Evaluation of the Results of Rehabilitation of Chronic Low Back Pain Syndrome in Physically Active and Inactive Patients During Leisure Time

Abstract

Introduction: Movement is one of the main, modifiable factors (behaviour-dependent) that affects the health and quality of life of individuals and the entire population. Physical activity, including evidence-based active rehabilitation, is the subject of many studies on the prevention and treatment of spinal disorders, which are some of the most serious health problems. The largest group of people with spinal disorders are patients suffering from Nonspecific Low Back Pain (ang. Nonspecific Low Back Pain – NLBP), with kinesitherapy having the widest application in the chronic pain phase. A significant part of the research is devoted to the problem of movement in patients with chronic non-specific low back pain (CNLBP). One physiotherapy treatment method used in chronic low back pain syndrome is the DBC method. It is based on a detailed functional diagnosis, answers given to a standardized questionnaire, individualized treatment plans and active exercises with spinal resistance using specialized DBC equipment. Aim: The aim of this study was to evaluate the influence of leisure-time physical activity on the results of the DBC functional restoration program in patients with chronic, non-specific, low back pain after outpatient rehabilitation. The researchers tested the hypothesis that patients with regular physical activity attained better results of functional restoration compared to physically inactive participants. M aterials and Methods: The research group was comprised of one-hundred forty-seven participants. All subjects suffered from low back pain syndrome lasting for a period of at least three months without neurological symptoms. All symptoms were non-specific. The subjects were divided into two groups. Group 1 was comprised of participants who undertake regular physical activity for more than 45-minutes per exercise session, at least twice a week. Participants in Group 2 did not undertake any physical activity other than that resulting from everyday activities. The study commenced with an interview and standardized DBC questionnaire to get participants’ subjective assessment of the following parameters: current level of pain, functional limitations and scale of depression. A clinical trial was conducted prior to the measurement of objective parameters in order to exclude radicular pain (Lasegue test). Next, the objective parameters were measured: bioelectric activity of the lumbar erector spinae muscles (ang. surfasce electromyography – sEMG) on the right and left side in two positions: standing upright and leaning forward with straight legs. Also, DBC devices were used to measure the following range of motion of the lumbo-thoracic spine: flexion, extension, rotation and lateral flexion/bending. Upon completing the tests (Test 1) both groups were subject to active DBC therapeutic treatment. The therapy consisted of 12 meetings carried out within a 6 week period. Each session lasted for 1.5 hours. When the treatments ended testing was repeated for each group (Test 2). Results: Mean values of functional parameters of the lumbar spine were calculated for both groups. Statistical significance was determined between the preliminary (Test 1) and final (Test 2) tests. All the objective parameters in Group 1 showed statistically significant improvement post-therapy. Different results were observed in Group 2 for participants who did not perform regular physical activity. Although all parameters improved, only some achieved statistical significance. Significance between the two groups was also studied at the beginning of the experiment (Test 1) and after its completion (Test 2). There results showed no statistically significant difference in values of some objective parameters prior to the treatment, while some parameters differed. The treatment achieved a statistically significant improvement in the “active” group compared to the “inactive” one in almost every tested parameter excluding the extension. Significant differences between the groups were observed in the subjective parameters such as: functional limitations (ADL) (ang. Activity of Daily Living – ADL) and level of depression both in the first and last tests. Conclusions: Patients with chronic non-specific low back pain syndrome who remain physically active in leisure time and participated in the 6-week DBC rehabilitation program achieved a statistically significant improvement in the functional parameters of the spine. Patients with chronic non-specific low back pain syndrome who remain physically active in leisure time and participated in the 6-week DBC rehabilitation program improved more in the objective and subjective functional parameters of the spine in comparison with the inactive participants. Active leisure time contributes to the efficacy of physiotherapy for people with low back disorders.