Physiotherapy Combined with Therapeutic Neuroscience Education Versus Physiotherapy Alone for Patients with Chronic Low Back Pain: A Pilot, Randomized-controlled Trial

Overview

Journal Turk J Phys Med Rehabil

Specialty Rehabilitation Medicine

Date 2021 Dec 6

PMID 34870114

Citations 7

Authors

Hatice Gul

Suat Erel

Naciye Fusun Toraman

Affiliations

Soon will be listed here.

Abstract

Objectives: The aim of this study was to investigate the effect of therapeutic neuroscience education (TNE) combined with physiotherapy on pain, kinesiophobia, endurance, and disability in chronic low back pain (CLBP) patients.

Patients And Methods: Between November 2016 and December 2017, a total of 31 patients with CLBP (5 males, 26 females; mean age: 42.3±10.8 years; range, 20 to 58 years) were randomly allocated to receive physiotherapy combined with TNE (experimental group, EG, n=16) and physiotherapy alone (control group, CG, n=15). All participants received physiotherapy consisting of five sessions per week for a total of three weeks. In addition to physiotherapy, the EG received TNE sessions consisting of two sessions per week for a total of three weeks. The primary outcomes were pain intensity as assessed by Visual Analog Scale (VAS) and kinesiophobia by Tampa Scale for Kinesiophobia (TSK), while and the secondary outcomes were trunk muscle endurance as assessed by the partial curl-up test (trunk flexor endurance [TFE]) and modified Sorensen test (trunk extensor endurance [TEE]) and disability by Roland-Morris Disability Questionnaire (RMDQ).

Results: All patients completed the study. The median VAS, TSK, TFE, TEE, and RMDQ scores for the EG significantly improved after three weeks, while there was only significant improvement in the VAS, TSK, and RMDQ scores in the CG. The TSK decreased more in the EG than in the CG. The significant difference was evident in TSK and TFE in favor of the EG (p<0.05).

Conclusion: These results suggest that the combination of TNE with physiotherapy can improve kinesiophobia and trunk flexor muscle endurance of patients with CLBP in the short-term.

Citing Articles

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Arguisuelas M, Garrigos-Pedron M, Martinez-Hurtado I, Lison J, Bivia-Roig G, Alvarez-Llanas A PLoS One. 2024; 19(6):e0303979.

PMID: 38843271 PMC: 11156268. DOI: 10.1371/journal.pone.0303979.

Effects of Pain Neuroscience Education and Physiotherapy on Chronic Low Back Pain, Fear of Movement and Functional Status: A Randomised Pilot Study.

Lendraitiene E, Styraite B, Sakaliene R, Misyte G, Bileviciute-Ljungar I J Clin Med. 2024; 13(7).

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Treatments for kinesiophobia in people with chronic pain: A scoping review.

Bordeleau M, Vincenot M, Lefevre S, Duport A, Seggio L, Breton T Front Behav Neurosci. 2022; 16:933483.

PMID: 36204486 PMC: 9531655. DOI: 10.3389/fnbeh.2022.933483.

References

Kucukdeveci A, Tennant A, Elhan A, Niyazoglu H . Validation of the Turkish version of the Roland-Morris Disability Questionnaire for use in low back pain. Spine (Phila Pa 1976). 2001; 26(24):2738-43. DOI: 10.1097/00007632-200112150-00024. View

Liddle S, Gracey J, Baxter G . Advice for the management of low back pain: a systematic review of randomised controlled trials. Man Ther. 2007; 12(4):310-27. DOI: 10.1016/j.math.2006.12.009. View

Pincus T, Burton A, Vogel S, Field A . A systematic review of psychological factors as predictors of chronicity/disability in prospective cohorts of low back pain. Spine (Phila Pa 1976). 2002; 27(5):E109-20. DOI: 10.1097/00007632-200203010-00017. View

Fletcher C, Bradnam L, Barr C . The relationship between knowledge of pain neurophysiology and fear avoidance in people with chronic pain: A point in time, observational study. Physiother Theory Pract. 2016; 32(4):271-6. DOI: 10.3109/09593985.2015.1138010. View

Leeuw M, Goossens M, Linton S, Crombez G, Boersma K, Vlaeyen J . The fear-avoidance model of musculoskeletal pain: current state of scientific evidence. J Behav Med. 2006; 30(1):77-94. DOI: 10.1007/s10865-006-9085-0. View

Stochkendahl M, Kjaer P, Hartvigsen J, Kongsted A, Aaboe J, Andersen M . National Clinical Guidelines for non-surgical treatment of patients with recent onset low back pain or lumbar radiculopathy. Eur Spine J. 2017; 27(1):60-75. DOI: 10.1007/s00586-017-5099-2. View

Qaseem A, Wilt T, McLean R, Forciea M, Denberg T, Barry M . Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2017; 166(7):514-530. DOI: 10.7326/M16-2367. View

Demoulin C, Vanderthommen M, Duysens C, Crielaard J . Spinal muscle evaluation using the Sorensen test: a critical appraisal of the literature. Joint Bone Spine. 2006; 73(1):43-50. DOI: 10.1016/j.jbspin.2004.08.002. View

Engers A, Jellema P, Wensing M, van der Windt D, Grol R, van Tulder M . Individual patient education for low back pain. Cochrane Database Syst Rev. 2008; (1):CD004057. PMC: 6999124. DOI: 10.1002/14651858.CD004057.pub3. View

10.

Tellez-Garcia M, de-la-Llave-Rincon A, Salom-Moreno J, Palacios-Cena M, Ortega-Santiago R, Fernandez-de-Las-Penas C . Neuroscience education in addition to trigger point dry needling for the management of patients with mechanical chronic low back pain: A preliminary clinical trial. J Bodyw Mov Ther. 2015; 19(3):464-72. DOI: 10.1016/j.jbmt.2014.11.012. View

11.

Suuden E, Ereline J, Gapeyeva H, Paasuke M . Low back muscle fatigue during Sørensen endurance test in patients with chronic low back pain: relationship between electromyographic spectral compression and anthropometric characteristics. Electromyogr Clin Neurophysiol. 2008; 48(3-4):185-92. View

12.

Koldas Dogan S, Sonel Tur B, Kurtais Y, Atay M . Comparison of three different approaches in the treatment of chronic low back pain. Clin Rheumatol. 2008; 27(7):873-81. DOI: 10.1007/s10067-007-0815-7. View

13.

Wood L, Hendrick P . A systematic review and meta-analysis of pain neuroscience education for chronic low back pain: Short-and long-term outcomes of pain and disability. Eur J Pain. 2018; 23(2):234-249. DOI: 10.1002/ejp.1314. View

14.

Moseley L . Combined physiotherapy and education is efficacious for chronic low back pain. Aust J Physiother. 2002; 48(4):297-302. DOI: 10.1016/s0004-9514(14)60169-0. View

15.

Moseley G, Gallace A, Spence C . Bodily illusions in health and disease: physiological and clinical perspectives and the concept of a cortical 'body matrix'. Neurosci Biobehav Rev. 2011; 36(1):34-46. DOI: 10.1016/j.neubiorev.2011.03.013. View

16.

. Classification of chronic pain. Descriptions of chronic pain syndromes and definitions of pain terms. Prepared by the International Association for the Study of Pain, Subcommittee on Taxonomy. Pain Suppl. 1986; 3:S1-226. View

17.

Moseley G, Butler D . Fifteen Years of Explaining Pain: The Past, Present, and Future. J Pain. 2015; 16(9):807-13. DOI: 10.1016/j.jpain.2015.05.005. View

18.

Louw A, Farrell K, Landers M, Barclay M, Goodman E, Gillund J . The effect of manual therapy and neuroplasticity education on chronic low back pain: a randomized clinical trial. J Man Manip Ther. 2018; 25(5):227-234. PMC: 5810776. DOI: 10.1080/10669817.2016.1231860. View

19.

Catley M, OConnell N, Moseley G . How good is the neurophysiology of pain questionnaire? A Rasch analysis of psychometric properties. J Pain. 2013; 14(8):818-27. DOI: 10.1016/j.jpain.2013.02.008. View

20.

Moseley G, Nicholas M, Hodges P . A randomized controlled trial of intensive neurophysiology education in chronic low back pain. Clin J Pain. 2004; 20(5):324-30. DOI: 10.1097/00002508-200409000-00007. View