Therapeutic aquatic exercise effective for patients with chronic low back pain: JAMA
China: Therapeutic aquatic exercise is an effective treatment for people with chronic low back pain (LBP), a recent study has suggested.
According to the study published in JAMA Network Open, therapeutic aquatic exercise program compared to physical therapy modalities resulted in a greater reduction in chronic low back pain and had a long-term effect of up to 12 months. This may prompt clinicians for recommending therapeutic aquatic exercise to patients with chronic LBP as a part of their health through active exercise rather than depending on passive relaxation.
Therapeutic aquatic exercise is defined as water-based treatments or exercise. Water is an ideal environment for conducting an exercise program owing to its properties such as conductivity, buoyancy pressure, thermal capacity, and density. This type of exercise is frequently offered to patients having chronic LBP, however, there is no larity on its long-term benefits.
Against the above background, Meng-Si Peng, Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China, and colleagues aimed to compare the effects of therapeutic aquatic exercise with physical therapy modalities in patients with chronic low back pain over a 12-month follow-up period in a single-blind randomized clinical trial performed from September 10, 2018, to March 12, 2019, and the trial follow-up was completed March 17, 2020.
The experiment included a total of 113 people with chronic LBP.
Patients were randomized to receive either the therapeutic aquatic exercise (n = 56) or the physical therapy modalities group (n = 57), and 98 patients (86.7%) completed the 12-month follow-up.
The therapeutic aquatic exercise group received aquatic exercise on the other hand, the physical therapy modalities group received transcutaneous electrical nerve stimulation and infrared ray thermal therapy. Both the groups were given the treatment for 60 minutes twice a week for 3 months.
The primary outcome included disability level that measured using the Roland-Morris Disability Questionnaire; scores range from 0 to 24, with higher scores indicating more severe disability. Secondary outcomes included pain intensity, sleep quality, quality of life, recommendation of intervention, and minimal clinically important difference.
The researchers also performed intention-to-treat and per-protocol analyses.
The study revealed the following findings:
- Compared with the physical therapy modalities group, the therapeutic aquatic exercise group showed greater alleviation of disability, with adjusted mean group differences of −1.77 after the 3-month intervention, −2.42 at the 6-month follow-up, and −3.61 at the 12-month follow-up.
- At the 12-month follow-up point, improvements were significantly greater in the therapeutic aquatic exercise group vs the physical therapy modalities group in the number of participants who met the minimal clinically important difference in pain (at least a 2-point improvement on the numeric rating scale) (most severe pain, 30 53.57% vs 21.05%; average pain, 25% vs 19.30%; and current pain, 39.29% vs 17.54%) and disability (at least a 5-point improvement on the Roland-Morris Disability Questionnaire) (46.43% vs 7.02%).
- One of the 56 participants (1.8%) in the therapeutic aquatic exercise group vs 2 of the 57 participants (3.5%) in the physical therapy modalities group experienced low back pain and other pains related to the intervention.
"Findings showed that atients with chronic LBO who received therapeutic aquatic exercise had a greater improvement in terms of pain, function, quality of life, sleep quality, and mental state versus those who underwent physical therapy modalities," wrote the authors. This implies that therapeutic aquatic exercise is a safe treatment for chronic low back pain and most participants who received it were willing to recommend it to other patients with chronic LBP.
Reference:
Peng M, Wang R, Wang Y, et al. Efficacy of Therapeutic Aquatic Exercise vs Physical Therapy Modalities for Patients With Chronic Low Back Pain: A Randomized Clinical Trial. JAMA Netw Open. 2022;5(1):e2142069. doi:10.1001/jamanetworkopen.2021.42069
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