2023-12-18 デラウェア大学 (UD)
The University of Delaware’s Gregory Hicks recently led a clinical trial to test new ways of treating chronic low back pain in adults 60 to 85 years old.
◆研究結果によれば、腰に焦点を当てた専用の理学療法は、腰痛障害を8週間の介入直後に大幅に減少させ、6ヵ月後には脊椎に焦点を当てた治療と差がなくなりました。腰に焦点を当てたグループでは46%が実質的な改善を達成し、脊椎に焦点を当てたグループでは33%でした。この結果は、異なる腰痛サブグループに合わせた治療法の開発が可能であり、高齢者の腰痛の適切な対応が進む可能性を示唆しています。
<関連情報>
- https://www.udel.edu/udaily/2023/december/greg-hicks-low-back-pain-therapy-mash-clinical-trial/
- https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(23)00267-9/fulltext
運動能力低下のリスクがある慢性腰痛の高齢者に対する股関節に焦点を当てた理学療法と脊椎に焦点を当てた理学療法(MASH):多施設、シングルマスク、無作為化比較試験 Hip-focused physical therapy versus spine-focused physical therapy for older adults with chronic low back pain at risk for mobility decline (MASH): a multicentre, single-masked, randomised controlled trial
Gregory E Hicks, Prof Steven Z George,Jenifer M Pugliese, Peter C Coyle, J Megan Sions, Sara Piva,Corey B Simon, Joseph Kakyomya, Charity G Patterson
The Lancet Rheumatology Published:January, 2024
DOI:https://doi.org/10.1016/S2665-9913(23)00267-9
Summary
Background
Previously, we identified a population of older adults with chronic low back pain, hip pain, and hip muscle weakness who had worse 12-month low back pain and functional outcomes than age-matched adults with only low back pain, indicating an increased risk for future mobility decline. We sought to determine whether tailored, hip-focused physical therapy reduced pain and functional limitations in this high-risk population compared with non-tailored, spine-focused physical therapy.
Methods
We did a multicentre, single-masked, randomised controlled trial at three research-based sites in the USA. We recruited older adults (aged 60–85 years) with hip pain and weakness who reported moderate low back pain intensity at least half the days in the last 6 months. Patients were randomly assigned to hip-focused physical therapy or spine-focused physical therapy using permuted blocks with random block size, stratified by site and sex (ie, male or female). The primary outcomes were self-reported disability using the Quebec Back Pain Disability Scale (QBPDS) and performance-based 10-Meter Walk Test (10MWT) at 8 weeks. All analyses were done in the intention-to-treat population. Adverse events were collected by study staff via a possible adverse event reporting form and then adjudicated by site investigators. This trial was registered with ClinicalTrials.gov, NCT04009837.
Findings
Between Nov 1, 2019, and April 30, 2022, 184 participants were randomly assigned to receive hip-focused (n=91) or spine-focused physical therapy (n=93) interventions. The mean age was 70·7 (SD 6·2) years. 121 (66%) of 184 participants were women, 63 (34%) were men, and 149 (81%) were White. At 8 weeks, the mean between-group difference on the QBPDS was 4·0 (95% CI 0·5 to 7·5), favouring hip-focused physical therapy. Both groups had similar, clinically meaningful gait speed improvements (10MWT) at 8 weeks (mean difference 0·004 m/s [95% CI –0·044 to 0·052]). No serious adverse events were related to study participation.
Interpretation
Tailored hip-focused physical therapy demonstrated greater improvements in low back pain-related disability at 8 weeks. However, both hip-focused physical therapy and spine-focused physical therapy produced clinically meaningful improvements in disability and function for this high-risk population at 6 months. These findings warrant further investigation before clinical implementation.
Funding
US National Institute on Aging of the National Institutes of Health.
