Aquatic exercise superior to physical therapy in relieving chronic lower back pain
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Therapeutic aquatic exercise results in greater lower back pain relief than physical therapy, and demonstrates long-term effects for up to 12 months, according to data published in JAMA Network Open.
“Among the numerous therapeutic exercises available, therapeutic aquatic exercise is often prescribed by physicians for chronic low back pain, and it is becoming increasingly popular for treatment of chronic low back pain,” Meng-Si Peng, MSc, of the Shanghai University of Sport, in China, and colleagues wrote. “Water is an ideal environment for conducting an exercise program given its various properties, including buoyancy pressure, density, thermal capacity and conductivity.
“Two systematic reviews suggested that therapeutic aquatic exercise can reduce pain intensity and improve function in patients with chronic low back pain,” they added. “However, to our knowledge, evidence of the long-term benefits of therapeutic aquatic exercise in patients with chronic low back pain does not exist, and no study has compared the efficacy of therapeutic aquatic exercise and physical therapy modalities for chronic low back pain.”
To analyze the long-term impacts of therapeutic aquatic exercise among patients with chronic lower back pain, Peng and colleagues conducted a 3-month, single-blind, randomized clinical trial with a 12-month follow-up period. A total of 113 patients with chronic lower back pain were randomly assigned 1:1 to receive either aquatic exercise or physical therapy. In the physical therapy group, participants received transcutaneous electrical nerve stimulation and infrared ray thermal therapy. Interventions in both groups were performed for 60 minutes twice per week for 3 months.
The primary outcome was disability level, measured using the Roland-Morris Disability Questionnaire and a score range of zero to 24, with higher scores indicating more severe disability. Secondary outcomes included pain intensity, quality of life, sleep quality, recommendation of intervention and minimal clinically important difference. The researchers additionally performed intention-to-treat and per-protocol analyses. The study was conducted from Sept. 10, 2018, to March 12, 2019, with the follow-up period ending on March 17, 2020.
A total of 98 participants completed the 12-month follow-up.
According to the researchers, patients who performed therapeutic aquatic exercise demonstrated greater disability relief, with adjusted mean group differences of –1.77 (95% CI, –3.02 to –0.51) after the 3-month intervention, –2.42 (95% CI, –4.13 to –0.7) at 6 months of follow-up, and –3.61 (95% CI, –5.63 to –1.58) at 12 months (P<.001 for overall group×time interaction).
In addition, improvements at 12-month follow-up were significantly greater in the aquatic exercise group, compared with those who received physical therapy, in terms of the number of participants who met the minimal clinically important difference in pain — at least a 2-point improvement on the numeric rating scale — with 30 (53.57%) versus 12 (21.05%) for most severe pain, respectively, 14 (25%) versus 11 (19.3%) for average pain, and 22 (39.29%) versus 10 (17.54%) for current pain.
Improvements at 12-month follow-up were also significantly greater in the aquatic exercise group, compared with physical therapy, in the number of participants who met the minimal clinically important difference in disability — at least a 5-point improvement on the Roland-Morris Disability Questionnaire — with 26 (46.43%) versus four (7.02%), respectively.
Lastly, 1.8% of participants in the aquatic exercise group experienced lower back pain and other pains related to the intervention, compared with 3.5% of those who received physical therapy modalities.
“In this randomized clinical trial, patients with chronic low back pain who received therapeutic aquatic exercise showed greater improvement in terms of function, pain, quality of life, sleep quality and mental state than those who underwent physical therapy modalities,” Peng and colleagues wrote. “Therapeutic aquatic exercise is a safe treatment for chronic low back pain and most participants who received it were willing to recommend it to other patients with chronic lower back pain.”
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