Tratamiento del dolor lumbar crónico inespecífico mediante ejercicio terapéutico y telemedicina

Resumo

Introduction. Chronic low back pain has been established as the largest generator of disability in the world, as well as the sixth cause in terms of health spending. In addition, it is estimated that the direct economic cost related to low back pain in countries of the European Union is between 188 million in Belgium, 4.2 billion in the Netherlands, reaching up to 90.6 billion dollars in the United States. The presence of CLBP represents a great impact on the lives of patients, they report a loss of function related to their ability to carry out domestic or recreational activities, deterioration of social relationships and a feeling of isolation, the need to modify their work activities or fear to lose his job. In addition, for many it is a great stigma to suffer from this pathology. Aims. To evaluate the effectiveness of therapeutic exercise through different programs in the approach to patients with chronic low back pain of non-specific origin in terms of pain, disability, fear of movement, quality of life, range of motion in lumbar flexion and resistance of the abdominal muscles. In addition to analyzing the effect of telemedicine in patients with the same problem. Material and methods. Two randomized clinical trials and a feasibility protocol were carried out for the development of this doctoral thesis. A total of 138 patients with chronic non-specific low back pain who met the inclusion criteria were recruited for the clinical trials of this thesis. The outcome measures recorded were pain (VAS), disability (RMDQ), fear of movement (TSK), quality of life (SF-36), endurance of abdominal muscles (McQuade Test) and range of mobility in lumbar flexion (finger-floor test). In the first clinical trial, data were collected before starting treatment, at 2 months and 6 months after finishing treatment, meanwhile in the second one, data were obtained before starting treatment, at 2 months from the beginning of the study. Regarding the protocol, a double-blind randomized controlled trial of an e-health or telemedicine intervention based on self-management in patients with chronic low back pain of non-specific origin was described. It describes the process of patient recruitment and randomization, along with the e-health intervention program and the control group.Likewise, the protocol of treatment and evaluation of the outcome measures in the participants is described. Results. Therapeutic exercise performed in person is presented as an effective procedure in reducing pain, disability and fear of movement, improving quality of life, abdominal muscle endurance and range of motion. In turn, exercise, administered through a web platform, shows positive results in improving the same outcome measures compared to the usual domiciliary exercise. Therefore, Telemedicine is postulated as a useful and effective tool together with therapeutic exercise in the management of patients with chronic non-especific low back pain. Conclusions. Telemedicine and therapeutic exercise can be considered tools for managing patients with chronic non-specific low back pain, showing benefits in pain management, disability, fear of movement, quality of life, abdominal muscle endurance and lumbar mobility.