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A pilot study examining the effectiveness of physical therapy as an adjunct to selective nerve root block in the treatment of lumbar radicular pain from disk herniation: a randomized controlled trial

BACKGROUND: Therapeutic selective nerve root blocks (SNRBs) are a common intervention for patients with sciatica. Patients often are referred to physical therapy after SNRBs, although the effectiveness of this intervention sequence has not been investigated. OBJECTIVE: This study was a preliminary investigation of the effectiveness of SNRBs, with or without subsequent physical therapy, in people with low back pain and sciatica. DESIGN: This investigation was a pilot randomized controlled clinical trial. SETTING: The settings were spine specialty and physical therapy clinics. PARTICIPANTS: Forty-four participants (64% men; mean age=38.5 years, SD=11.6 years) with low back pain, with clinical and imaging findings consistent with lumbar disk herniation, and scheduled to receive SNRBs participated in the study. They were randomly assigned to receive either 4 weeks of physical therapy (SNRB+PT group) or no physical therapy (SNRB alone [SNRB group]) after the injections. INTERVENTION: All participants received at least 1 SNRB; 28 participants (64%) received multiple injections. Participants in the SNRB+PT group attended an average of 6.0 physical therapy sessions over an average of 23.9 days. MEASUREMENTS: Outcomes were assessed at baseline, 8 weeks, and 6 months with the Low Back Pain Disability Questionnaire, a numeric pain rating scale, and the Global Rating of Change. RESULTS: Significant reductions in pain and disability occurred over time in both groups, with no differences between groups at either follow-up for any outcome. Nine participants (5 in the SNRB group and 4 in the SNRB+PT group) underwent surgery during the follow-up period. LIMITATIONS: The limitations of this study were a relatively short-term follow-up period and a small sample size. CONCLUSIONS: A physical therapy intervention after SNRBs did not result in additional reductions in pain and disability or perceived improvements in participants with low back pain and sciatica

Keywords : Adult,Back Pain,Chi-Square Distribution,complications,Disability Evaluation,etiology,Female,Humans,Injections,innervation,Intervertebral Disc Displacement,Low Back Pain,Lumbar Vertebrae,Male,methods,Nerve Block,Pain,Pain Measurement,Physical Therapy Modalities,Pilot Projects,Radiculopathy,rehabilitation,Sample Size,Sciatica,Spinal Nerve Roots,Spine,Statistics,Nonparametric,surgery,therapy,Treatment Outcome,, Pilot,Study,Examining,Effectiveness, massage back pain marylebone

Date of Publication : 2010 Dec

Authors : Thackeray A;Fritz JM;Brennan GP;Zaman FM;Willick SE;

Organisation : Department of Physical Therapy, University of Utah, 520 Wakara Way, Salt Lake City, UT 84108, USA. a.thackeray@utah.edu

Journal of Publication : Phys Ther

Pubmed Link : https://www.ncbi.nlm.nih.gov/pubmed/20864600

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