EFFECTS OF STABILIZATION EXERCISES IN ADDITION TO ROUTINE PHYSICAL THERAPY IN ELDERLY PATIENTS WITH BACK PAIN; A RANDOMIZED CONTROLLED TRIAL
Main Article Content
Keywords
Back Pain, Elderly, Endurance, Physical Therapy, Spinal Mobility, Stabilization Exercises
Abstract
Background: Back pain is a prevalent musculoskeletal condition among the elderly, which significantly impacts their quality of life. Physical therapy is a common treatment option for back pain, but the addition of specified treatment such as stabilization exercises may improve outcomes for elderly patients.
Methods: This 18-month single-blind, randomized controlled trial was conducted at Banu Bai Physiotherapy Centre in Karachi, Pakistan. The study had a sample size of 72, 36 participants per group, determined using Noordzij et al.'s (2010) formula. Participants, aged 60 or older with chronic back pain, were randomly assigned to stabilization exercise (SE) group or routine physical therapy (RPT). In addition, both groups participated in co-interventions and home exercise programs, with 45-minute treatment sessions.
Results: The average age was 71.5 years, and the average BMI was 27.4. Both groups showed similar demographic and medical characteristics at baseline. After the intervention, the SE group showed a significant improvement in all endurance test outcomes, including trunk flexors (p=0.003), trunk extensors (p=0.004), trunk right side flexors (p=0.007), and trunk left side flexors (p=0.005), compared to the RPT group. The SE group also showed a significant improvement in spinal mobility (p=0.013).
Conclusion: Adding stabilization exercise therapy to routine physical therapy can significantly improve trunk muscle endurance and spinal mobility in elderly patients with back pain. These findings suggest that healthcare professionals should consider incorporating stabilization exercises into their practices to optimize back pain management in this population. Further research is needed to explore the long-term effects of stabilization exercises and compare their effectiveness with other exercise therapies.
References
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24. Lim YZ, Wang Y, Cicuttini FM, Hughes HJ, Chou L, Urquhart DM, et al. Association between inflammatory biomarkers and nonspecific low back pain: a systematic review. The Clinical journal of pain. 2020;36(5):379-89.
25. Cheng JOS, Cheng S-T. Effectiveness of physical and cognitive-behavioural intervention programmes for chronic musculoskeletal pain in adults: A systematic review and meta-analysis of randomised controlled trials. PLoS One. 2019;14(10):e0223367.
26. Shafshak TS, Elnemr R. The visual analogue scale versus numerical rating scale in measuring pain severity and predicting disability in low back pain. JCR: Journal of Clinical Rheumatology. 2021;27(7):282-5.
27. Kim B, Yim J. Core stability and hip exercises improve physical function and activity in patients with non-specific low back pain: a randomized controlled trial. The Tohoku journal of experimental medicine. 2020;251(3):193-206.
28. Laratta JL, Glassman SD, Atanda AA, Dimar JR, Gum JL, Crawford III CH, et al. The Berg balance scale for assessing dynamic stability and balance in the adult spinal deformity (ASD) population. Journal of Spine Surgery. 2019;5(4):451.
29. Zahari Z, Justine M, Ishak NA. Reliability and Validity of Malay Version of Revised Oswestry Low Back Pain Disability Questionnaire. Healthscope: The Official Research Book of Faculty of Health Sciences, UiTM. 2019;2.
30. Johnson M, Mulcahey M. Interrater reliability of spine range of motion measurement using a tape measure and goniometer. Journal of chiropractic medicine. 2021;20(3):138-47.
31. Lim C-Y, In J. Randomization in clinical studies. Korean journal of anesthesiology. 2019;72(3):221-32.
32. Amjad F, Mohseni-Bandpei MA, Gilani SA, Ahmad A, Hanif A. Effects of non-surgical decompression therapy in addition to routine physical therapy on pain, range of motion, endurance, functional disability and quality of life versus routine physical therapy alone in patients with lumbar radiculopathy; a randomized controlled trial. BMC Musculoskeletal Disorders. 2022;23(1):255.
33. de Oliveira NTB, Ricci NA, dos Santos Franco YR, Salvador EMES, Almeida ICB, Cabral CMN. Effectiveness of the Pilates method versus aerobic exercises in the treatment of older adults with chronic low back pain: a randomized controlled trial protocol. BMC musculoskeletal disorders. 2019;20:1-7.
34. Tilak A, Arivazhahan A. Non-parametric Tests. Introduction to Basics of Pharmacology and Toxicology: Volume 3: Experimental Pharmacology: Research Methodology and Biostatistics: Springer; 2022. p. 889-96.
35. Deyo RA, Mirza SK, Martin BI, Kreuter W, Goodman DC, Jarvik JG. Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. Jama. 2010;303(13):1259-65.
36. Hicks GE, Sions JM, Coyle PC, Pohlig RT. Altered spatiotemporal characteristics of gait in older adults with chronic low back pain. Gait & posture. 2017;55:172-6.
37. Ferreira ML, Smeets RJ, Kamper SJ, Ferreira PH, Machado LA. Can we explain heterogeneity among randomized clinical trials of exercise for chronic back pain? A meta-regression analysis of randomized controlled trials. Physical therapy. 2010;90(10):1383-403.
38. Bagherian S, Ghasempoor K, Rahnama N, Wikstrom EA. The effect of core stability training on functional movement patterns in college athletes. Journal of sport rehabilitation. 2019;28(5):444-9.
39. Koumantakis GA, Watson PJ, Oldham JA. Trunk muscle stabilization training plus general exercise versus general exercise only: randomized controlled trial of patients with recurrent low back pain. Physical therapy. 2005;85(3):209-25.
40. Stevens VK, Coorevits PL, Bouche KG, Mahieu NN, Vanderstraeten GG, Danneels LA. The influence of specific training on trunk muscle recruitment patterns in healthy subjects during stabilization exercises. Manual therapy. 2007;12(3):271-9.
41. Shamsi MB, Rezaei M, Zamanlou M, Sadeghi M, Pourahmadi MR. Does core stability exercise improve lumbopelvic stability (through endurance tests) more than general exercise in chronic low back pain? A quasi-randomized controlled trial. Physiotherapy theory and practice. 2016;32(3):171-8.
42. You JH, Kim S-Y, Oh D-W, Chon S-C. The effect of a novel core stabilization technique on managing patients with chronic low back pain: A randomized, controlled, experimenter-blinded study. Clinical rehabilitation. 2014;28(5):460-9.
43. Zhang Y, Tang S, Chen G, Liu Y. Chinese massage combined with core stability exercises for nonspecific low back pain: a randomized controlled trial. Complementary therapies in medicine. 2015;23(1):1-6.
2. Hartvigsen J, Hancock MJ, Kongsted A, Louw Q, Ferreira ML, Genevay S, et al. What low back pain is and why we need to pay attention. The Lancet. 2018;391(10137):2356-67.
3. De Souza IMB, Sakaguchi TF, Yuan SLK, Matsutani LA, do Espírito-Santo AdS, Pereira CAdB, et al. Prevalence of low back pain in the elderly population: a systematic review. Clinics. 2019;74.
4. Pergolizzi JV, LeQuang JA. Rehabilitation for low back pain: A narrative review for managing pain and improving function in acute and chronic conditions. Pain and therapy. 2020;9:83-96.
5. Barry TJ. A multi-factorial evaluation of lower back injury risk factors in fast bowlers: Manchester Metropolitan University; 2021.
6. Grabovac I, Dorner TE. Association between low back pain and various everyday performances: Activities of daily living, ability to work and sexual function. Wiener klinische Wochenschrift. 2019;131(21-22):541-9.
7. Urits I, Burshtein A, Sharma M, Testa L, Gold PA, Orhurhu V, et al. Low back pain, a comprehensive review: pathophysiology, diagnosis, and treatment. Current pain and headache reports. 2019;23:1-10.
8. D'Onofrio G, Kirschner J, Prather H, Goldman D, Rozanski A. Musculoskeletal exercise: Its role in promoting health and longevity. Progress in Cardiovascular Diseases. 2023.
9. Tinnirello A, Mazzoleni S, Santi C. Chronic pain in the elderly: mechanisms and distinctive features. Biomolecules. 2021;11(8):1256.
10. Barnsley J, Buckland G, Chan P, Ong A, Ramos A, Baxter M, et al. Pathophysiology and treatment of osteoporosis: challenges for clinical practice in older people. Aging clinical and experimental research. 2021;33:759-73.
11. Kim HS, Wu PH, Jang I-T. Lumbar degenerative disease part 1: anatomy and pathophysiology of intervertebral discogenic pain and radiofrequency ablation of basivertebral and sinuvertebral nerve treatment for chronic discogenic back pain: a prospective case series and review of literature. International journal of molecular sciences. 2020;21(4):1483.
12. Frizziero A, Pellizzon G, Vittadini F, Bigliardi D, Costantino C. Efficacy of Core Stability in Non-Specific Chronic Low Back Pain. Journal of Functional Morphology and Kinesiology. 2021;6(2):37.
13. Yagci G, Yakut Y. Core stabilization exercises versus scoliosis-specific exercises in moderate idiopathic scoliosis treatment. Prosthetics and Orthotics International. 2019;43(3):301-8.
14. Ponde K, Agrawal R, Chikte NK. Effect of core stabilization exercises on balance performance in older adults. International Journal of Contemporary Medicine. 2021;9(1):12-7.
15. Moisset X, Bouhassira D, Couturier JA, Alchaar H, Conradi S, Delmotte M, et al. Pharmacological and non-pharmacological treatments for neuropathic pain: Systematic review and French recommendations. Revue neurologique. 2020;176(5):325-52.
16. Tagliaferri SD, Miller CT, Ford JJ, Hahne AJ, Main LC, Rantalainen T, et al. Randomized Trial of General Strength and Conditioning versus Motor Control and Manual Therapy for Chronic Low Back Pain on Physical and Self-Report Outcomes. Journal of Clinical Medicine. 2020;9(6):1726.
17. Steffens D, Maher CG, Pereira LS, Stevens ML, Oliveira VC, Chapple M, et al. Prevention of low back pain: a systematic review and meta-analysis. JAMA internal medicine. 2016;176(2):199-208.
18. Gomes-Neto M, Lopes JM, Conceicao CS, Araujo A, Brasileiro A, Sousa C, et al. Stabilization exercise compared to general exercises or manual therapy for the management of low back pain: A systematic review and meta-analysis. Physical therapy in Sport. 2017;23:136-42.
19. Ponzano M, Tibert N, Brien S, Funnell L, Gibbs J, Keller H, et al. International consensus on the non-pharmacological and non-surgical management of osteoporotic vertebral fractures. Osteoporosis International. 2023:1-10.
20. Tufail M. Design for assisting elderly with poor motor control skills and managing their low-back pain. 2020.
21. Noordzij M, Tripepi G, Dekker FW, Zoccali C, Tanck MW, Jager KJ. Sample size calculations: basic principles and common pitfalls. Nephrology dialysis transplantation. 2010;25(5):1388-93.
22. Cowley A, Goldberg SE, Gordon AL, Logan PA. Rehabilitation potential in older people living with frailty: a systematic mapping review. BMC geriatrics. 2021;21(1):1-13.
23. van der Laag PJ, Arends SA, Bosma MS, van den Hoogen A. Factors associated with successful rehabilitation in older adults: A systematic review and best evidence synthesis. Geriatric Nursing. 2021;42(1):83-93.
24. Lim YZ, Wang Y, Cicuttini FM, Hughes HJ, Chou L, Urquhart DM, et al. Association between inflammatory biomarkers and nonspecific low back pain: a systematic review. The Clinical journal of pain. 2020;36(5):379-89.
25. Cheng JOS, Cheng S-T. Effectiveness of physical and cognitive-behavioural intervention programmes for chronic musculoskeletal pain in adults: A systematic review and meta-analysis of randomised controlled trials. PLoS One. 2019;14(10):e0223367.
26. Shafshak TS, Elnemr R. The visual analogue scale versus numerical rating scale in measuring pain severity and predicting disability in low back pain. JCR: Journal of Clinical Rheumatology. 2021;27(7):282-5.
27. Kim B, Yim J. Core stability and hip exercises improve physical function and activity in patients with non-specific low back pain: a randomized controlled trial. The Tohoku journal of experimental medicine. 2020;251(3):193-206.
28. Laratta JL, Glassman SD, Atanda AA, Dimar JR, Gum JL, Crawford III CH, et al. The Berg balance scale for assessing dynamic stability and balance in the adult spinal deformity (ASD) population. Journal of Spine Surgery. 2019;5(4):451.
29. Zahari Z, Justine M, Ishak NA. Reliability and Validity of Malay Version of Revised Oswestry Low Back Pain Disability Questionnaire. Healthscope: The Official Research Book of Faculty of Health Sciences, UiTM. 2019;2.
30. Johnson M, Mulcahey M. Interrater reliability of spine range of motion measurement using a tape measure and goniometer. Journal of chiropractic medicine. 2021;20(3):138-47.
31. Lim C-Y, In J. Randomization in clinical studies. Korean journal of anesthesiology. 2019;72(3):221-32.
32. Amjad F, Mohseni-Bandpei MA, Gilani SA, Ahmad A, Hanif A. Effects of non-surgical decompression therapy in addition to routine physical therapy on pain, range of motion, endurance, functional disability and quality of life versus routine physical therapy alone in patients with lumbar radiculopathy; a randomized controlled trial. BMC Musculoskeletal Disorders. 2022;23(1):255.
33. de Oliveira NTB, Ricci NA, dos Santos Franco YR, Salvador EMES, Almeida ICB, Cabral CMN. Effectiveness of the Pilates method versus aerobic exercises in the treatment of older adults with chronic low back pain: a randomized controlled trial protocol. BMC musculoskeletal disorders. 2019;20:1-7.
34. Tilak A, Arivazhahan A. Non-parametric Tests. Introduction to Basics of Pharmacology and Toxicology: Volume 3: Experimental Pharmacology: Research Methodology and Biostatistics: Springer; 2022. p. 889-96.
35. Deyo RA, Mirza SK, Martin BI, Kreuter W, Goodman DC, Jarvik JG. Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. Jama. 2010;303(13):1259-65.
36. Hicks GE, Sions JM, Coyle PC, Pohlig RT. Altered spatiotemporal characteristics of gait in older adults with chronic low back pain. Gait & posture. 2017;55:172-6.
37. Ferreira ML, Smeets RJ, Kamper SJ, Ferreira PH, Machado LA. Can we explain heterogeneity among randomized clinical trials of exercise for chronic back pain? A meta-regression analysis of randomized controlled trials. Physical therapy. 2010;90(10):1383-403.
38. Bagherian S, Ghasempoor K, Rahnama N, Wikstrom EA. The effect of core stability training on functional movement patterns in college athletes. Journal of sport rehabilitation. 2019;28(5):444-9.
39. Koumantakis GA, Watson PJ, Oldham JA. Trunk muscle stabilization training plus general exercise versus general exercise only: randomized controlled trial of patients with recurrent low back pain. Physical therapy. 2005;85(3):209-25.
40. Stevens VK, Coorevits PL, Bouche KG, Mahieu NN, Vanderstraeten GG, Danneels LA. The influence of specific training on trunk muscle recruitment patterns in healthy subjects during stabilization exercises. Manual therapy. 2007;12(3):271-9.
41. Shamsi MB, Rezaei M, Zamanlou M, Sadeghi M, Pourahmadi MR. Does core stability exercise improve lumbopelvic stability (through endurance tests) more than general exercise in chronic low back pain? A quasi-randomized controlled trial. Physiotherapy theory and practice. 2016;32(3):171-8.
42. You JH, Kim S-Y, Oh D-W, Chon S-C. The effect of a novel core stabilization technique on managing patients with chronic low back pain: A randomized, controlled, experimenter-blinded study. Clinical rehabilitation. 2014;28(5):460-9.
43. Zhang Y, Tang S, Chen G, Liu Y. Chinese massage combined with core stability exercises for nonspecific low back pain: a randomized controlled trial. Complementary therapies in medicine. 2015;23(1):1-6.
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Oct 27, 2023
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Muhammad Shahid, Mohammad A Mohseni Bandpei, & Ashfaq Ahmed. (2023). EFFECTS OF STABILIZATION EXERCISES IN ADDITION TO ROUTINE PHYSICAL THERAPY IN ELDERLY PATIENTS WITH BACK PAIN; A RANDOMIZED CONTROLLED TRIAL. Journal of Population Therapeutics and Clinical Pharmacology, 30(18), 1170–1178. https://doi.org/10.53555/jptcp.v30i18.3254
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Author Biographies
Muhammad Shahid
University Institute of Physical Therapy, University of Lahore - Pakistan
Mohammad A Mohseni Bandpei
University of Social Welfare and Rehabilitation Sciences, Tehran - Iran
Ashfaq Ahmed
Faculty of Allied Health Sciences, University of Lahore, Lahore - Pakistan