디지털융복합연구 (Journal of Digital Convergence)

  • 제18권10호
  • /
  • Pages.547-555
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  • 2020
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  • 2713-6434(pISSN)
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  • 2713-6442(eISSN)
한국디지털정책학회 (The Society of Digital Policy and Management)
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만성 요통 환자의 자가 관리 요법에 따른 통증 및 기능의 변화

Self-management techniques and subsequent changes in pain and function in patients with chronic low back pain

  • 최준현 (예수병원 재활의학과) ;
  • 김은실 (예수병원 재활의학과) ;
  • 윤용순 (예수병원 재활의학과) ;
  • 김가은 (전주대학교 보건복지대학원 자연의학과) ;
  • 이미현 (성결대학교 체육교육과) ;
  • 장홍영 (전주대학교 의과학융합연구소)
  • Choi, Jun Hyun (Rehabilitation Medicine, Presbyterian(Jesus) Medical Center) ;
  • Kim, Eun-Shil (Rehabilitation Medicine, Presbyterian(Jesus) Medical Center) ;
  • Yoon, Yong-Soon (Rehabilitation Medicine, Presbyterian(Jesus) Medical Center) ;
  • Kim, Ka-Eun (Dept. of Naturopathic Medicine, Graduate School of Health and Welfare, Jeonju University) ;
  • Lee, Mi-Hyun (Dept. of Physical Education, Sungkyul University) ;
  • Jang, Hong-Young (Convergence Research Center for Medical Sciences, Jeonju University)
  • 투고 : 2020.09.14
  • 심사 : 2020.10.20
  • 발행 : 2020.10.28
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초록

재활치료를 받고 호전된 만성 요통 환자들이 집에서 수행하는 자가 관리 프로그램의 효과를 알아보고자 63명을 자가 운동 (SEG), 핫팩 및 저주파 전기 자극 (HEG) 및 온열 마사지 (TMG) 3개 그룹으로 나누었다. 통증장애 지표로 통증 수치 등급 척도 (PNRS), Oswestry 장애 지수 (ODI) 및 Roland Morris 장애 설문지 (RMDQ)를 병원 내원시, 치료 후 및 가정에서 자가 관리 6 개월 후에 평가하였고 재발 빈도 (RF)를 내원 전 6 개월 전과 자가관리 6 개월 후에 평가하였다. 각 그룹 내의 비교에서 SEG 및 TMG의 PNRS, ODI, RMDQ는 6개월 후에도 효과가 유지되었으나, HEG에서는 치료 후 개선되었던 PNRS가 6개월 후에 악화되었다. 그룹간 비교에서 SEG 및 TMG의 PNRS, ODI, RMDQ 및 RF는 6개월 후에 HEG에 비해 더 좋았다. 운동과 온열 마사지는 요통 자가 관리 방법으로 고려볼 수 있으나, 향후 더 많은 환자들과 다양한 연령, 직업들을 고려하여 추가 연구가 필요하다.

To investigate the effects of self-management programs for chronic low back pain (LBP), 63 subjects were assigned to three groups; self-exercise group (SEG), hot pack and low-frequency electrical stimulation group (HEG), and thermo-massage group (TMG). Parameters were the pain numeric rating scale (PNRS), Oswestry Disability Index (ODI), Roland Morris Disability Questionnaire (RMDQ) and Relapse frequency (RF). PNRS, ODI and RMDQ of SEG and TMG sustained effectiveness, however, PNRS, which improved after treatment in HEG, worsened in 6 month. Between the groups, all parameters were better in SEG and TMG compare to HEG. Exercise and thermo-massage can be considered as useful self-management performed at home to prevent the relapse of chronic LBP.

키워드

참고문헌

  1. J. W. Frymoyer, M. H. Pope, J. H. Clements, D. G. Wilder, B. MacPherson, & T. Ashikaga (1983). Risk factors in low-back pain. An epidemiological survey. JBJS, 65(2), 213-218. DOI : 10.2106/00004623-198365020-00010
  2. J. L. Kelsey, & A. A. White 3rd (1980). Epidemiology and impact of low-back pain. Spine, 5(2), 133-142. DOI : 10.1097/00007632-198003000-00007
  3. G. B. Andersson (1999). Epidemiological features of chronic low-back pain. The lancet, 354(9178), 581-585. DOI : 10.1016/S0140-6736(99)01312-4
  4. T. S. Carey, J. M. Garrett, A. Jackman, N. Hadler & The North Carolina Back Pain Project. (1999). Recurrence and care seeking after acute back pain: results of a long-term follow-up study. Medical care, 157-164. DOI : 10.1097/00005650-199902000-00006
  5. L. H. Pengel R. D.Herbert, C. G. Maher & K. M. Refshauge (2003). Acute low back pain: systematic review of its prognosis. Bmj, 327(7410), 323. DOI : 10.1136/bmj.327.7410.323
  6. M. Von Korff (1994). Studying the natural history of back pain. Spine, 19(18 Suppl), 2041S-2046S. DOI : 10.1097/00007632-199409151-00005
  7. M. Bergquist-Ullman & U. Larsson (1977). Acute low back pain in industry: a controlled prospective study with special reference to therapy and confounding factors. Acta Orthopaedica Scandinavica, 48(sup170), 1-117. DOI : 10.3109/ort.1977.48.suppl-170.01
  8. A. Faas, A. W. Chavannes, J. T. M. Van Eijk, & J. W. Gubbels, (1993). A randomized, placebo-controlled trial of exercise therapy in patients with acute low back pain. Spine (Phila Pa 1976). 18(11), 1388-1395. https://doi.org/10.1097/00007632-199318110-00002
  9. W. S. Marras, S. A. Ferguson, D. Burr, P. Schabo & A. Maronitis (2007). Low back pain recurrence in occupational environments. Spine, 32(21), 2387-2397. DOI : 10.1097/BRS.0b013e3181557be9
  10. S. Snelgrove & C. Liossi (2013). Living with chronic low back pain: a metasynthesis of qualitative research. Chronic illness, 9(4), 283-301. DOI : 10.1177/1742395313476901
  11. M. W. van Tulder, B. W. Koes, J. F. Metsemakers, & L. M. Bouter (1998). Chronic low back pain in primary care: a prospective study on the management and course. Family Practice, 15(2), 126-132. DOI : 10.1093/fampra/15.2.126
  12. J. A. DeLeo, & B. A. Winkelstein, (2002). Physiology of chronic spinal pain syndromes: from animal models to biomechanics. Spine, 27(22), 2526-2537. DOI : 10.1097/00007632-200211150-00026
  13. S. H. Sanders, K. S. Rucker, K. O. Anderson, R. N. Harden, K. W. Jackson, P. J. Vicente, & R. M. Gallagher (1995). Clinical practice guidelines for chronic non-malignant pain syndrome patients. Journal of Back and Musculoskeletal Rehabilitation, 5(2), 115-120. DOI : 10.3233/BMR-1995-5204
  14. Chou, R., Qaseem, A., Snow, V., Casey, D., Cross Jr, J. T., Shekelle, P., & Owens, D. K. (2007). Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Annals of internal medicine, 147(7), 478-491. DOI : 10.7326/0003-4819-147-7-200710020-00006
  15. T. R. Stanton, J. Latimer, C. G. Maher & M. J. Hancock (2010). How do we define the condition 'recurrent low back pain'? A systematic review. European Spine Journal, 19(4), 533-539. DOI : 10.1007/s00586-009-1214-3
  16. H. C. De Vet, M. W. Heymans, K. M. Dunn, D. P. Pope, A. J. Van der Beek, G. J. Macfarlane & P. R. Croft (2002). Episodes of low back pain: a proposal for uniform definitions to be used in research. Spine, 27(21), 2409-2416. DOI : 10.1097/01.BRS.0000030307.34002.BE.
  17. G. A. Koumantakis, P. J. Watso & J. A. Oldham (2005). Supplementation of general endurance exercise with stabilisation training versus general exercise only: physiological and functional outcomes of a randomised controlled trial of patients with recurrent low back pain. Clinical biomechanics, 20(5), 474-482. DOI : 10.1016/j.clinbiomech.2004.12.006
  18. J. C. Fairbank, J. Couper, J. B. Davies & J. P. O’brien (1980). The Oswestry low back pain disability questionnaire. Physiotherapy, 66(8), 271-273.
  19. Roland M, Morris R (1983). A study of the natural history of back pain. Part 1: Development of a reliable and sensitive measure of disability in low-back pain. spine(Phila Pa 1976). 8(2), 141-144. DOI : 10.1097/00007632-198303000-00004
  20. F. Bonetti, S. Curti, S. Mattioli, R. Mugnai, C. Vanti, F. S. Violante & P. Pillastrini (2010). Effectiveness of a'Global Postural Reeducation'program for persistent low back pain: a non-randomized controlled trial. BMC Musculoskelet Disord., 16(11), 285. DOI : 10.1186/1471-2474-11-285
  21. P. W. Stratford & J. M. Binkley (2000). A comparison study of the back pain functional scale and Roland Morris Questionnaire. North American Orthopaedic Rehabilitation Research Network. The Journal of rheumatology, 27(8), 1928.
  22. V. M. Taylor, R. A. Deyo, D. C. Cherkin & W/ Kreuter (1994). Low back pain hospitalization. Recent United States trends and regional variations. Spine, 19(11), 1207-1212. DOI : 10.1097/00007632-199405310-00002
  23. S. Sahrmann, D. C. Azevedo & L. V. Dillen (2017). Diagnosis and treatment of movement system impairment syndromes. Brazilian journal of physical therapy, 21(6), 391-399. DOI : 10.1016/j.bjpt.2017.08.001
  24. H. O. Lee (2010). Activation of trunk muscles during stabilization exercises in four-point kneeling. The Journal of Korean Physical Therapy, 22(5), 33-38. DOI : 10.1016/j.bjpt.2017.08.001
  25. J. H. Sun (2005). The effect of yoga on adolescent flexibility. Kyungnam University (Doctoral dissertation, Dissertation of Master's Degree).
  26. S. Y. Kim (2010). Changes in cross-sectional area of lumbar muscle in patients with chronic back pain. The Journal of Korean Physical Therapy, 22(5), 39-47.
  27. J. F. Leheman, B. J. Delateur (1990). Therapeutic Heat and Cold 4th edition. Philadelphia : Lippincott Williams & Wilkins, 120-37.
  28. S. F. Nadler, D. J. Steiner, G. N. Erasala, D. A. Hengehold, R. T. Hinkle, M. B. Goodale & K. W. Weingand (2002). Continuous low-level heat wrap therapy provides more efficacy than Ibuprofen and acetaminophen for acute low back pain. Spine, 27(10), 1012-1017. DOI : 10.1097/00007632-200205150-00003
  29. M. Nordin & M. Campello (1999). Physical therapy: Exercises and the modalities: When, what and why?. Neurologic clinics, 17(1), 75-89. DOI : 10.1016/S0733-8619(05)70115-8
  30. S. M. Fishman, J. C. Ballantyne, J. P. Rathmel. (2010). Bonica's Management of Pain 4th edition. Philadelphia : Lippincott Williams & Wilkins, 1365-1374.
  31. S. Milne, V. Welch, L. Brosseau, M. Saginur, B. Shea, P. Tugwell & G. Wells (2001). Transcutaneous electrical nerve stimulation (TENS) for chronic low back pain. The Cochrane database of systematic reviews, (2), CD003008. DOI : 10.1002/14651858.CD003008
  32. R. A. Deyo, N. E. Walsh, D. C. Martin, L. S. Schoenfel & S. Ramamurthy (1990). A controlled trial of transcutaneous electrical nerve stimulation (TENS) and exercise for chronic low back pain. New England Journal of Medicine, 322(23), 1627-1634. DOI : 10.1056/NEJM199006073222303
  33. D. C. Cherkin, D. Eisenberg, K. J. Sherman, W. Barlow, T. J. Kaptchuk, J. Street & R. A. Deyo (2001). Randomized trial comparing traditional Chinese medical acupuncture, therapeutic massage, and self-care education for chronic low back pain. Archives of internal medicine, 161(8), 1081-1088. DOI : 10.1001/archinte.161.8.1081
  34. M. Preyde (2000). Effectiveness of massage therapy for subacute low-back pain: a randomized controlled trial. CMAJ, 162(13), 1815-1820.
  35. D. C. Cherkin, K. J. Sherman, R. A. Deyo, & P. G. Shekelle (2003). A review of the evidence for the effectiveness, safety, and cost of acupuncture, massage therapy, and spinal manipulation for back pain. Annals of internal medicine, 138(11), 898-906. DOI : 10.7326/0003-4819-138-11-200306030-00011
  36. M. van Tulder, A. Malmivaara, R. Esmail & B. Koes (2000). Exercise therapy for low back pain: a systematic review within the framework of the cochrane collaboration back review group. Spine, 25(21), 2784-2796. DOI : 10.1097/00007632-200011010-00011
  37. H. Frost S. E. Lamb, J. K. Moffett, J. C. T. Fairbank & J. S. Moser (1998). A fitness programme for patients with chronic low back pain: 2-year follow-up of a randomised controlled trial. Pain, 75(2-3), 273-279. DOI : 10.1016/s0304-3959(98)00005-0
  38. R. Chou, A. Qaseem, V. Snow, D. Casey, J. T. Cross Jr, P. Shekelle & D. K. Owens (2007). Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Annals of internal medicine, 147(7), 478-491. DOI : 10.7326/0003-4819-147-7-200710020-00006
  39. C. A. Richardson, C. J. Snijders, J. A. Hides, L. Damen, M. S. Pas & J. Storm (2002). The relation between the transversus abdominis muscles, sacroiliac joint mechanics, and low back pain. Spine, 27(4), 399-405. DOI : 10.1097/00007632-200202150-00015
  40. P. B. O’Sullivan, A. Burnett, A. N. Floyd, K. Gadsdon, J. Logiudice, D. Miller & H. Quirke (2003). Lumbar repositioning deficit in a specific low back pain population. Spine, 28(10), 1074-1079. DOI : 10.1097/01.BRS.0000061990.56113.6F