Man FT Pada LBP

Manajemen Fisioterapi
Pada Low Back Pain

Dengan Evidence-Based Practice
Wahyuddin, Ftr, M.Sc, Ph.D
Outline
• Pendahuluan
• Diagnosis
• Prognosis
• Intervensi
• Outcome
• CPG
2

3
4
5
Pendahuluan
• LBP: nyeri (radikuler/non radikuler pada 1 atau 2

tungkai) selama paling tidak 1 hari
• Anatomi: “low back” aspek posterior dari lower

margin 12th ribs-gluteal folds
Jacek Cholewicki, Alan Breen, John M. Popovich, Peter Reeves, Shirley A. Sahrmann, Linda R Van Dillen, Andry Vleeming, Paul W Hodges 2019
7
Pendahuluan
• Penyebab spesi k sulit diidenti kasi
• Prevalensi > non-speci c low back pain (NS-

LBP)
• De sit proprioceptive: sense of effort pada

CLBP (Michel W. Coppieters, Jesper Andersen, Håvard Selbæk, Kjell Herland, Rahma Ajja,
Harald Markussen, Paul W. Hodges 2021)
8
fi

fi
fi
fi

Michel W. Coppieters, Jesper Andersen, Håvard Selbæk, Kjell Herland, Rahma Ajja, Harald Markussen, Paul W. Hodges 2021
9
10
Mamata Tamrakar, Priti Kharel, Adrian Traeger, Chris Maher,
11 Mary O'Keeffe,Giovanni Ferreira 2021

Lancet 2020
12
Alarcos Cieza, Kate Causey, Kaloyan Kamenov,
13 Sarah Wulf Hanson, Somnath Chatterji, Theo Vos
Lancet 2020


Lancet 2020


Lancet 2020

16
17
18
\
Hiroki Saito, Yoshiteru Watanabe, Toshiki Kutsuna, Toshihiro Futohashi, Yasuaki Kusumoto, Hiroki Chiba, Masayoshi Kubo, Hiroshi Takasaki 2020
19
\
20
\
21
\
22
Reference standard:
uoroscopically guided
intra-articularinjection of
local anesthetic
23
fl
24Laslett
Mark
Mark Laslett
25
SIJ CPR
• Three or more provocation tests provoke the

usual pain
• Centralization of pain is not achieved during a

McKenzie evaluation of repeated movements/
sustained positions
Mark Laslett
26

27
28
Viktoria E Wilde, Jon J Ford, Joan M McMeeken 2007
29
30
31
Diagnosis
Brinjikji W, Luetmer PH, Comstock B, etal. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations 2015
32
Diagnostic
Triage
Traeger A, Buchbinder R, Harris I, Maher C. 2017

33
Decision
aid
Amanda M Hall, Kris Aubrey-Bassler, Kris Aubrey-

34 Bassler, Maher C. 2017
Jenkins HJ, Moloney NA, French SD, et al 2018

35
36
37
J.B. Staal, E.J.M. Hendriks, M. Heijmans, H. Kiers, A.M. Lutgers-Boomsma, G. Rutten, M.W. van Tulder, J. den Boer, R. Ostelo,J.W.H. Custers 2013
38
https://dita.org.au
39
Prognosis
• Perbaikan mayoritas acute & subacute NS-LBP

6 mgg
• 2/3 masih mengalami LBP pada 3 & 12 bulan
Deyo RA, Weinstein JN 200

da C Menezes Costa L, Maher CG, Hancock MJ, et al. 2012
40

Exercise
• Mekanisme via peningkatan PPT
• Reguler exercise —> adaptasi central inhibition
Daniel L. Belavy et al 2021

41

42
Daniel L. Belavy et al 2021
Daniel L.43
Belavy et al 2021
Sciatica (Diagnosis)
• Leg pain > back pain
• Gejala sampai di bawah knee
• Parasthesia in line dengan area dermatom
• Kelemahan & perubahan re eks pada area

myotom
• Peningkatan leg pain: coughing, sneezing &/

taking a deep breath
Raymond WJG Ostelo 2020
44

fl

Sciatica (Exercise)
• Danish guidelines: supervised
exercise (motor control
exercise, nerve mobilisation,
strength exercises) (Stochkendahl MJ,
Kjaer P, Hartvigsen J, Kongsted A, Aaboe J, Andersen M, et al.
2018)
• Pertimbangan lain: pasien

lebih membutuhkan supervisi
• Level kinesiphobia yang Alice Kongstead et al 2020
tinggi (Schaafstra M, Spinnewijn W, Bons S, Borg M,

Koes B, Ostelo R, et al. 2015)
45
Sciatica (MT)
• Mobilisation: low-grade
velocity, small/large
amplitude passive
movement techniques
• Manipulation: high-velocity
impulse/thrust applied
• Secara umum: efek SMT

kecil & short-term
46

Sciatica (Post Op)

• Akselerasi ke ADL/work & pencegahan simptom
kronis
• Recovery rates post conventional

microdiscectomy: 66% (4 mgg) & 75% (8 mgg)
(Arts MP, Brand R, van den Akker ME, Koes BW, Bartels RHMA, Peul WC, et al. 2009)
• Return to work 15% (2 bln) (Rasmussen S, Krum-Møller DS, Lauridsen

LR, Jensen SEH, Mandøe H, Gerlif C, et al. 2008)
47

Sciatica (Post Op)
• 77% post conventional microdiscectomy (2 thn):

good recovery
• SR dari 39 cohort studies (N=13,883): level

moderat pain & disability (5-year follow-up) —>
mean pain score 21 skala 0-100 (95% CI 13 to
30) & mean disability score 13 (95% CI 11 to 16)
(Machado GC, Witzleb AJ, Fritsch C, Maher CG, Ferreira PH, Ferreira ML. 2016)
48

Sciatica (Post-Op)
49
Sciatica (Kajian Lanjut)
• 77% post conventional microdiscectomy (2 thn):

good recovery
• SR dari 39 cohort studies (N=13,883): level

moderat pain & disability (5-year follow-up) —>
mean pain score 21 skala 0-100 (95% CI 13 to
30) & mean disability score 13 (95% CI 11 to 16)
(Machado GC, Witzleb AJ, Fritsch C, Maher CG, Ferreira PH, Ferreira ML. 2016)
50

51
52
Silvia Gianola, Silvia Bargeri , Gabriele Del Castillo, Davide Corbetta
Andrea Turolla, Anita Andreano, Lorenzo Moja, Greta Castellini 2021
53
,

54
,

55
,
56
Witold Golonka, Christoph Raschka, Vahid M. Harandi, Bruno Domokos,
Håkan Alfredson, FlorianMaria Alfen, Christoph Spang 2021
57

58
Linda R. van Dillen, Vanessa M. Lanier, Karen Steger-May, Michael Wallendorf, Barbara J. Norton,
Jesse M. Civello, Sylvia L. Czuppon, Sara J. Francois, Kristen Roles, Catherine E. Lang 2021
59

60
Sidney M Rubinstein, Annemarie de Zoete, Marienke van Middelkoop,
Willem J J Assendelft,Michiel R de Boer, Maurits W van Tulder1 2019
61


62


63

64
Carolina Lavazza , Margherita Galli, Alessandra Abenavoli, Alberto Maggiani 2021
65
66
1. Manual Therapy has No Unique Speci c Effects
2. Use of Manual Therapy Leads to Patient Reliance

and Dependency and Subsequent low Self-
Ef cacy
3. Manual Therapy provides only Short-Term

Changes, which do Not Equate to Long-Term
Changes
4. Manual Therapy Techniques are based on

Outdated, Inappropriate Philosophies that were
derived to Support a Guru’s Theories
67
fi

fi

5. Manual Therapists lack Skills in

Communication, Reassurance, and Empathy
6. Manual Therapy does not t within Value-Based

Care
7. Manual Therapy Causes as Much Harm as

Help
8. We Can’t Identify Candidates for Manual

Therapy, which Means the Techniques are
Unnecessary
68
fi

IFOMPT 2016
69
Chad E. Cook 2021
70
Geri T, Viceconti A, Minacci M et al.t 2019
71
72
Self-Management
73 et al 2021
Alice Kongstead
74 et al 2021
Alice Kongstead
75 et al 2021
Alice Kongstead
76 et al 2021
Alice Kongstead
77 et al 2021
Alice Kongstead
78
Guillaume Christe, Jessica Nzamba, Ludovic Desarzens, Arnaud Leuba, Ben Darlow, Claude Pichonnaz 2021
79
80
81
Eva Rasmussen-Barr, Cecilia Lindqvist, Sara ¨Osthols, Carina Bostr¨om 2021
82
Outcome
www.sralab.org
83
84
Tarcisio F de Campos ,Chris G Maher
Joel T Fuller ,Daniel Steffens ,Stephanie
Attwell, Mark J Hancock 2019
85
Attwell, Mark J Hancock 2019
86
87 Attwell, Mark J Hancock 2019
88
Nic Saraceni, Amity Campbell, Peter Kent,
Leo Ng, Leon Straker, Peter O’Sullivan 2021
89
Nic Saraceni, Amity Campbell, Peter Kent,
Leo Ng, Leon Straker, Peter O’Sullivan 2021
90
David G Magee 2020
91
92
93
Reni M. A. van Erp, Ivan P. J. Huijnen, Antonius W. Ambergen,
Jeanine A.Verbunt & Rob J. E. M. Smeets 2021
94

95
96
97
Karime Mescouto , Rebecca E. Olson , Paul W. Hodges & Jenny Setchell 2020
98
99
100
101
102
103
104
105
106
107
108
109
Nadia Corp, Gemma Mansell,, Siobhán Stynes, Gwenllian Wynne-Jones,
Lars Morsø4,Jonathan C. Hill,, Danielle A. van der Windt 2020
110

Nadia Corp, Gemma Mansell,, Siobhán Stynes, Gwenllian Wynne-Jones,

Lars Morsø4,Jonathan C. Hill,, Danielle A. van der Windt 2020
111

217 hal
112
113
114
115
Te ma Kasih
116
ri

Man FT Pada LBP

Uploaded by

Document Information

Original Description:

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Man FT Pada LBP

Uploaded by

Copyright:

Available Formats

Manajemen Fisioterapi

Pada Low Back Pain

Wahyuddin, Ftr, M.Sc, Ph.D

• LBP: nyeri (radikuler/non radikuler pada 1 atau 2

• Anatomi: “low back” aspek posterior dari lower

• Penyebab spesi k sulit diidenti kasi

• Prevalensi > non-speci c low back pain (NS-

• De sit proprioceptive: sense of effort pada

Alarcos Cieza, Kate Causey, Kaloyan Kamenov,

Alarcos Cieza, Kate Causey, Kaloyan Kamenov,

• Three or more provocation tests provoke the

• Centralization of pain is not achieved during a

Traeger A, Buchbinder R, Harris I, Maher C. 2017

Amanda M Hall, Kris Aubrey-Bassler, Kris Aubrey-

Jenkins HJ, Moloney NA, French SD, et al 2018

• Perbaikan mayoritas acute & subacute NS-LBP

• 2/3 masih mengalami LBP pada 3 & 12 bulan

Deyo RA, Weinstein JN 200

• Mekanisme via peningkatan PPT

• Reguler exercise —> adaptasi central inhibition

Daniel L. Belavy et al 2021

• Gejala sampai di bawah knee

• Parasthesia in line dengan area dermatom

• Kelemahan & perubahan re eks pada area

• Peningkatan leg pain: coughing, sneezing &/

• Pertimbangan lain: pasien

• Level kinesiphobia yang Alice Kongstead et al 2020

tinggi (Schaafstra M, Spinnewijn W, Bons S, Borg M,

• Secara umum: efek SMT

Sciatica (Post Op)

• Recovery rates post conventional

• Return to work 15% (2 bln) (Rasmussen S, Krum-Møller DS, Lauridsen

Sciatica (Post Op)

• 77% post conventional microdiscectomy (2 thn):

• SR dari 39 cohort studies (N=13,883): level

• 77% post conventional microdiscectomy (2 thn):

• SR dari 39 cohort studies (N=13,883): level

Silvia Gianola, Silvia Bargeri , Gabriele Del Castillo, Davide Corbetta

Silvia Gianola, Silvia Bargeri , Gabriele Del Castillo, Davide Corbetta

Sidney M Rubinstein, Annemarie de Zoete, Marienke van Middelkoop,

Sidney M Rubinstein, Annemarie de Zoete, Marienke van Middelkoop,

2. Use of Manual Therapy Leads to Patient Reliance

3. Manual Therapy provides only Short-Term

4. Manual Therapy Techniques are based on

5. Manual Therapists lack Skills in

6. Manual Therapy does not t within Value-Based

7. Manual Therapy Causes as Much Harm as

8. We Can’t Identify Candidates for Manual

Nadia Corp, Gemma Mansell,, Siobhán Stynes, Gwenllian Wynne-Jones,

You might also like