority of exercise intervention studies

Conclusions

The results of this preliminary study suggest that NPS and ODI scores statistically improved for both groups receiving multimodal care. However, the group that included WBV therapy plus traction in combination with multimodal care had greater clinical results.

Funding sources and conflicts of interest

Focus on Therapeutic Outcomes Inc. (FOTO; Knoxville, TN) and the Illinois Back Institute (Chicago, IL) provided the data to conduct this secondary analysis. No conflicts of interest were reported for this study.

Contributorship Information

Concept development (provided idea for the research): G.F.M.

Design (planned the methods to generate the results): G.F.M.

Supervision (provided oversight, responsible for organization and implementation, writing of the manuscript): G.F.M.

Data collection/processing (responsible for experiments, patient management, organization, or reporting data): G.F.M.

Analysis/interpretation (responsible for statistical analysis, evaluation, and presentation of the results): G.F.M., B.K., J.W.G., W.A.M., C.D.M.

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