ABSTRACT. Original Articles /

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1 Original Articles / 2553; 2(2): J Thai Rehabil Med 21; 2(2): ก ก ก..*, ก ก..,.. *,..,.. **,..,.. * * ก ** ก ABSTRACT Effectiveness of Lumbar Traction in Patients with Lumbar Spondylosis Luanjamroen N*, Kitisomprayoonkul W*, Sukonthamarn K**, Chaiwanichsiri D* *Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. **Thai Red Cross Rehabilitation Center, Samutprakarn, Thailand. Objectives: To assess an effect of lumbar traction on pain reduction and functional activities in patients with lumbar spondylosis with or without spondylolisthesis. Study design: Experimental study Setting: Department of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital Subjects: Patients with lumbar spondylosis with/without spondylolisthesis who had onset of back pain less than 6 weeks. Methods: Patients were divided into two treatment groups by purpose. Both groups were received rehabilitation program including proper posture, rest, back exercise, hot pack and muscle relaxants for 2 weeks. The experimental group additionally received lumbar traction for 1 days during this period. Visual analog scale (VAS), percent improvement (PI), Waddell Disability Index (WDI) and Roland-Morris Disability Questionnaire (RMQ) were evaluated before and after 2 weeks treatment. Results: Twenty seven patients were participated in this study. Eighteen were in experimental group and the rest were in the control group. Both groups had similar demographic data. After treatment, VAS were significantly decreased in the experimental group when compared with the control group ( VAS = and.55 respectively, Corresponding to: Dr.Wasuwat Kitisomprayoonkul. Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, wkitisom@yahoo.co.th p <.5). The PI of the experimental and the control groups were 45% and 29%, respectively with no significant difference (p >.5). The WDI and the RMQ scores were improved in the experimental group (WDI increased.2, RMQ deceased 1.33) and worse in the control group (WDI decreased.22, RMQ increased.55) with no significant difference (p >.5). Conclusion: Lumbar traction showed effect on pain reduction in patients who had lumbar spondylosis with or without spondylolisthesis with acute and moderately severe low back pain. The functional activities also showed trend of improvement. Keywords: Lumbar spondylosis, lumbar spondylolisthesis, lumbar traction, back pain, rehabilitation J Thai Rehabil Med 21; 2(2): : ก ก ก ก ก ก ก / ก ก ก : ก ก ก ก : ก ก ก : ก ก ก ก / ก ก ก 6 ก ก : 2 ก 2 ก ก ก ก ก กก ก ก 2 ก ก 1 visual analog scale (VAS), percent improvement (PI), Waddell Disability Index (WDI) Roland-Morris Disability Questionnaire (RMQ) 2 ก ; 2(2)

2 ก ก : ก ก 27 ก 18 ก 9 2 ก ก ก 2 ก กก ก (VAS ก ) (p <.5) ก PI 45 ก 29 WDI ก.2 ก.22 RMQ ก 1.33 ก.55 PI, WDI RMQ 2 ก ก ก (p >.5) : ก ก ก ก ก ก ก ก ก ก : ก ก, ก ก, ก,, ก 2553; 2(2): ก ก ก ก ก ก ก ก ก ก ก ก ก ก (1,2) ก ก (lumbar pelvic traction) ก ก ก ก ก ก ก ก ก ก ก ก ก ก ก ก (2,3) ก ก (4,5,6) ก ก ก ก ก ก ก ก ก ก ก (7,8) ก ก ก ก ก ก ก (9) ก ก ก ก ก ก ก ก ก ก ก placebo (1,11,12) ก ก ก ก ก ก ก ก ก ก ก interferential therapy (13) J Thai Rehabil Med 21; 2(2) กก ก ก ก ก ก ก (ultrasound) ก ก ก ก ก ก ก (14) ก ก ก ก (nonspecific low back pain) ก ก (< 6 ) กก ก (6-3 ) ก (> 3 ) (7) ก ก ก ก ก ก ก ก ก ก ก ก (nonsteroidal anti-inflammatory drugs, NSAIDs) ก ก ก กก ก ก (15) ก ก ก ก ก ก ก ก ก กก ก ก ก ก ก ก ก ก ก ก ก ก ก ก ก ก ก ก ก ก ก ก ก ก ก ก ก ก ก ก ก ก ก ก ก ก ก - ก ก ก ก ก ก ก ก ก ก ก (lumbar spondylosis) ก ก (lumbar spondylolisthesis) ก ก ก ก ก ก ก ก - ก ก 6 - ก (radicular pain) ก - ก ก ก ก ก 1-2

3 ก ก ก - ก ก ก - ก neurological claudication ก ก (spinal stenosis) - ก ก 3-5 ก ก (instability) ก - ก ก ก peripheral neuropathy, nerve entrapment - ก ก ก ก ก ก ก ก - ก ก ก ก ก ก ก - ก ก 7 - ก ก ก ก ก - ก (case record form) ก 1) ก ก ก ก 2) visual analog scale (VAS) of pain 3) Waddell Disability Index (WDI) 16 Roland-Morris Disability Questionnaire (RMQ) 16 5) Percent improvement - motorized traction with split-table BJC Triton M.P.1 ก - ก ก ก ก ก ก ก ก VAS ก, ก ก (activities of daily living) WDI RMQ - ก ก 2 ก ก ก ก (ก ) ก ก (ก ) ก ก ก ก ก ก ก ก ก ก ก ก ก ก (muscle relaxant) ก ก NSAIDs, opioid steroid - ก ก ก 1 ก (2 ) parameter intermittent traction ; hold : release (2 : 1 ), ก (flex) 3 ก ก ก 45 ก ก, ก 5 ก 3 - ก ก 2 2 ก ก ก VAS, WDI RMQ ก ก ก ก (percent improvement) ก ก ก ก ก ก ก ก - - ก ก Unpaired t-test Chi-square test - VAS ก, WDI RMQ ก ก ก - ก Wilcoxson sign rank test ก ก ก ก Mann-Whitney U test - ก ก SPSS version 1. ก p <.5 ก ก ก 3 ก ก 2 ก ( 12.85) ( ) ก กก ก ก ก ก 3 กก 2 ก 1 ก ก ก ก 7 27 ก 18 ก 9 2 ก ก ก ก ก ก VAS, WDI RMQ ก ก ก 2 ก ก ก (P >.5) ; 2(2)

4 ก (n=18) ก (n=9), ( ) 54.2 (12.74) 56.6 (13.48) ( : ) 4:14 3:6 ก, กก. ( ) 63.9 (17.56) 58. (7.31),. ( ) (8.75) (5.38) ก (spondylosis:spondylolisthesis) 15:3 7:2 ก ก ก ( : ) 7:11 4:5 VAS,. ( ) (19.78) (24.88) WDI ( ) 5.78 (1.55) 5.11 (1.61) RMQ ( ) 1.28 (4.73) 11. (6.8) 1 ก (traction) ก (non-traction) (VAS = visual analog scale, WDI = Waddell disability index, RMQ = Roland-Morris disability Questionnaire) ก ก ก 2 ก VAS ก (p <.5) WDI RMQ ( ก ก ) คะแนน คะแนน ก (traction group) ก (non-traction group) 1 visual analog scale (VAS), Waddell disability index (WDI) Roland-Morris disability questionnaire (RMQ) ก - ก ก ก (* p <.5) J Thai Rehabil Med 21; 2(2) WDI VAS RMQ * ก (p >.5) ก VAS, WDI RMQ ก 2 ก VAS, WDI RMQ 1 ก VAS ก 2 VAS ก ก.55 ก ก (p <.5) ก WDI RMQ ก ก ก ก ก ก ก ก (p >.5) ก ก 45 ก ก ก ก ก 29 ก (p >.5) ก กก ก ก ก 2 ก ก ก ก 2 ก ก ก ก ก ก ก ก ก VAS 2 กก ก ก กก ก ก ก ก ก ก (joints mobilization) ก กก ก ก ก ก ก WDI RMQ ก ก ก ก ก ก ก

5 ก ก ceiling effect ก ก ก ก ก ก ก ก ก ก ก ก ก ก ก ก ก ก ก ก (3) กก ก ก ก ก (< 6 ) ก (6-3 ) ก (> 3 ) (7) ก ก ก ก ก ก ก ก ก ก (acute disc herniation) (15) ก ก ก ก กก ก ก ก ก ก ก กก ก ก ก ก ก ก ก กก ก ก ก ก ก ก ก ก ก ก ก ก ก ก ก ก 2 ก ก ก ก ก ก ก ก ก ก ก ก ก ก ก ก ก ก ก ก ก ก ก ก ก ก ก ก ก ก ก ก ก 2 ก ก ก ก / ก ก ก ก. ก 1. Mannion AF, Müntener M, Taimela S, Dvorak J. Comparison of three active therapies for chronic low back pain: results of a randomized clinical trial with one year follow-up. Rheumatology 21; 4: Van Tulder MW, Koes BW, Boster LM. Conservative treatment of acute and chronic nonspecific low back pain: a systematic review of randomized controlled trials of the most common intervention. Spine 1997; 22: Clarke JA, van Tulder MW, Blomberg SE, de Vet HC, van der Heijden GJ, Bronfort G, et al. Traction for low-back pain with or without sciatica. Cochrane Database of Systematic Reviews 27; 18: CD Beurskens AJ, de Vet HC, Koke AJ, Lindeman E, Regton W, van der Heijden GJ, et al. Efficacy of traction for non-specific low back pain: a randomized clinical trial. Lancet 1995; 346: Revel M: Does traction still have a role in non-specific low back disorders. Joint Bone Spine 2; 67: Hansen FR, Bendix T, Skov P, Jensen CV, Kristanse JH, Krohn L, et al. Intensive dynamic back muscle exercises, conventional physiotherapy or placebo control treatment of low back pain. Spine 1993; 18: Krause M, Refshauge KM, Dessen M, Boland R. Lumbar spine traction, evaluation of effects and recommended application for treatment. Man Ther 2; 5: Tekeoglu I, Adak B, Bozkurt M, Gurbuzoglu N. Distraction of lumbar vertebrae in gravitational traction. Spine 1998; 23: Lee RY, Evans JH. Loads in the lumbar spine during traction therapy. Aust J Physiother 21; 47: Beurskens AJ, van der Heijden GJ, De Vet HC, Koke AJ, Lindeman E, Regtop W, et al. The efficacy of traction for lumbar back pain: design of a randomized clinical trial. J Manipulative Physiol Ther 1995; 18: Beurskens AJ, de Vet HC, Koke AJ, Regton W, van der Heijden GJ, Lindeman E, et al. Efficacy of traction for non-specific low back pain.12-week and 6-month results of a randomized clinical trial. Spine 1997; 22: Reust P, Chantraine A, Vischer TL. Treatment of lumbar sciatica with or without neurological deficit using mechanical traction: a double-blind study. Schweiz Med Wochenschr 1988; 118: (Abstract). 13. Werners R, Pynsent PB, Bulstrode CJ. Randomized trial comparing interferential therapy with motorized lumbar traction and massage in the management of low back pain in a primary care setting. Spine 1999; 24: Borman P, Keskin D, Bodur H. The efficacy of lumbar traction in the management of patients with low back pain. Rheumato Int 22; 23: Rattanatharn R, Sanjaroensuttikul N, Anadirekkul P, Chaivisate R, Wannasetta W. Effectiveness of lumbar traction with routine conservative treatment in acute herniated disc syndrome. J Med Assoc Thai 24; 87(Suppl 2): S Pensri P, Baxter G, McDonough S. Reliability and internal consistency of Thai version of Roland-Morris Disability Questionnaire and Waddell Disability Index for back pain patients. Chula Med J 25; 49: ; 2(2)