Wirksamkeit und Durchführbarkeit von Graphästhesie-Training bei Patienten mit chronisch unspezifischen Rückenschmerzen

Zusammenfassung

Hintergrund Chronisch unspezifischer Rückenschmerz (CURS) stellt ein erhebliches Gesundheitsproblem dar. Aktuelle Studien weisen darauf hin, dass kortikale Veränderungen bei den betroffenen Patienten ein beitragender Faktor für die Persistenz von Schmerzen sein können. Bei anderen Patienten mit chronischen Schmerzen und nachgewiesenen kortikalen Veränderungen konnte die Wirksamkeit sensorischer Trainingsansätze gezeigt werden. Unklar ist, ob diese Ansätze auch bei Patienten mit CURS wirksam sind.

Ziel Das Ziel dieser Pilotstudie war es, die Größenordnung möglicher Effekte des Graphästhesie-Trainings einzuschätzen und dessen Durchführbarkeit zu überprüfen.

Methoden 9 Probanden wurden randomisiert in 2 Gruppen eingeteilt. In der 3-wöchigen Interventionsphase erhielt die Kontrollgruppe physiotherapeutische „Usual Care“, während die Interventionsgruppe zusätzlich 2-mal wöchentlich ein 20-minütiges Graphästhesie-Training absolvierte.

Ergebnisse Im Vergleich der beiden Messzeitpunkte innerhalb sowie zwischen den Gruppen zum Messzeitpunkt 2 fanden sich keine signifikanten Unterschiede. Deskriptiv zeigte sich die Tendenz einer verbesserten Graphästhesie-Fehlerrate und Zweipunktdiskriminationsschwelle sowie von Schmerzintensität, -interferenz und körperlicher Funktion in der Interventionsgruppe.

Schlussfolgerung Das Graphästhesie-Training ist im klinischen physiotherapeutischen Kontext durchführbar und führt nicht zu unerwünschten Nebenwirkungen. Bezüglich der Wirksamkeit bestehen lediglich Tendenzen. Aufgrund des Pilotcharakters der Arbeit sind die Ergebnisse mit Vorsicht zu interpretieren. Es bedarf Folgestudien mit größeren Studienpopulationen zu kombinierten sensomotorischen Trainingsprogrammen bei CURS, insbesondere erweitert um den Aspekt einer vorangehenden Klassifizierung der Patienten in Subgruppen.

Abstract

Background Non-specific chronic low back pain (NSCLBP) is a major health problem. Current studies indicate that cortical alterations may be a contributing factor to persistent pain in affected patients. In other patients with chronic pain and identified cortical alterations, sensory training approaches showed initial effectiveness. It is unclear whether these approaches are also effective in patients with NSCLBP.

Objective The aim of this pilot study was to assess the degree of possible treatment effects of a graphaesthesia training and to investigate its feasibility.

Method Nine patients were randomised into two groups. During the three-week intervention period the control group received usual physiotherapy care whilst the intervention group performed an additional 20 minutes graphaesthesia training twice a week.

Results The comparison of the two measurement points within the groups as well as between the groups at measurement point two showed no significant differences. Descriptive data revealed a tendency of improved graphaesthesia error rates and two-point discrimination thresholds as well as pain severity, pain interference and physical function in the intervention group.

Conclusions In the clinical physiotherapeutic context graphaestesia training is feasible and does not lead to any unwanted adverse effects. Regarding the effectiveness there exist only tendencies. Due to the pilot character of the study, the results should be interpreted with caution. More research studies with larger sample sizes regarding combined sensorimotor exercise programmes for NSCLBP are necessary, especially extended by a preceding classification of patients into subgroups.

Schlüsselwörter

chronische Rückenschmerzen - sensomotorischer Kortex - physiotherapeutische Behandlungsverfahren - randomisierte kontrollierte Studie - Graphästhesie

Key words

chronic low back pain - sensorimotor cortex - physiotherapy modalities - randomised controlled trial - graphaesthesia

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