Başlık: Effect of Radial Extracorporeal Shock Wave Therapy on Pain Intensity, Functional Efficiency, and Postural Control Parameters in Patients with Chronic Low Back Pain: A Randomized Clinical Trial

• Abstract

  Low back pain (LBP) is the leading cause of disability worldwide, placing a significant economic burden on healthcare systems. Radial extracorporeal shock wave therapy (rESWT) is useful in the rehabilitation of orthopedic diseases; however, there is still limited evidence for patients with LBP. The aim of this study was to assess the effect of rESWT on pain level, functional efficiency, and parameters of postural control in patients with LBP. Participants were randomized into group A (n = 20) treated with rESWT and group B (n = 20) treated with sham rESWT (placebo). Both groups received conventional physiotherapy, including core stability exercises. The following tests were performed: the Laitinen Pain Scale (LPS), the Roland–Morris Questionnaire (RMQ), the original Schober Test (OST), and a stabilometric platform for the assessment of postural sway, including total sway path (TSP). We found that the analgesic effect was higher after rESWT, especially in the follow-up’s (p < 0.05). Similar results were found for functional efficiency and range of motion (p < 0.05). The improved posture stability in placebo group B was not statistically significant (p > 0.05). The stabilometric parameters in group A were still gradually improved and statistically significant, even in follow-ups (p < 0.05). In conclusion, the rESWT had a significant effect on the reduction of pain and the improvement of functional condition compared to a conventional physiotherapy program. Also, rESWT with core stability exercises led to significant improvements in postural sway compared with conventional physiotherapy in patients with LBP.

  Keywords: extracorporeal shock wave therapy, orthopedic diseases, low back pain, functional ability, pain level, postural stability, rehabilitation

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  1. Introduction

  Low back pain (LBP) is the leading cause of disability worldwide, having a substantial effect on patients’ quality of life (QOL) and placing a significant economic burden on healthcare systems. In the majority of cases, treatment of chronic LBP begins with pharmacological conservative management, such as opioid medications, lumbar epidural steroid injections (LESI), muscle relaxants, or nonsteroidal anti-inflammatory drugs (NSAIDs). The total cost and utilization of the maximum nonoperative therapies (MNTs) for LBP are still rising [1].

  In 2018, the Lancet LBP Working Group identified a global problem of LBP mismanagement [2,3,4]. The phenomenon of unnecessary care in both high- and low-income settings was documented, whereby patients receive health services that are discordant with international guidelines. The strong evidence was presented that unnecessary care, including pain medications, spinal imaging tests, spinal injections, and surgical operations, is hazardous for most patients with LBP.

  Therefore, searching for modern, low-cost, and effective new therapies is strongly recommended. The use of various nonpharmacological supportive and conservative methods in LBP management is well-known, including exercise training [5,6], manual therapies [6,7], or myofascial techniques [8]. However, effective physical agents are also needed [9,10,11].

  One of the promising physical methods for the treatment of musculoskeletal pain syndromes is an extracorporeal shock wave therapy (ESWT). From the biophysical point of view, shock waves are defined as a sequence of high energy mechanical pulses generating short-term pressure changes during their propagation [12]. In general, there are two types of ESW, which differ in terms of the method and the range of acoustic energy propagation [13].

  Focused ESWT (fESWT) is generated by electromagnetic, electrohydraulic, or piezoelectric methods. The energy of fESWT increases rapidly < 10 ns, reaching high peak values of 10–100 MPa (absorbency up to 12 cm). The fESWT beam has a concentrated shape and so-called focal point, which is the highest energy density in a relatively small area. In turn, the radial ESWT (rESWT) is generated by the pneumatic method and generates slowly increasing pressure up to 5 µs, reaching the level of 0.1–1.0 MPa (absorbency up to 3 cm) with dispersed beam shape [14]. It should be noticed that both types of ESWT also differ in the size and shape of the applicators’ heads (Figure 1).

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