Lumbar stabilizing exercises improve activities of daily living in patients with lumbar disc herniation

Appraisers: Ms. Zoila Celestine P. Dayao, Jeffrey Arboleda, Giana Mae Balbuena, Jessica Francine Limjap, Janine Marie Recamara Appraisal Date: Review Date: Clinical Scenario: A.B. is a 40-year old female with low back pain (LBP) secondary to herniated nucleus pulposus (HNP) of L5, S1 and S2 vertebrae. She has been undergoing physical therapy since 2010; however, she still experiences intermittent shooting pain on her right buttock area during abrupt twisting of torso, carrying heavy loads, forward bending, and prolonged sitting, standing and walking (>1 hour). Consequently, she has difficulty in performing her roles as a homemaker and primary caregiver to her 4-year old daughter with special needs. Her main concern is to minimize the pain during prolonged standing, sitting and walking. Upon assessment, she reported radiating pain on her right buttock area during passive trunk flexion and shooting pain on low back region and down the leg at 45 degrees of hip flexion during the Straight Leg Raise test. Core strengthening exercises, which are prevalent intervention for patients with LBP, are currently used as one of her physical therapy management to develop muscular control around the lumbar spine to maintain functional stability. However, their effectiveness is questioned due to their minimal effects on A.B. The team also deems to consolidate specific protocols in administering these exercises to ensure the effectiveness of this treatment. Clinical Question: Patient: Intervention: Comparison intervention: Outcomes: Clinical Bottom Line: Evidence suggests that LSE protocol is effective. The team decided to continue with the treatment because the study shows that all the outcome measures, including pain, favored the LSE protocol. Moreover, the exercise can be improved given that the specific protocol provided in the study with specific dosimetry is followed.

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. no significant difference was seen between the two groups at the end of the study  Time of 10 meter walking improved by 39. & Rezasoltani.001) at the end of the first four week period.Four week LSE protocol. followed by a four week no-exercise period Exercise group B – Four week no-exercise period. followed by a four week LSE protocol      Pain perception Range of trunk flexion Measure of SLR angle without pain Time required to complete ADL tasks Pain was significantly reduced at the end of the first four week period (p < 0.03).3% (p = 0.03). patients in group A performed significantly faster when laying prone from standing position by 52. A.0001). same results was seen in group B at the end of the study  Measures of SLR angle without pain significantly increased by 80% in the left side (p = 0.004) in group A.02) and when standing from the laying prone position by 55.1% (p = 0.003) and 60% in the right side (p = 0..4%) in group A (p < 0. same results were seen in group B at the end of the study. Safavi-Farokhi.4% (p = 0. A. 2005) Randomized Controlled Trial  History of LBP  Sciatic pain  Reduced functional performance due to the L4-L5 or L5-S1 disc herniation for more than 2 months Sixty patients with clinically diagnosed herniated lumbar disc at L4-L5. or L5-S1 level participated in this study and were divided into two groups:  Exercise group A – 27 participants (three were lost to follow up)  Exercise group B – 25 participants (five were lost to follow up) Inclusion Criteria Sample Intervention Exercise group A . Z. H.007) and climbing stairs by 48.7% (p = 0. compared to group B at the end of the first four week period.. no significant difference between the two groups was seen at the second four week period Outcome Measures Results/ Outcomes . no significant difference was seen at the end of the study  Range of trunk flexion increased significantly (56.Summary of Study: Study Methodology Design (Bakhtiary.

Our patient meets the Weaknesses Blinding of the therapists and participants were not performed. Computer generated randomization list drawn up by the statistician was used to ensure thorough randomization of the participants. Internal Validity          Results    There was no power calculation mentioned. There was an inadequate follow-up of those who dropped out of the study. A physiotherapist regularly inspected the compliance of the patients and the quality of the home exercises performed to guarantee accuracy.   Applicability  The small sample population of . The two groups were similar in their baseline measurements. The researchers established a 95% CI and a p-value of <0. Intention to treat analysis was used to interpret data. The assessors were different from the staff who administered the LSE protocols.05. The study has both point measures and measures of variability. The researchers reported between-group statistical comparisons on all outcome measures.Comments: Strengths Randomized controlled trial (RCT) was used to reduce the effects of confounding variables such as natural recovery. Sealed envelopes were used to ensure concealed allocation.

 the study might be underpowered.  The study could be implemented in local settings due to its simple administration.stringent selection criteria specified. Citations: Appendix: . Specific instructions of the LSE protocols were not mentioned.

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