PDF herunterladen
physioscience 2018; 14(02): 57-68
DOI: 10.1055/a-0600-5121
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Wirksamkeit und Durchführbarkeit von Graphästhesie-Training bei Patienten mit chronisch unspezifischen Rückenschmerzen

Randomisierte kontrollierte PilotstudieEffectiveness and Feasibility of Graphaesthesia Training in Patients with Non-specific Chronic Low Back PainRandomised Controlled Pilot Study
Katharina van Baal
  Hochschule für Gesundheit, Bochum
,
Fiona Schwarz
  Hochschule für Gesundheit, Bochum
,
Katja Ehrenbrusthoff
  Hochschule für Gesundheit, Bochum
,
Christian Grüneberg
  Hochschule für Gesundheit, Bochum
› Institutsangaben
Weitere Informationen

Publikationsverlauf

20. April 2017

10. November 2017

Publikationsdatum:
12. Juni 2018 (online)

   Lizenzen und Reprints

Zusammenfassung

Hintergrund Chronisch unspezifischer Rückenschmerz (CURS) stellt ein erhebliches Gesundheitsproblem dar. Aktuelle Studien weisen darauf hin, dass kortikale Veränderungen bei den betroffenen Patienten ein beitragender Faktor für die Persistenz von Schmerzen sein können. Bei anderen Patienten mit chronischen Schmerzen und nachgewiesenen kortikalen Veränderungen konnte die Wirksamkeit sensorischer Trainingsansätze gezeigt werden. Unklar ist, ob diese Ansätze auch bei Patienten mit CURS wirksam sind.

Ziel Das Ziel dieser Pilotstudie war es, die Größenordnung möglicher Effekte des Graphästhesie-Trainings einzuschätzen und dessen Durchführbarkeit zu überprüfen.

Methoden 9 Probanden wurden randomisiert in 2 Gruppen eingeteilt. In der 3-wöchigen Interventionsphase erhielt die Kontrollgruppe physiotherapeutische „Usual Care“, während die Interventionsgruppe zusätzlich 2-mal wöchentlich ein 20-minütiges Graphästhesie-Training absolvierte.

Ergebnisse Im Vergleich der beiden Messzeitpunkte innerhalb sowie zwischen den Gruppen zum Messzeitpunkt 2 fanden sich keine signifikanten Unterschiede. Deskriptiv zeigte sich die Tendenz einer verbesserten Graphästhesie-Fehlerrate und Zweipunktdiskriminationsschwelle sowie von Schmerzintensität, -interferenz und körperlicher Funktion in der Interventionsgruppe.

Schlussfolgerung Das Graphästhesie-Training ist im klinischen physiotherapeutischen Kontext durchführbar und führt nicht zu unerwünschten Nebenwirkungen. Bezüglich der Wirksamkeit bestehen lediglich Tendenzen. Aufgrund des Pilotcharakters der Arbeit sind die Ergebnisse mit Vorsicht zu interpretieren. Es bedarf Folgestudien mit größeren Studienpopulationen zu kombinierten sensomotorischen Trainingsprogrammen bei CURS, insbesondere erweitert um den Aspekt einer vorangehenden Klassifizierung der Patienten in Subgruppen.

Abstract

Background Non-specific chronic low back pain (NSCLBP) is a major health problem. Current studies indicate that cortical alterations may be a contributing factor to persistent pain in affected patients. In other patients with chronic pain and identified cortical alterations, sensory training approaches showed initial effectiveness. It is unclear whether these approaches are also effective in patients with NSCLBP.

Objective The aim of this pilot study was to assess the degree of possible treatment effects of a graphaesthesia training and to investigate its feasibility.

Method Nine patients were randomised into two groups. During the three-week intervention period the control group received usual physiotherapy care whilst the intervention group performed an additional 20 minutes graphaesthesia training twice a week.

Results The comparison of the two measurement points within the groups as well as between the groups at measurement point two showed no significant differences. Descriptive data revealed a tendency of improved graphaesthesia error rates and two-point discrimination thresholds as well as pain severity, pain interference and physical function in the intervention group.

Conclusions In the clinical physiotherapeutic context graphaestesia training is feasible and does not lead to any unwanted adverse effects. Regarding the effectiveness there exist only tendencies. Due to the pilot character of the study, the results should be interpreted with caution. More research studies with larger sample sizes regarding combined sensorimotor exercise programmes for NSCLBP are necessary, especially extended by a preceding classification of patients into subgroups.

Schlüsselwörter

chronische Rückenschmerzen - sensomotorischer Kortex - physiotherapeutische Behandlungsverfahren - randomisierte kontrollierte Studie - Graphästhesie

Key words

chronic low back pain - sensorimotor cortex - physiotherapy modalities - randomised controlled trial - graphaesthesia
 

  • Literatur

  • 1 Schmidt CO, Raspe H, Pfingsten M. et al. Back pain in the German adult population: prevalence, severity, and sociodemographic correlates in a multiregional survey. Spine (Phila Pa 1976) 2007; 32: 2005-2011
    CrossrefPubMedGoogle Scholar
  • 2 Handelsblatt. Volkswirtschaftliche Schäden aufgrund chronischer Erkrankungen von Arbeitnehmern nach Krankheiten im Jahr 2010 (in Milliarden Euro). Handelsblatt 2012; 130: 16
    PubMedGoogle Scholar
  • 3 Barmer GEK. Heil- und Hilfsmittelreport. 2014 www.barmer.de/presse/infothek/studien-und-reports/heil-und-hilfsmittelreport/report-2014-38588 (02.04.2018)
    PubMedGoogle Scholar
  • 4 Deyo RA. Measuring the functional status of patients with low back pain. Arch Phys Med Rehabil 1988; 69: 1044-1053
    PubMedGoogle Scholar
  • 5 Airaksinen O, Brox JI, Cedraschi C. et al. Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J 2006; 15 (Suppl. 02) S192-S300
    CrossrefPubMedGoogle Scholar
  • 6 Bundesärztekammer (BÄK), Arbeitsgemeinschaft der Deutschen Ärztekammern, Kassenärztliche Bundesvereinigung KBV, Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) et al. Nationale VersorgungsLeitlinie Nicht-spezifischer Kreuzschmerz – Langfassung. 2017 Version 1 2. Aufl. www.leitlinien.de/mdb/downloads/nvl/kreuzschmerz/kreuzschmerz-2aufl-vers1-lang.pdf (02.04.2018)
    PubMedGoogle Scholar
  • 7 Wand BM, O’Connell NE. Chronic non-specific low back pain – sub-groups or a single mechanism?. BMC Musculoskelet Disord 2008; 9: 11
    CrossrefPubMedGoogle Scholar
  • 8 Van Tulder MW, Koes B, Malmivaara A. Outcome of non-invasive treatment modalities on back pain: an evidence-based review. Eur Spine J 2006; 15 (Suppl. 01) S64-S81
    CrossrefPubMedGoogle Scholar
  • 9 Van Tulder MW, Assendelft WJ, Koes BW. et al. Spinal radiographic findings and nonspecific low back pain. A systematic review of observational studies. Spine (Phila Pa 1976) 1997; 22: 427-434
    CrossrefPubMedGoogle Scholar
  • 10 Apkarian AV, Baliki MN, Geha PY. Towards a theory of chronic pain. Prog Neurobiol 2009; 87: 81-97
    CrossrefPubMedGoogle Scholar
  • 11 Wand BM, Parkitny L, O’Connell NE. et al. Cortical changes in chronic low back pain: current state of the art and implications for clinical practice. Man Ther 2011; 16: 15-20
    CrossrefPubMedGoogle Scholar
  • 12 Luomajoki H, Moseley GL. Tactile acuity and lumbopelvic motor control in patients with back pain and healthy controls. Br J Sports Med 2011; 45: 437-440
    CrossrefPubMedGoogle Scholar
  • 13 Flor H, Braun C, Elbert T. et al. Extensive reorganization of primary somatosensory cortex in chronic back pain patients. Neurosci Lett 1997; 224: 5-8
    CrossrefPubMedGoogle Scholar
  • 14 Lloyd D, Findlay G, Roberts N. et al. Differences in low back pain behavior are reflected in the cerebral response to tactile stimulation of the lower back. Spine (Phila Pa 1976) 2008; 33: 1372-1377
    CrossrefPubMedGoogle Scholar
  • 15 Maihofner C, Handwerker HO, Neundorfer B. et al. Patterns of cortical reorganization in complex regional pain syndrome. Neurology 2003; 61: 1707-1715
    CrossrefPubMedGoogle Scholar
  • 16 Pleger B, Tegenthoff M, Ragert P. et al. Sensorimotor retuning [corrected] in complex regional pain syndrome parallels pain reduction. Ann Neurol 2005; 57: 425-429
    CrossrefPubMedGoogle Scholar
  • 17 Vartiainen NV, Kirveskari E, Forss N. Central processing of tactile and nociceptive stimuli in complex regional pain syndrome. Clin Neurophysiol 2008; 119: 2380-2388
    CrossrefPubMedGoogle Scholar
  • 18 Tracey I, Bushnell MC. How neuroimaging studies have challenged us to rethink: is chronic pain a disease?. J Pain 2009; 10: 1113-1120
    CrossrefPubMedGoogle Scholar
  • 19 Flor H, Elbert T, Knecht S. et al. Phantom-limb pain as a perceptual correlate of cortical reorganization following arm amputation. Nature 1995; 375: 482-484
    CrossrefPubMedGoogle Scholar
  • 20 Moseley GL, Zalucki NM, Wiech K. Tactile discrimination, but not tactile stimulation alone, reduces chronic limb pain. Pain 2008; 137: 600-608
    CrossrefPubMedGoogle Scholar
  • 21 Wand BM, Di Pietro F, George P. et al. Tactile thresholds are preserved yet complex sensory function is impaired over the lumbar spine of chronic non-specific low back pain patients: a preliminary investigation. Physiotherapy 2010; 96: 317-323
    CrossrefPubMedGoogle Scholar
  • 22 Moseley GL. I can’t find it! Distorted body image and tactile dysfunction in patients with chronic back pain. Pain 2008; 140: 239-243
    CrossrefPubMedGoogle Scholar
  • 23 Moberg E. Two-point discrimination test. A valuable part of hand surgical rehabilitation, e. g. in tetraplegia. Scand J Rehabil Med 1990; 22: 127-134
    CrossrefPubMedGoogle Scholar
  • 24 Amshoff T, von Aufschnaiter D, Bader-Johansson C. et al. physiolexikon: Physiotherapie von A bis Z. Stuttgart: Thieme; 2010
    Google Scholar
  • 25 Knecht S, Kunesch E, Schnitzler A. Parallel and serial processing of haptic information in man: effects of parietal lesions on sensorimotor hand function. Neuropsychologia 1996; 34: 669-687
    CrossrefPubMedGoogle Scholar
  • 26 Staal JB. HE, Heijmanns M, Kiers H. et al. KNGF Guideline Low back Pain. 2013 www.ipts.org.il/_Uploads/dbsAttachedFiles/low_back_pain_practice_guidelines_2013.pdf (02.04.2018)
    PubMedGoogle Scholar
  • 27 Waddell G. 1987 Volvo award in clinical sciences. A new clinical model for the treatment of low-back pain. Spine (Phila Pa 1976) 1987; 12: 632-644
    CrossrefPubMedGoogle Scholar
  • 28 Waddell G. An approach to backache. Br J Hosp Med 1982; 28: 190-191 , 193–194, passim
    PubMedGoogle Scholar
  • 29 Chapman JR, Norvell DC, Hermsmeyer JT. et al. Evaluating common outcomes for measuring treatment success for chronic low back pain. Spine (Phila Pa 1976) 2011; 36: S54-S68
    CrossrefPubMedGoogle Scholar
  • 30 Morfeld M, Kirchberger I, Bullinger M. SF-36 Fragebogen zum Gesundheitszustand – deutsche Version des Short-Form-36 Health Survey. Göttingen: Hogrefe; 2011
    Google Scholar
  • 31 Ellert U, Kurth BM. Robert Koch-Institut Berlin.. Methodische Betrachtungen zu den Summenscores des SF-36 anhand der erwachsenen bundesdeutschen Bevölkerung. Bundesgesundheitsbl –Gesundheitsforsch – Gesundheitsschutz; 2004 47. 1027-1032
    PubMedGoogle Scholar
  • 32 Bullinger M. German translation and psychometric testing of the SF-36 Health Survey: preliminary results from the IQOLA Project. International Quality of Life Assessment. Soc Sci Med 1995; 41: 1359-1366
    CrossrefPubMedGoogle Scholar
  • 33 Roland M, Fairbank J. The Roland-Morris Disability Questionnaire and the Oswestry Disability Questionnaire. Spine (Phila Pa 1976) 2000; 25: 3115-3124
    CrossrefPubMedGoogle Scholar
  • 34 Junge A, Mannion AF. Questionnaires for patients with back pain. Diagnosis and outcome assessment. Orthopade 2004; 33: 545-552
    CrossrefPubMedGoogle Scholar
  • 35 Roland M, Morris R. A study of the natural history of back pain. Part I: development of a reliable and sensitive measure of disability in low-back pain. Spine (Phila Pa 1976) 1983; 8: 141-144
    CrossrefPubMedGoogle Scholar
  • 36 Wiesinger GF, Nuhr M, Quittan M. et al. Cross-cultural adaptation of the Roland-Morris questionnaire for German-speaking patients with low back pain. Spine (Phila Pa 1976) 1999; 24: 1099-1103
    CrossrefPubMedGoogle Scholar
  • 37 Radbruch L, Loick G, Kiencke P. et al. Validation of the German version of the Brief Pain Inventory. J Pain Symptom Manage 1999; 18: 180-187
    CrossrefPubMedGoogle Scholar
  • 38 Cleeland CS. The Brief Pain Inventory – User Guide. 2009 www.mdanderson.org/documents/Departments-and-Divisions/Symptom-Research/BPI_UserGuide.pdf (02.04.2018)
    PubMedGoogle Scholar
  • 39 Cleeland CS, Ryan KM. Pain assessment: global use of the Brief Pain Inventory. Ann Acad Med Singap 1994; 23: 129-138
    PubMedGoogle Scholar
  • 40 Faul F, Erdfelder E, Lang AG. et al. G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. 2007 www.gpower.hhu.de/fileadmin/redaktion/Fakultaeten/Mathematisch-Naturwissenschaftliche_Fakultaet/Psychologie/AAP/gpower/GPower3-BRM-Paper.pdf (02.04.2018)
    PubMedGoogle Scholar
  • 41 Wand BM, O’Connell NE, Di Pietro F. et al. Managing chronic nonspecific low back pain with a sensorimotor retraining approach: exploratory multiple-baseline study of 3 participants. Phys Ther 2011; 91: 535-546
    CrossrefPubMedGoogle Scholar
  • 42 Wälti P, Kool J, Luomajoki H. Short-term effect on pain and function of neurophysiological education and sensorimotor retraining compared to usual physiotherapy in patients with chronic or recurrent non-specific low back pain, a pilot randomized controlled trial. BMC Musculoskelet Disord 2015; 16: 83
    CrossrefPubMedGoogle Scholar
  • 43 Ryan C, Harland N, Drew BT. et al. Tactile acuity training for patients with chronic low back pain: a pilot randomised controlled trial. BMC Musculoskelet Disord 2014; 15: 59
    CrossrefPubMedGoogle Scholar
  • 44 Ehrenbrusthoff K, Ryan CG, Grüneberg C. et al. The intra- and inter-observer reliability of a novel protocol for two-point discrimination in individuals with chronic low back pain. Physiological Measurement 2016; 37: 1074-1088
    PubMedGoogle Scholar
  • 45 Catley MJ, O’Connell NE, Berryman C. et al. Is tactile acuity altered in people with chronic pain? A systematic review and meta-analysis. J Pain 2014; 15: 985-1000
    CrossrefPubMedGoogle Scholar
  • 46 Catley MJ, Tabor A, Wand BM. et al. Assessing tactile acuity in rheumatology and musculoskeletal medicine--how reliable are two-point discrimination tests at the neck, hand, back and foot?. Rheumatol (Oxford) 2013; 52: 1454-1461
    CrossrefPubMedGoogle Scholar
  • 47 Wand BM, Catley MJ, Luomajoki HA. et al. Lumbar tactile acuity is near identical between sides in healthy pain-free participants. Man Ther 2014; 19: 504-507
    CrossrefPubMedGoogle Scholar
  • 48 Airaksinen O, Brox JI, Cedraschi C. et al. Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J 2006; 15 (Suppl. 02) S192-S300
    CrossrefPubMedGoogle Scholar
  • 49 Fersum KV, Dankaerts W, O’Sullivan PB. et al. Integration of subclassification strategies in randomised controlled clinical trials evaluating manual therapy treatment and exercise therapy for non-specific chronic low back pain: a systematic review. Br J Sports Med 2010; 44: 1054-1062
    CrossrefPubMedGoogle Scholar
  • 50 Billis EV, McCarthy CJ, Oldham JA. Subclassification of low back pain: a cross-country comparison. Eur Spine J 2007; 16: 865-879
    CrossrefPubMedGoogle Scholar