Effect Of Aquatic Exercise On Patients With Chronic Low Back Pain

Purpose Low back pain is a global health problem,with a lifetime prevalence rate of 84%.After the first attack of low back pain,about 2/3 of people turn into chronic low back pain(CLBP)and suffer from it for a long time.As the leading cause of disability,low back pain brings heavy direct medical burden and indirect economic loss to the social economy.For the treatment of low back pain,exercise therapy is the first choice recommended by many guidelines.Chinese experts have reached a consensus to list aquatic exercise as a strongly recommended exercise type.Thus,we conduct a randomized controlled trial to explore the effects of aquatic exercise on CLBP patients,in order to provide a theoretical basis for the clinical application and promotion of aquatic exercise.Methods In this study,67 subjects were recruited,of whom 53 met the inclusion criteria.They were randomly divided into two groups: aquatic exercise group(n = 27)and physical therapy modalities group(n = 26).Both groups received 60-minute intervention twice a week for 12 weeks.Aquatic exercise is conducted in a swimming pool at 29 ±1 ?.The training includes 10 minutes of warm-up,40 minutes of water exercise(abdominal support,press plate vertically,press plate laterally,press plate obliquely downward,straight leg press downward,step on plate downward,deep water running),and 10 minutes of cool down.The physical therapy modalities group was treated with transcutaneous neuromuscular electrical stimulation(TENS)for 30 minutes and infrared therapy for 30 minutes respectively.The subjects of the two groups completed the basic information before the intervention,filled out the questionnaire and participated in the test before and after 12 weeks invention.The main evaluation indicators included the pain numerical score(NRS)(three NRS scores for "the worst in the past week","the slightest in the past week" and "right now")and the Roman-Roland Disability questionnaire(RMDQ).Secondary indicators include quality of life(SF-36),quality of sleep(PSQI),pain anxiety symptoms scale(SPSS),Tampa scale of kinesiophobia(TSK),fear avoidance beliefs questionnaire(FABQ),lumbar range of motion(LROM),proprioceptive sensation,Y balance,minimum clinical important difference(MCID),global perceived efficacy(GPE)and treatment recommendation.SPSS24.0 statistical software was used to analyze the experimental data,the quantitative data were compared between groups by independent sample T-test,compared intra-group by paired sample T-test,and the qualitative data were analyzed by chi-square test.The level of significance was P <0.05.The treatment effect was analyzed by intention to treat analysis,and the baseline data were used to replace the missing ones.Results In the aquatic exercise group,the pain degree(NRS most pain value p < 0.001,NRS at this moment P = 0.001),lumbar dysfunction(P = 0.001),quality of life(mental aspect)(P = 0.026),sleep quality(P = 0.022),pain anxiety symptoms(P = 0.031),Tampa scale of kinesiophobia(P = 0.001),fear avoidance beliefs questionnaire(FABQ work P < 0.001,total score of FABQ P< 0.001),lumbar range of motion(extension P = 0.002,left flexion P = 0.013,right flexion P = 0.024,left rotation P = 0.038),dynamic balance(left P < 0.001,right P = 0.002),minimum clinically significant difference(MCID of the most painful value of NRS P = 0.001,MCID of NRS at this moment P = 0.037,MCID of RMDQ P = 0.041)and treatment recommendation(P = 0.003)were significantly better than physical therapy modalities group.Conclusions 1)Compared with TENS and infrared therapy,aquatic exercise could significantly improve pain and dysfunction of CLBP patients.The effect is not only statistically significant,but also clinically significant.2)Compared with TENS and infrared therapy,aquatic exercise can significantly improve the quality of life(mental aspect),sleep quality,pain anxiety symptoms,Tampa scale of kinesiophobia,fear avoidance beliefs,lumbar range of motion and dynamic balance of CLBP patients.3)There was no difference in the global perceived efficacy score of CLBP patients between aquatic exercise group and physical therapy modalities group,but the proportion of improved CLBP patients in aquatic exercise group was higher than that in physical therapy modalities group,and the treatment recommendation of aquatic exercise was significantly higher than physical therapy modalities.