ARTICLE INFO

Article Type

Original Research

Authors

Faraji   E (1)
Barati   A.H (2)
Sadeghi   H (1)
Allami   M (*3)
Fateh   H.R (4)






(*3) Medical Device Department, Janbazan Medical & Engineering Research Center (JMERC), Tehran, Iran
(1) Sport Injuries & Corrective Exercise Department, Physical Education & Sport Sciences Faculty, Kharazmi University, Tehran, Iran
(1) Sport Injuries & Corrective Exercise Department, Physical Education & Sport Sciences Faculty, Kharazmi University, Tehran, Iran
(2) Sport Injuries & Corrective Exercise Department, Physical Education & Sport Sciences Faculty, Shahid Beheshti University, Tehran, Iran
(4) Physical Medicine & Rehabilitation Department, Tehran University of Medical Sciences, Tehran, Iran

Correspondence

Article History

Received:  November  5, 2017
Accepted:  December 25, 2017
ePublished:  May 15, 2019

BRIEF TEXT


Different studies have shown different effects of exercise on low back pain.

.... [1-6]. According to the studies, biomechanical factors are considered as a potential factor in the development of low back pain in people with lower limb amputation [7, 8]. Changes in motor strategies [9, 10] and compensatory movements, kinetics and cinematic changes [11, 12] are responsible for the occurrence of low back pain compared with healthy people [8]. Exercise therapy is one of the most important treatments for people with chronic low back pain and is evaluated in several studies [13]. A meta-analysis study has shown that reinforcement and core stability exercises are more effective in back pain in comparison with aerobic exercises [14]. In contrast, another study has shown that core stability exercises have no effect on back pain compared with other interventions [15]. ... [16]. Home-based exercises with a regular follow-up by therapists and physical activity are prescribed for patients with chronic low back pain [17, 18]. [19-20].

The aim of the present study was to assess the effect of selective home-based exercises on chronic low back pain in unilateral below knee amputees.

This research is a randomized controlled clinical trial with pretest-posttest design.

This research was conducted on 53 unilateral below knee amputees with chronic low back pain referred to the Kowsar orthotic and prosthetic center to assess their health status in 2016

The patients with chronic low back pain from 175 unilateral below knee amputees who were referred to the Kowsar orthotic and prosthetic center were voluntarily studied. . Lowe back pain was defined by a positive answer to the question "Have you had back pain most days in the last three months?" [21]. The inclusion criteria included unilateral below knee amputee, chronic low back pain (12 weeks or more) and the using prosthesis for at least one year. The exclusion criteria also included red flag, spinal cord injury (e.g. tumor, infection, fracture, inflammatory disease) and surgery over the past 2 years. The number of participants in each group calculated 25 subjects with the power of 80% and a confidence level of 95%.62 subjects were randomly selected due to the probability of falling in the samples and randomly divided into the intervention (35 persons) and control (n=27) groups based on the days attending the center. Three subjects from the intervention group due to their illness and 3 samples because of being absent in re-evaluation were excluded, and also 3 participants from the control group were excluded due to their absence in in re-evaluation. At the end of the study, 29 patients were assigned into the intervention group and 24 participants considered for the control group.

Participants in the intervention group received a training program for a 12-week course (5 days a week), but the subjects in the control group did not receive any interventions. The training program was based on the National Academy of Sports Medicine (NASM). The intervention included a training program package, including in-person and multimedia training by providing foam roller. A three-month training program was designed for myofascial release, stretching, activation, and integration in three phases. The first two exercises were performed once a day and the third one was performed twice a day. The researchers received personal information prior performing pain assessment and electromyography. Numerical Weight Scale (NRS) and the Oswestry Disability Index (ODI) questionnaire were used to measure pain intensity and functional disability of the back pain. Abdominal muscle strength and endurance (do sit-ups) and the modified Biering-Sorensen test to measure endurance of trunk extensor muscles were used. Electromyography was performed using the 8-channel Wireless V8.24EMG BayaMed (Biomed Co., Iran) and the F-55 Skintact electrodes (Leonhard Lang, GmbH, Austria). Sampling rate of 1000 Hz, digital-to-analog (D/A) converter with 16 bits of monotonicity and the band-pass filter of 20 to 490 Hz were used. Data analysis was performed by the Labview software. Data was analyzed by SPSS 20. Normal distribution of data was investigated using Kolmogorov-Spirnov test. Analysis of variance was not possible, so dependent T-test was used for intra-group comparison and independent t-test was employed for intergroup comparison.

There was no significant difference between the control and intervention groups in age, body mass index and the time elapsed after injury (p>0.05).There was no significant difference between two groups in the pre-test (P> 0.05) in the pain intensity and ODI. Although the control group showed higher pain intensity and disability level in the post-test than pre-test, however these changes were not statistically significant (p> 0.05), but there was a significant decrease in the intervention group in the intensity of back pain and disability index after exercise (p <0.05). Also, in the pre-test, the mean of extensor and flexor muscle endurance was not significantly different between two groups (p> 0.05). However, after 12 weeks of training, extensor muscle endurance increased significantly in the intervention group (p <0.05), but no significant difference was observed between the groups in the post-test. Flexor muscle endurance was significantly improved in the post-test in the intervention group (p <0.05) and showed a significant difference compared with the control group in the post-test (Table 2). In the pre-test, there was no significant difference in the electrical activity in the modified Biering-Sorensen test between the groups in multifidus muscles in the amputation and normal sides and the erector spinae muscles in the amputation and normal sides (p> 0.05)....

.... [22-29]. Our study results showed the positive effects of exercises for low back pain in lower limb amputees with chronic low back pain, which are consistent with the results of studies on subjects without similar amputation [30-32]. ... [33-43]. The aim of the stretching exercises was to increase flexibility and increase neuromuscular efficacy in the extensor and flexor muscles of the trunk and lower extremities. Sherman et al. also considered the stretching of the tibia and lower extremities muscle alongside reinforcing exercises to improve back pain [44]. Also, Tonosu et al. indicated the positive effect of back extension exercise “One Stretch” in patients with low back pain based on the Mckenzie Method [45]. In recent years, local muscle function has become more well-known, and more attention has been paid to the role of trunk deep muscles in central stability. Facilitating muscular activity for local and global muscles improves the balance and the ability for walking, trunk stability improvement and improvement of performance of the organs in subjects [46, 47] . ... [48-50].

It is recommended to study the factors affected the participation of amputee veteran in home-based therapy.

The limited study population to select unilateral below knee amputees with similar characteristics (such as associated injuries, age, secondary complications) was one of the limitations of the study.

A comprehensive program with parts of myofacial release, stretching, activation, and integration affects the low back pain in lower limb amputees.

The authors are grateful to all who helped in this study, as well as the veterans who participated in this research.

None declared.

The informed consent for participation of the subjects in the study was obtained and their information was kept confidential.

This study was supported by the The cost of this project is provided by the Janbazan Medical and Engineering Research Center (JMERC)

TABLES and CHARTS

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