Optimization Of The Elements Of Rehabilitation Therapy For Low Back Pain And Its Influence On Gait

Objective: To compare the clinical effect of different rehabilitation elements and their combination on patients with low back pain(LBP)by using 5 factors and 2 levels orthogonal test,with JOA score,VAS visual analogue pain score,ODI lumbar dysfunction index and finger-ground distance as the main efficacy observation indexes,and finally to screen out the optimal scheme for the treatment of LBP,and to observe the effect of each rehabilitation element on the gait of LBP patients.Methods: In this study,96 patients with LBP who met the inclusion criteria from the rehabilitation clinics of Yueyang Hospital and various cooperative units were enrolled in chronological order.The patients were divided into three levels according to the JOA score: mild,moderate and severe.16 treatment factor groups were set for each level.16 treatment programs formed by acupuncture,manipulation,physiotherapy,traction,training and their combination were used for intervention,2-3 times a week for 2 weeks,5 times in total.After the end of the trial,the changes of the main observation indicators of each treatment group were compared to observe the effect of each treatment factor and its interaction,and the best treatment plan for LBP was screened.At the same time,the gait analysis system was used to test the gait data of some subjects,including the range of motion of trunk,hip joint and knee joint,compared with the gait before treatment,the gait pattern of patients with low back pain was obtained,and the relationship between each gait parameter and each treatment element was analyzed and obtained.Results:1.General data 105 cases were observed in this study,9 cases dropped out and 96 cases completed the test,there were 34 males and 62 females,the age was 53.06 ± 18.326 years,Height 165.43 ± 14.263 cm,the body weight was 63.05 ± 12.823 kg.Before treatment,the VAS score was 46.15 ± 21.343.The distance between finger and ground is 16.10 ± 12.860 cm;ODI score before treatment was 30.71 ± 16.626;The JOA Low Back Pain Questionnaire scored 13.82 ±6.264 before treatment.2.VAS score results(1)The order of clinical therapeutic effect value from large to small is: light layer is E training,C physiotherapy,D traction,A acupuncture,B manipulation;medium layer is A acupuncture,E training,C physiotherapy,B manipulation,D traction;heavy layer is C physiotherapy,B manipulation,E training,D traction,A acupuncture.(2)The difference between different levels of each factor: A Acupuncture at the 1st level was good,and the other 2nd levels were good.The middle 1st level of B manipulation is better;the level of 2nd in light and severe layers was good.The level of 2nd in severe layer of C physiotherapy was better,light and moderate 1st level was good.The first st level of D traction is better in light and medium level,the 2nd level of severe layer is better.The slight level 1 of E training is better than that of ST level,the other 2nd levels were better.(3)Analysis of variance:Mild A-needling and C-physiotherapy have antagonistic effects(F=6.681).The combined use of A-needling and C-physiotherapy can reduce the Alleviative Effect of comprehensive treatment on pain.3.Finger-to-Ground Distance Results(1)The order of clinical therapeutic effect is: light E-training,D-traction,B-manipulation,C-physiotherapy,A-acupuncture;medium A-acupuncture,E-training,D-traction,C-physiotherapy,B-manipulation;severe E-training,B-manipulation,D-traction,C-physiotherapy,A-acupuncture.(2)Differences among different levels of each factor:A needling at mild 2nd level is better,middle 1st level is better,and severe 2nd level is better;The level of 2nd in mild layer of B manipulation was better.The level of St in mild layer 1 of C physiotherapy was better than that of 2nd in other layers.D traction mild layer 2nd level is better,the rest level 1 st level is better;The level of St in the light level of E training is better,the level of 2nd in other degree layers was good.(3)Moderate D traction and A needling have synergistic effect(F=7.193).Both of them can improve the finger distance of patients better.4.JOA score results(1)The order of clinical therapeutic effects is as follows:The slight layer included D traction,B manipulation,A acupuncture,C physiotherapy and E training.The middle level included B manipulation,A acupuncture,D traction,C physiotherapy and E training.Severe layers were A needling = E training,C physiotherapy,B manipulation and D traction.(2)The difference between different levels of each factor: the level of mild 1 is better,the level of other age groups 2 is better,the level of B manipulation mild 1 is better,and the level of other age groups 2 is better;The level of C physiotherapy in mild layer 2 was good,while that in the other layer 1 was good.Thelevel of D mild level 1 was better than that of other age groups 2.Level 1 of E training is good,Level 2 of other levels is good.5.ODI score results(1)The order of clinical therapeutic effect is as follows:The slight layer included B manipulation,E training,C physiotherapy,A acupuncture and D traction;The middle level included E training,D traction,C physiotherapy,B manipulation and A acupuncture;Severe layers were E training,A needling,D traction,C physiotherapy and B manipulation.(2)The difference between different levels of each factor:The level of St in mild layer 1of A needling was better than that in mild layer 1 of A needling,the 2nd level of the other degree layers was better than that of the 1st level.The first st level of B manipulation was better in mild level,the 2nd level of the other degree layers was good;The level of 2nd in mild layer of C physiotherapy was better than that of 1st;D traction slight 1st level is better,the 2nd level of the other degree layers was better than that of the 1st level.The 1st level of E slight layer is better than that of 2 level,the level of 2nd in other degree layers was better.Gait patternPatients who completed gait analysis were compared with healthy adults included.The flexion and extension of the left and right sides of the trunk in patients with it is foundation after treatment were greater than those before treatment.Hip joint range of motion;The difference of knee joint activity between healthy adults was statistically significant(P < 0.05),and the gait pattern of patients with low back pain was obtained.Conclusion:(1)When the main symptoms of the patients are low back pain,the best treatment options are selected in turn:The mild layer was acupuncture plus manipulation,plus or minus physiotherapy;The middle level was acupuncture plus physiotherapy,plus or minus training;The severe layer is therapy plus manipulation,plus or minus training.(2)When the main symptoms of the patients are the limitation of lumbar motion,the best treatment options are selected in turn:The slight layer is training +physiotherapy,plus or minus manipulation;The middle level is training + physiotherapy,plus or minus manipulation;Severe layer is training + manipulation,plus or minus traction(3)When the main symptoms of the patients are the decrease of lumbar vertebral function,the best treatment options are selected in turn:The mild layer was manipulation plus training plus subtraction physiotherapy;The middle level was training plus traction plus subtraction physiotherapy;The severe layer is training plusacupuncture plus plus or minus traction.(4)When the patients' daily function is the best treatment plan:The mild layer was traction + manipulation plus or minus acupuncture;The middle layer was manipulation + acupuncture plus or minus traction;The severe layer is treatment plus training plus plus or minus acupuncture and manipulation.