Original researchComparison 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
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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Effect of whole body vibration on the electromyographic activity of core stabilizer muscles: WBV ON CORE STABILIZER MUSCLES
2021, Journal of Bodywork and Movement TherapiesCitation Excerpt :In clinical practice, core muscle training has been considered an effective method to treat low back pain (Barr et al., 2007; Hodges, 2003; Kobill et al., 2017; McGill, 2001) and to prevent injuries, especially those related to sports practice, where a search for increased performance and health promotion is constant (Blaiser et al., 2018; Hibbs et al., 2008; Kibler et al., 2006; Leetun et al., 2004; Prieske et al., 2015). The use of a vibrating platform, or whole body vibration (WBV), has appeared among training techniques as a new alternative to stimulate core muscles in order to intensify their activation (Maddalozzo et al., 2016; Wirth et al., 2011). It is taken into account that the vibration caused by the vibrating platform produces mechanical stimuli capable of provoking adaptations to the musculoskeletal system and its use may improve neuromuscular performance (Torvinen et al., 2002).
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2019, Archives of Physical Medicine and RehabilitationCitation Excerpt :According to the response, we excluded 2 studies12,26 because of data loss. Moreover, we excluded 1 study27 because it had no clear intervention time. Finally, 16 records (13 trials in English and 3 trials in Chinese) were included in our meta-analysis.
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2017, Asian Pacific Journal of Tropical MedicineCitation Excerpt :In this study, the vibrations applied were carried out at 30 Hz and 0.49 g RMS for several reasons: firstly and most importantly, our preliminary research on the effects of axial vibration on degeneration of lumbar intervertebral disc of modified bipedal rats in vitro showed that anabolic genes were up-regulated at 30 Hz and that the most marked effect on up-regulation of all genes of interest was observed at a factor of amplification of 0.49 g RMS. Secondly, medical workers in clinical practice have found that mid-frequency vibration (18–30 Hz) may have a beneficial impact on low back pain in whole-body vibration exercise programs [9,10]. The choice of vibration parameters applied in this study is furthermore supported by a report by Kasra et al. on the effects of high-frequency vibration (20–300 Hz), which was suggested to promote protein and collagen biosynthesis in rabbit IVDs [11].
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