Acupressure May Be More Effective Than Physical Therapy at Relieving Low Back Pain
Acupressure is more effective than physical therapy at relieving low back pain, according to the results of a randomized Study reported in the February 17 Online First issue of the BMJ.
"The efficacy of acupressure in relieving pain associated with low back pain has been shown by a randomized controlled trial," write Lisa Li-Chen Hsieh, MD, From National Taiwan University in Taipei, and colleagues. However, the outcomes in that Study were assessed by description of pain character and failed to take into account functional status and disability as recommended by most low back pain researchers. Although trials have investigated the efficacy of physical therapy, acupuncture, and acupressure in reducing low back pain, the type of outcome measurement has varied From Study to Study."
At an orthopedic Clinic in Kaohsiung, Taiwan, 129 patients with chronic low back pain were randomized to receive acupressure or physical therapy for 1 month. Primary endpoints were self-administered Chinese versions of standard outcome measures for low back pain (Roland and Morris disability questionnaire) at baseline, after treatment, and at 6-month follow-up.
After treatment, the mean total Roland and Morris disability questionnaire score was significantly lower in the acupressure group than in the physical therapy group regardless of the difference in absolute score (-3.8; 95% confidence interval [CI], -5.7 to -1.9) or mean change From baseline (-4.64; 95% CI, -6.39 to -2.89).
Compared with physical therapy, acupressure was associated with an 89% reduction in significant disability (95% CI, 61% - 97%), and that improvement was maintained at 6-month follow-up. There were statistically significant differences between the groups for all 6 domains of the core outcome, pain visual Scale, and modified Oswestry disability questionnaire after treatment, and at 6-month follow-up.
Study limitations include a confounding psychological effect of therapy; loss of 15.5% of patients to follow-up at 6 months; and effectiveness of any manipulation therapy dependent on the therapist's technique and experience.
"Acupressure was effective in reducing low back pain in terms of disability, pain scores, and functional status," the authors write. "The benefit was sustained for six months."
The authors have disclosed no relevant financial relationships.
BMJ. Posted Online February 13, 2006.
Learning Objectives for This Educational Activity
Upon completion of this activity, participants will be able to:
"The efficacy of acupressure in relieving pain associated with low back pain has been shown by a randomized controlled trial," write Lisa Li-Chen Hsieh, MD, From National Taiwan University in Taipei, and colleagues. However, the outcomes in that Study were assessed by description of pain character and failed to take into account functional status and disability as recommended by most low back pain researchers. Although trials have investigated the efficacy of physical therapy, acupuncture, and acupressure in reducing low back pain, the type of outcome measurement has varied From Study to Study."
At an orthopedic Clinic in Kaohsiung, Taiwan, 129 patients with chronic low back pain were randomized to receive acupressure or physical therapy for 1 month. Primary endpoints were self-administered Chinese versions of standard outcome measures for low back pain (Roland and Morris disability questionnaire) at baseline, after treatment, and at 6-month follow-up.
After treatment, the mean total Roland and Morris disability questionnaire score was significantly lower in the acupressure group than in the physical therapy group regardless of the difference in absolute score (-3.8; 95% confidence interval [CI], -5.7 to -1.9) or mean change From baseline (-4.64; 95% CI, -6.39 to -2.89).
Compared with physical therapy, acupressure was associated with an 89% reduction in significant disability (95% CI, 61% - 97%), and that improvement was maintained at 6-month follow-up. There were statistically significant differences between the groups for all 6 domains of the core outcome, pain visual Scale, and modified Oswestry disability questionnaire after treatment, and at 6-month follow-up.
Study limitations include a confounding psychological effect of therapy; loss of 15.5% of patients to follow-up at 6 months; and effectiveness of any manipulation therapy dependent on the therapist's technique and experience.
"Acupressure was effective in reducing low back pain in terms of disability, pain scores, and functional status," the authors write. "The benefit was sustained for six months."
The authors have disclosed no relevant financial relationships.
BMJ. Posted Online February 13, 2006.
Learning Objectives for This Educational Activity
Upon completion of this activity, participants will be able to:
- Compare the effect of acupressure vs physical therapy on disability in low back pain.
- Compare the effect of acupressure vs physical therapy on pain and functional status 6 months after treatment.
Clinical Context
Low back pain is a common condition worldwide, and the efficacy of acupuncture in alleviating low back pain remains uncertain. However, acupressure, using finger rather than needles for acupoints has been used to treat various pain Disorders and may be useful for low back pain, according to the authors. The current Study is an open randomized controlled trial using Chinese versions of validated standard outcome measures to compare the efficacy of acupressure with that of physical therapy in alleviating the pain and disability associated with low back pain in the short term and for 6 months in patients presenting to an outpatient specialist orthopedic Clinic in Taiwan.
Study Highlights
- Inclusion criteria were aged 18 to 81 years, chronic low back pain for 4 months diagnosed by a senior orthopedic specialist and absence of organic disease, cancer, psychiatric disease, or acute severe pain.
- Exclusion criteria were pregnancy and contraindication to acupressure.
- 64 patients were randomized to acupressure and 65 to physical therapy.
- Each participant received 6 treatment sessions within a 1-month period.
- Acupressure was delivered by 1 experienced therapist. Technique and acupoints used were not described.
- Physical therapy was provided by therapists in the orthopedic Clinic and included pelvic manual traction, spinal manipulation, thermotherapy, infrared light therapy, electrical stimulation, and exercise therapy as recommended by the physical therapist.
- Primary outcome was the Roland and Morris disability score administered in Chinese to participants.
- Secondary outcomes were core outcome measures, including a visual analog pain Scale and Oswestry disability score also administered in Chinese.
- The Roland and Morris disability score defined minimal disability as a score of 0 to 12 and significant disability as a score of 13 to 24.
- The modified Oswestry Scale was used and defined degree of disability as "minimal" (0 - 11), "moderate" (12 - 22), "severe" (23 - 32), "crippled" (33 - 43), and "bed bound" (>/= 44).
- Questionnaires were administered at baseline, posttreatment at 1 month, and at 6 months' posttreatment.
- Therapists were blinded to participant baseline assessments.
- Mean age was 51 years, 30% were men, 84% were married, 12% to 27% were office workers, and 13% were heavy laborers.
- Median time since onset of low back pain was 3.3 years in the acupressure and 1.6 years in the physical therapy group.
- The mean total Roland and Morris score after treatment was significantly lower in the acupressure group regardless of the difference in absolute score (-3.8; 95% CI, -5.7 to -1.9) and mean change from baseline (-4.64; 95% CI, -6.39 to -2.89).
- Acupressure conferred an 89% reduction in significant disability with a number needed to treat of 5.98.
- After adjustment for pretreatment score, mean scores were lower for the acupressure group for "low back pain," "leg pain," "pain interferes with normal work," "days cut down on doing things," and "days off from work/school."
- Mean scores after treatment were higher in the acupressure group for "satisfaction of life with the symptoms" and "satisfaction with previous treatment."
- Mean scores for the pain visual scale and sleeping with back pain were lower in the acupressure group after treatment.
- The statistically significant improvements in all these areas remained for the 6-month follow-up questionnaire.
- The mean total Oswestry disability questionnaire score after treatment was significantly lower in the acupressure group than in the physical therapy group regardless of the difference in absolute score or mean change from baseline.
- The odds ratio of increasing 1 grade of disability was 0.22 (95% CI, 0.11 - 0.48, P = .0001) for the acupressure group, and the difference remained significant after adjustment for pretreatment score and other baseline characteristics.
- The estimated number needed to treat for acupressure to reduce the disability by 1 grade was 6.15.
- The improvement in Oswestry score in the acupressure group vs the physical therapy group remained at 6 months with a number needed to treat of 4.58.
Pearls for Practice
- Acupressure compared with physical therapy for 1 month is associated with an 89% reduction in significant disability in patients with low back pain.
- The beneficial effects of acupressure compared with physical therapy for low back pain on disability, function, and pain for 1 month persist at 6 months' posttreatment.
Saludos Cordiales
Dr. José Manuel Ferrer Guerra
posted by Klip7 at
1:17 PM
