Efficacy of Therapeutic Aquatic Exercise vs Physical Therapy Modalities for Patients With Chronic Low Back Pain

Abstract

IMPORTANCE Therapeutic aquatic exercise is frequently offered to patients with chronic low back pain, but its long-term benefits are unclear.OBJECTIVE To assess the long-term effects of therapeutic aquatic exercise on people with chronic low back pain. DESIGN, SETTING, AND PARTICIPANTSThis 3-month, single-blind randomized clinical trial with a 12-month follow-up period was performed from September 10, 2018, to March 12, 2019, and the trial follow-up was completed March 17, 2020. A total of 113 people with chronic low back pain were included in the experiment. INTERVENTIONS Participants were randomized to either the therapeutic aquatic exercise or the physical therapy modalities group. The therapeutic aquatic exercise group received aquatic exercise, whereas the physical therapy modalities group received transcutaneous electrical nerve stimulation and infrared ray thermal therapy. Both interventions were performed for 60 minutes twice a week for 3 months. MAIN OUTCOMES AND MEASURESThe primary outcome was disability level, which was 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, quality of life, sleep quality, recommendation of intervention, and minimal clinically important difference. Intention-totreat and per-protocol analyses were performed. RESULTSOf the 113 participants, 59 were women (52.2%) (mean [SD] age, 31.0 [11.5] years).Participants were randomly allocated into the therapeutic aquatic exercise group (n = 56) or the physical therapy modalities group (n = 57), and 98 patients (86.7%) completed the 12-month follow-up. 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 (95% CI, −3.02 to −0.51; P = .006) after the 3-month intervention, −2.42 (95% CI, −4.13 to −0.70; P = .006) at the 6-month follow-up, and −3.61 (95% CI, −5.63 to −1.58; P = .001) at the 12-month follow-up (P < .001 for overall group × time interaction). 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 12 [21.05%]; average pain, 14 [25%] vs 11 [19.30%]; and current pain, 22 [39.29%] vs 10 [17.54%]) and disability (at least a 5-point improvement on the Roland-Morris Disability Questionnaire) (26 (continued) Key Points Question Is therapeutic aquatic exercise as effective as physical therapy modalities in the management of adults with chronic low back pain? Findings In this randomized clinical trial of 113 individuals with chronic low back pain, therapeutic aquatic exercise had a greater influence on pain, function, quality of life, sleep quality, and mental state than physical therapy modalities a...

Exercise for Osteoarthritis: A Literature Review of Pathology and Mechanism

“…Proper exercise can improve the physiological function of various organs of the body and improve the overall morphology of the body ( Benedetti et al, 2018 ). In addition, exercise can also relieve pain ( Belavy et al, 2021 ; Zheng et al, 2021 ; Peng et al, 2022 ; Wu et al, 2022 ). For OA patients, ladder treatment is generally adopted, starting with basic treatment.…”

The Last Decade Publications on Diabetic Peripheral Neuropathic Pain: A Bibliometric Analysis

“…Due to the high morbidity and family burden of DPNP, an increasing number of studies have been involved in the field of DPNP, and relevant literature has been published in academic journals. Some studies have explored the mechanisms of pain relief by non-pharmacological interventions ( Zheng et al, 2021 ; Peng et al, 2022 ; Wu et al, 2022 ). However, only a few large-scale systematic global reviews of DPNP have been published ( Çakici et al, 2016 ).…”

Effect of Tai Chi Quan on the Pressure Pain Thresholds of Lower Back Muscles in Healthy Women

“…Various exercises have been recommended to mitigate chronic pain, and different types of exercise produce different analgesic effects. [19][20][21][22][23] A quasi-experiment found that healthy women experienced an increase in PPTs after completing knee extension strength training, and the effect returned to baseline levels after 20-minute exercise even if the test sites were far from the area of active muscles. 24 Jones et al recruited 16 healthy adults to complete 20 minutes of moderateintensity aerobic exercise on a cycle ergometer, and the results showed a substantial increase in PPTs but not in heat pain thresholds after exercise.…”