Physiotherapy for Sleep Disturbance in People With Chronic Low Back Pain: Results of a Feasibility Randomized Controlled Trial

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• 作者：Jennifer Eadie ; MSc^a ; ^b ; Alexander T. van de Water ; MSc^a ; ^c ; Chris Lonsdale ; PhD^a ; ^d ; Mark A. Tully ; PhD^e ; Willem van Mechelen ; PhD^f ; Colin A. Boreham ; PhD^a ; Leslie Daly ; PhD^a ; Suzanne M. McDonough ; PhD^g ; Deirdre A. Hurley ; PhD^a ; ^{deirdre.hurleyosing@ucd.ie" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Actigraphy ; Dyssomnias ; Low back pain ; Physical therapy specialty ; Rehabilitation
• 刊名：Archives of Physical Medicine and Rehabilitation
• 出版年：2013
• 出版时间：November 2013
• 年：2013
• 卷：94
• 期：11
• 页码：2083-2092
• 全文大小：222 K

文摘

To determine the feasibility of a randomized controlled trial investigating the effectiveness of physiotherapy for sleep disturbance in chronic low back pain (CLBP) (≥12wks).

Design

Randomized controlled trial with evaluations at baseline, 3 months, and 6 months.

Setting

Outpatient physiotherapy department in an academic teaching hospital.

Participants

Participants with CLBP were randomly assigned to a walking program (n=20; mean age ± SD, 46.4±13.8y), supervised exercise class (n=20; mean age ± SD, 41.3±11.9y), or usual physiotherapy (n=20; mean age ± SD, 47.1±14.3y). The 3-month evaluation was completed by 44 participants (73%), and 42 (70%) participants completed the 6-month evaluation.

Interventions

Participants received a physiotherapy-delivered 8-week walking program, an 8-week group supervised exercise class (1 class/wk), or 1-to-1 usual physiotherapy (advice, manual therapy, and exercise).

Main Outcome Measures

Sleep was assessed by the self-reported Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Pittsburgh Sleep Diary, and objective actigraphy.

Results

Groups were comparable at baseline. Most (95%, n=57) of the participants had sleep disturbance. The acceptability of actigraphy was excellent at baseline (58 of 60 participants), but dropped at 3 months (26 of 44 participants). There were improvements on the PSQI and ISI in all groups at 3 and 6 months, with predominantly medium effect sizes (Cohen d=0.2–0.5).

Conclusions

The high prevalence of sleep disturbance indicated the feasibility of good recruitment in future trials. The PSQI would be a suitable screening tool and outcome measure alongside an objective nonobtrusive sleep outcome measure. The effectiveness of physiotherapy for sleep disturbance in CLBP warrants investigation in a fully powered randomized controlled trial.