Evaluation einer stationären nicht operativen Behandlung von akuten, subakuten und chronischen Rückenschmerzen

Background Currently, there is a need for scientific evidence on the efficacy of classical massage therapy for chronic, unspecific back pain, especially for the improvement in functional impairment and long-term pain reduction. According to the National Health Care Guidelines, classical massage for nonspecific low back pain may only be prescribed in combination with exercise therapy and a share of the remuneration. Acupuncture, on the other hand, is recognised in the guidelines as an independent treatment for chronic back pain and is remunerated by health insurance companies. This raises the question of whether classical massage therapy is not inferior compared to acupuncture, based on the therapy of the GERAC study. The Clinic of Naturopathy in Blankenstein, Hattingen uses classical massage therapy subjectively successfully in patients with back pain. To objectify the success of the treatment, a randomised controlled, non-inferiority study was conducted. Methods The efficacy of classical massage (KMT, n = 66) was compared with acupuncture therapy (AKU, n = 66) in patients with chronic back pain. The primary endpoint was the non-inferiority of classical massage compared with the acupuncture treatment in respect of the impairment in everyday life, with the help of the Hannover function questionnaire (HFAQ) and the reduction in pain (“Von Korff”-Questionnaire) at the follow-up after one month. Results In the per-protocol analysis during the period between enrollment in the study and follow-up, the responder rate of the KMT was 56.5% and thus tended to be inferior to the responder rate of the AKU with 62.5% (Δ = − 6%; KIΔ: − 23.5 to + 11.4%). Conclusions The results show that classical massage therapy is not significantly inferior to acupuncture therapy in the period from admission to follow-up. Thus, the non-inferiority of the KMT to the AKU cannot be proven in the context of the defined irrelevance area.

Section: Discussionmentioning

confidence: 98%

“…Their aim was to apply a holistic concept incorporating both complex treatment and psychological care. Conservative treatment was regarded not only as an alternative to surgery, but also as a synergic tool [24].…”

Section: Discussionmentioning

confidence: 99%

Classical Massage and Acupuncture in Chronic Back Pain – Non-Inferiority Randomised Trial

Klassen

Wiebelitz²,

Beer

2018

“…Verschiedene Methoden, um einen klinisch relevanten Unterschied zu bestimmen, sind vorgeschlagen worden. Unterschieden werden generell verteilungsbasierte und ankerbasierte Ansätze [6 -9] [15].…”

Section: Hintergrund Und Fragestellungunclassified

Clinical Relevance of Changes in Pain Intensity in Patients with Specific Back Pain

Haase¹,

Kladny²

2021

Self Cite

Background Pain intensity is frequently measured on the 11-point numerical pain rating scale (NRS-PI), ranging from 0 (no pain) to 10 points (worst imaginable pain). However, it is difficult to interpret the clinical importance of changes from baseline to endpoint on this instrument. Objectives To estimate the minimal detectable change (MDC) and the minimal clinically important difference (MCID) for average pain intensity in patients with specific back pain. Materials and Methods Data on 1232 subjects with specific back pain from a German hospital were included in this study. A score combining the patientʼs (PGIC) and the physicianʼs global impression of change (CGIC) over the in-patient length of stay was used as an external criterion. A priori, we considered the score value “slightly improved” as the MCID. MDC was calculated using the standard error of measurement (SEM) and the standard deviation (SD) of the sample. MCID was estimated by the mean value of PI-NRS change in patients who self-assess as “slightly improved”, and by sensitivity/specificity analyses, computed by the receiver operating characteristic method (ROC). Results MDC was 1.77. The MCS and ROC methods consistently showed an MCID of 2 for the total sample. Both methods showed the dependence of the MCID on the initial pain: 1 for mild to moderate pain at baseline (1 – 4 NRS points), 2 for moderate to severe pain (5 – 7) and 3 – 4 for very severe to extreme pain (8 – 10). For patients with lumbosacral intervertebral disc disorders and patients in the acute phase (duration of pain < 6 weeks), the ROC method resulted in a higher limit than the MCS method. Conclusions In order to facilitate the interpretation of changes and to take into account the patientʼs perspective, the global assessment of the success of treatment should be used as an anchor criterion. In addition to dealing with pain measurement, function-related and psychosocial aspects of pain symptoms should be kept in mind.

“…By far, an overwhelming proportion of patients (83 %) were referred by spinal specialists (orthopaedic surgeons/accident surgeons and neurosurgeons). They accounted for 87 % of all referrers in 2019 and between 82 % [11] and 88 % in previous years since 2013 (unpublished data from the scientific monitoring).…”

Section: Case Numbersmentioning

confidence: 99%

Konservative stationäre Behandlung von spezifischen Rückenschmerzen vor und während der Corona-Pandemie

Haase¹,

Kladny²

2021

Self Cite

Zusammenfassung Hintergrund Als Fach mit einem sehr hohen Anteil elektiv planbarer Operationen war die Orthopädie und Unfallchirurgie strukturell und finanziell stark von den Maßnahmen gegen die Coronapandemie betroffen. Erfahrungen aus der konservativen Orthopädie wurden bisher kaum berichtet. Ziel Die Studie soll Erkenntnisse darüber liefern, welche Veränderungen sich im Patientenkollektiv einer stationären konservativen Behandlung von Patienten mit Wirbelsäulenerkrankungen unter der Coronapandemie hinsichtlich Fallzahlen, Patientenstruktur und Behandlungsverlauf ergeben haben. Material und Methoden Es wurden retrospektiv Daten von insgesamt 954 Patienten aus der Routinedokumentation einer Abteilung für konservative Behandlung von Rückenschmerzen aus den Jahren 2019 und 2020 verglichen, die Aussagen über den Verlauf der stationären konservativen Wirbelsäulenbehandlung erlauben. Neben soziodemografischen Daten wurden numerische Schmerzratingskalen, Skalen zur Beeinträchtigung durch die Schmerzen und zur körperlichen Funktionsfähigkeit bei Behandlungsbeginn und bei Behandlungsende mittels deskriptiver Statistik und Unterschiedstests analysiert. Ergebnisse Die Studie zeigte eine Reduktion der Fallzahlen um 21% gegenüber dem Zeitraum vor der Pandemie. Die Patientenstruktur hat sich geändert hinsichtlich der Diagnosegruppen und der körperlichen Funktionsfähigkeit. Die Werte der Assessments bei Entlassung wie auch deren Prä-post-Differenzen zeigen ein nahezu identisches Bild der Ergebnisqualität vor und nach Pandemiebeginn. Diskussion Der relativ geringe Rückgang an stationären Einweisungen zur nicht operativen Behandlung von spezifischen Wirbelsäulenerkrankungen verweist darauf, dass auch in der pandemiebedingten Krise dieses Behandlungsangebot erforderlich war. Bei geringen Veränderungen in der Patientenzusammensetzung konnten vergleichbare Behandlungsergebnisse erzielt werden.