Efetividade de um programa de escola de coluna para dor lombar crônica, incapacidade e fatores associados: ensaio clínico aleatório

Abstract

Objective: To evaluate the effectiveness of a Back School Program (BSP) for patients with chronic low back pain regarding disability, pain, fear of movement, resilience, muscle strength (lumbar and lower limbs) and range of motion of anterior flexion of the lumbar spine. Methods: This is a randomized clinical trial. The sample was non-probabilistic and consisted of 80 participants divided into 4 groups of 20 participants: Group 1 (BSP-multiprofessional): received the interventions of education (3 sessions), physiotherapy (6 sessions) and physical exercises (6 sessions), total of 15 sessions; Group 2 (BSP-education) received the education intervention, a total of 3 sessions, once a week; Group 3 (BSP-physiotherapy): received physical therapy interventions, including kinesiotherapy and electrothermophototherapy, twice a week, a total of 12 sessions and Group 4 (BSP-physical education): received physical education interventions, twice a week, total of 12 sessions. The assessment instruments: Oswestry Disability Index (ODI), Visual Analogue Scale (VAS), Douleur Neuropathique 4 Questions (DN4), Tampa Scale of Kinesiophobia, Connor-Davidson Resilience Scale, dorsal dynamometer to measure muscle (lumbar) strength and lower limbs) and the Schöber test verified the range of motion (ROM) of the anterior flexion of the lumbar spine. Results: Group 1 (BSP-multiprofessional) showed statistical difference in disability index, pain intensity (at the time of assessment and in seven days), neuropathic pain components, fear of movement and anterior flexion amplitude of the lumbar spine. Group 2 (BSP-education) showed improvement only in lumbar muscle strength. Group 3 (BSP-physiotherapy) improved disability, pain (at the time of assessment and within seven days), neuropathic pain components and anterior flexion amplitude of the lumbar spine, and group 4 (BSP-physical education) showed statistical difference in disability index, in pain intensity (at the time of evaluation and in seven days), in the components of neuropathic pain, fear of movement, lumbar muscle strength and range of anterior flexion of the lumbar spine. Neither group improved the resilience scores. In the difference between groups (before/after), significant results were found regarding the disability index (group 4 > group 1 > group 3 > group 2), pain intensity (group 4 > group 1 > group 3 > group 2) , neuropathic pain components (group 1 > group 3 > group 4 > group 2), fear of movement (group 1 > group 4 > group 3 > group 2) and lumbar muscle strength (group 4 > group 2 > group 3>group 1). There were no significant results, after the study between the groups, the resilience and amplitude of the anterior flexion of the lumbar spine. Conclusion: The primary outcome of the study, the disability index, was

better in the groups, 4 (BSP-physical education), 1 (BSP-multiprofessional) and 3 (BSP- physiotherapy). In the comparison by group, the BSP-physical education showed the best

results in terms of disability, pain intensity, neuropathic pain components, fear of movement, lumbar muscle strength and anterior flexion amplitude of the lumbar spine. As for the difference between the groups (before/after), regarding the disability index, a significant improvement was observed in group 4 (BSP-physical education). Overall, the best results were obtained with BSP-physical education (group 4) and BSP-multiprofessional (group 1).