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Background: Low back pain (LBP) is a major health problem around the world. It affects almost 80% of the population. Patient with LBP suffer from a heavy pain which is associated to long time incapacity. Different methods of treatment are applied in the objective of reducing pain and thus improving functional capacities of patients.
Objectives: Our study aimed to compare the benefits, with regard to LBP symptoms, of a thermal cure and a rehabilitation treatment.
Methods: It is a randomized therapeutic trial including patients with LBP, randomly divided into two groups: thermal cure and physical rehabilitation. Both of them were conducted in the same spa center of Djbal El Ouest. Outcome measures were visual analogic scale of pain (VAS), Oswestry Disability Index (ODI), Short Form-36 (SF36) questionnaire and schober test. Evaluation was carried out at day 18, 3 months, 6 months and 12 months following treatment.
Results: Seventy-four patients were included, divided into 2 groups: thermal group (n=37) and dry rehabilitation group (n=37). Seventy patients performed the full treatment.
In the group of patients treated with thermal cure treatment (n=37), a significant improvement of VAS of pain, ODI and SF 36 was noted in day 18, 3 months,6 months and 12 months (
Tendencies of the clinical indexes after treatment by thermal cure
|
D0
|
D18
|
3months
|
6months
|
12months
|
|
|---|---|---|---|---|---|
| VAS ± SD | 68,2 ± 16,2 | 35,8 ± 26,5 | 55 ± 19 | 60,2 ± 18,1 | 56,1 ± 19 |
| P | 0,000 | 0,000 | 0,008 | 0,002 | |
| ODI ± SD | 38,3 ± 14,1 | 29 ± 17,5 | 32 ± 14,1 | 30,2 ± 14,1 | 28,5 ± 13,6 |
| P | 0,03 | 0,03 | 0,07 | 0,000 | |
| SF 36 physical mean score ± SD | 34,4 ± 14,3 | 64,2 ± 18 | 45,9 ± 19 | 50 ± 21,8 | 47,9 ± 18,5 |
| P | 0,000 | 0,000 | 0,000 | 0,001 | |
| SF36 mental mean score ± SD | 38,9 ± 16,3 | 71 ± 21,6 | 55,1 ± 20,4 | 56,4 ± 19,9 | 52,2 ± 20,8 |
| P | 0,000 | 0,000 | 0,000 | 0,000 | |
| Scober test ± SD | 3,1 ± 1,3 | 3,5 ± 1,3 | 2,8 ± 1 | 3 ± 1,1 | 3,2 ± 1,5 |
| P | 0,037 | 0,322 | 0,812 | 0,657 |
VAS: visual analog scale; ODI: Oswestry Disability Index; SF36: short form 36
In the group of patients treated with physical rehabilitation (n=33), a significant improvement of the VAS of pain and of the physical mean score of SF36 was noted only on day 18 (
Tendencies of the clinical indexes after treatment by physical rehabilitation
|
D0
|
D18
|
3 months
|
6 months
|
12 months
|
|
|---|---|---|---|---|---|
| VAS ± SD | 64 ± 19,5 | 47,4 ± 24,6 | 55,7 ± 18,1 | 50,5 ± 27,5 | 62,2 ± 22,2 |
| P | 0,002 | 0,091 | 0,057 | 0,567 | |
| ODI ± SD | 34,3 ± 12,3 | 31,1 ± 17,3 | 31,9 ± 15,6 | 30,3 ± 18,8 | 31,1 ± 12 |
| P | 0,268 | 0,258 | 0,296 | 0,150 | |
|
SF 36 physical
| 38,1 ± 16,1 | 53,8 ± 22 | 42,6 ± 16,4 | 45,1 ± 18,7 | 42,6 ± 16,2 |
| P | 0,002 | 0,284 | 0,202 | 0,185 | |
|
SF36 mental
| 39,3 ± 17,5 | 61,6 ± 23,5 | 45,1 ± 18,9 | 49,6 ± 24,6 | 46,9 ± 22,1 |
| P | 0,000 | 0,130 | 0,033 | 0,09 | |
| Schober test ± SD | 3,2 ± 1,4 | 3,5 ± 1,3 | 3,4 ± 1,4 | 2,7 ± 1,2 | 2,9 ± 1,3 |
| P | 0,845 | 0,983 | 0,091 | 0,346 |
VAS: visual analog scale; ODI: Oswestry Disability Index; SF36: short form 36
Comparison of the two types of tested treatments showed a certain number of statistically significant differences. The VAS and physical mean score of SF 36 at day 18 and mental mean score of SF-36 at 3 months were significantly lower on the thermal cure group, while schober test at 3 months was significantly lower in the physical rehabilitation group.
Conclusion: Our study suggests a superiority of thermal cure in relieving pain and improving quality of life at short term among patient with LBP and a comparable efficacy in improving lumbar spine function. However, the effectiveness of physical rehabilitation was greater on spine mobility.
Disclosure of Interests: None declared