The measurable impact of a protocoled multimodal physiotherapeutic intervention on the quality of life in patients with non-specific chronic low back pain. A RCT study

van Amstel, R. N., Vaes, P., & Malone, S. (2018).
Physical Therapy and Rehabilitation, 5(1), 2.

Robbert Nimal van Amstel1*, Peter Vaes2 and Shaun Malone3

Abstract Study design: One-way, mixed, real experimental RCT study. Background: A multimodal physiotherapeutic approach to treat non-specific (NSP) Chronic Low Back Pain (CLBP), may affect the quality of life (QoL), pain intensity (PI) and active range of motion (AROM). The 4 X T method by orthopaedic disorder® (4MTOR®) is a decision tree to guide the physical therapist to treat NSP-CLBP. Objectives: To investigate the measureable impact on the QoL, PI and the AROM in patients with NSPCLBP, after physiotherapeutic back rehabilitation care according to the 4MTOR® , twice a week during a 6 weeks period. Methods: This was a RCT, where the experimental group (EGR) received the 4MTOR® compared to an control group (CGR) who received exercise therapy with sham application. The subjects were randomly assigned to one of the two groups. Both groups received physiotherapeutic intervention twice a week for a period of six weeks. Results: The QoL in the EGR significantly improved on the EQ-5D-index p=0.001. The QoL measured with the EQ-VAS, did significantly improve in both groups p<0.001. However, only a clinically important change was found for the EGR (W0= 59.72±SD15.43 to W7=78.63± SD17.14). The flexion AROM increased significantly (p< 0.005) in the EGR (W0=87.53±SD20.45, W3=96.29±SD16.34, W7= 98.28±SD17.01). A significant (p<0.01) change was also seen for the extension AROM in the EGR (W0= 19.36±SD9.27,W3= 22.25±SD5.99, W7=25.55±SD7.30). The PI reduced only significantly in the EGR during active flexion (p<0.001). The extension PI did not significantly decrease in both groups, however, a clinically important change was found in the EGR. Conclusion: The positive effects of the 4MTOR® on the Qol, PI and AROM in NSP-CLBP exceeded the effect of exercise therapy with sham application. Further research is required. Keywords: Low back/lumbar spine, Multimodal Physical therapy interventions, Quality of life, Range of Motion, Pain. Chronic complaints

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