[논문]만성 요통 환자의 자가 관리 요법에 따른 통증 및 기능의 변화

최준현; 김은실; 윤용순; 김가은; 이미현; 장홍영

doi:10.14400/jdc.2020.18.10.547

만성 요통 환자의 자가 관리 요법에 따른 통증 및 기능의 변화
Self-management techniques and subsequent changes in pain and function in patients with chronic low back pain 원문보기

디지털융복합연구 = Journal of digital convergence, v.18 no.10, 2020년, pp.547 - 555

최준현 (예수병원 재활의학과) , 김은실 (예수병원 재활의학과) , 윤용순 (예수병원 재활의학과) , 김가은 (전주대학교 보건복지대학원 자연의학과) , 이미현 (성결대학교 체육교육과) , 장홍영 (전주대학교 의과학융합연구소)

초록
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재활치료를 받고 호전된 만성 요통 환자들이 집에서 수행하는 자가 관리 프로그램의 효과를 알아보고자 63명을 자가 운동 (SEG), 핫팩 및 저주파 전기 자극 (HEG) 및 온열 마사지 (TMG) 3개 그룹으로 나누었다. 통증장애 지표로 통증 수치 등급 척도 (PNRS), Oswestry 장애 지수 (ODI) 및 Roland Morris 장애 설문지 (RMDQ)를 병원 내원시, 치료 후 및 가정에서 자가 관리 6 개월 후에 평가하였고 재발 빈도 (RF)를 내원 전 6 개월 전과 자가관리 6 개월 후에 평가하였다. 각 그룹 내의 비교에서 SEG 및 TMG의 PNRS, ODI, RMDQ는 6개월 후에도 효과가 유지되었으나, HEG에서는 치료 후 개선되었던 PNRS가 6개월 후에 악화되었다. 그룹간 비교에서 SEG 및 TMG의 PNRS, ODI, RMDQ 및 RF는 6개월 후에 HEG에 비해 더 좋았다. 운동과 온열 마사지는 요통 자가 관리 방법으로 고려볼 수 있으나, 향후 더 많은 환자들과 다양한 연령, 직업들을 고려하여 추가 연구가 필요하다.

Abstract ▼ AI-Helper

To investigate the effects of self-management programs for chronic low back pain (LBP), 63 subjects were assigned to three groups; self-exercise group (SEG), hot pack and low-frequency electrical stimulation group (HEG), and thermo-massage group (TMG). Parameters were the pain numeric rating scale (PNRS), Oswestry Disability Index (ODI), Roland Morris Disability Questionnaire (RMDQ) and Relapse frequency (RF). PNRS, ODI and RMDQ of SEG and TMG sustained effectiveness, however, PNRS, which improved after treatment in HEG, worsened in 6 month. Between the groups, all parameters were better in SEG and TMG compare to HEG. Exercise and thermo-massage can be considered as useful self-management performed at home to prevent the relapse of chronic LBP.

주제어

표/그림 (4)

표 Table 1. Basic Characteristics
표 Table 2. Comparison of the Variables between Baseline, Post-treatment, and 6 month.
표 Table 3. Comparison of the Variables in Each Groups
표 Table 4. Comparison of the Recurrent Frequency during 6 month

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문제 정의

Thus, this study aimed to investigate the effects of various forms of self-management on LBP management, changes in function, and incidence of recurrence in patients with chronic LBP.

제안 방법

Among patients who underwent 2∼3 weeks of rehabilitation therapy, the self-management methods of LBP used for 6 months were surveyed to classify them into the following groups: (1) self-exercise group (SEG), (2) hot pack and low-frequency electrical stimulation group (HEG), and (3) thermo-massage group (TMG).
During treatment at the hospital, patients were taught about self-exercises (stretching and strengthening exercise) by a therapist, including stretching of the erector spinae, hamstrings, gastrocnemius-soleus, quadriceps, and piriformis, as well as maneuvers such as thoraco-lumbar rotation in standing posture, press-up back extension, bridge pose, cat and camel, pelvic tilt, partial curl, quadruped arm/leg raise, balance training, and knee roll. A printout containing figures of the exercise methods and a video were also given.
Among the patients who presented to the hospital with LBP as the chief complaint, only those who showed improvement after undergoing 2∼3 weeks of rehabilitation therapy at the hospital were included. Medical records of patients who received the same nonsteroidal anti-inflammatory drug (NSAID) doses, injection, manual therapy and physiotherapy, including low-frequency electrical stimulation (transcutaneous electrical nerve stimulation; TENS), hot packs and ultrasound therapy, three times a week while being trained for self-exercises were reviewed. The inclusion criteria were ≥ 12 weeks of LBP, age 19–75 years, frequent recurrence of LBP prior to hospital visit, a pain numeric rating scale (PNRS) of ≥ 3, and Oswestry Disability Index (ODI) of ≤ 50%.
Other patients purchased a thermo-massage bed (CGM MB-1401, Ceragem, South Korea), or used them at a paid massage center, for 1–2 times a day for 40 minutes, at least 5 days a week over the 6 months.
A printout containing figures of the exercise methods and a video were also given. The patients were instructed to exercise at least five times a week, for 30 minutes each session.
This study comparatively analyzed the self-management techniques for LBP used at home, and examined the PNRS, ODI, RMDQ scores, as well as the recurrence incidence of LBP.

대상 데이터

A total of 120 subjects were recruited, and following the application of the inclusion and exclusion criteria, 63 subjects were enrolled. Twenty-six were men, and 37 were women.
Common comorbidities were hypertension (n = 10) and diabetes mellitus (n = 9). The SEG, HEG and TMG consisted of 20, 22, and 21 subjects, respectively. No statistically significant differences were observed in all baseline parameters among the three groups (Table 1).
A total of 120 subjects were recruited, and following the application of the inclusion and exclusion criteria, 63 subjects were enrolled. Twenty-six were men, and 37 were women. The mean age was 60.

데이터처리

Changes of PNRS, ODI, and RMDQ scores within each group were analyzed with repeated-measures ANOVA, while comparison among the groups was performed using one-way ANOVA. If a significant interaction between group and time was observed, the differences in the pattern of change was examined by contrast analysis with Bonferroni’s correction.
If a significant interaction between group and time was observed, the differences in the pattern of change was examined by contrast analysis with Bonferroni’s correction. The difference in the recurrence incidence between 6 months before hospital visit and 6 months after self-management was analyzed with the Wilcoxon signed rank test. Statistical significance was set to p<0.

이론/모형

Values are given as mean(SD), p<0.05, PT: Post-Treatment, PNRS: Pain numeric rating scale, ODI: Oswestry disability index, RMDQ: Roland & Morris Disability Questionnaire.

성능/효과

Between the groups, no difference in PNRS, ODI, and RMDQ scores were observed before and after treatment in the clinic, but at 6MO, all three scores were better maintained in the SEG and the TMG as compare to the HEG (p＜0.05) (Table 3).
During the 6 months prior to study participation, the average number of LBP recurrences was 10.79 ± 4.92 times, and the average pain score was 3.99 ± 0.69.
The PNRS, ODI, and RMDQ scores before treatment (baseline, BA) and 2–4 weeks post-treatment at the hospital (PT) were obtained from medical records, and patients who consistently complied to self-management were further assessed 6 months after their final hospital visit (6MO).
The PNRS, ODI, and RMDQ scores of all subjects improved at PT and 6MO as compared to BA, but there was no difference between PT and 6MO (p<0.05) (Table 2).
Through this study, it was found that consistent self-management at home through exercise and the use of thermo-massage beds reduces pain, decreases the recurrence of pain, and improves function in patients with chronic LBP who have received hospital treatment. Therefore, it would be important for physicians to inform and teach patients about effective self-management techniques, and adequately advocate them on the importance of continuous compliance in order to improve chronic LBP and recurrence of pain.
Within the SEG and TMG, the PNRS, ODI, and RMDQ scores improved at PT and 6MO compared to BA (p＜0.05) (Table 3).

후속연구

In addition, the subjects’ physical traits, lifestyle factors, exercise capacity, and duration of illness were not taken into consideration, and compliance with the self-management program over 6 months was not able to objectively investigate because it was measured solely on the basis of self-reporting. Finally, additional studies are needed to examine the long-term effects with follow-ups beyond 6 months. No side effects were reported during this trial.

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