Evidenz für die Wirksamkeit von Maßnahmen zur Prävention von Rückenschmerzen - Europäische Leitlinien[1]

Zusammenfassung

Hintergrund: Die primären Ursachen von Rückenschmerzen sind vielfältig und oft nicht identifizierbar, was die Möglichkeiten zur Prävention eines ersten Auftretens sehr begrenzt. Die Modifikation bekannter Risikofaktoren kann nur bedingt präventiv wirken. Es besteht jedoch die Möglichkeit zur Beeinflussung der Konsequenzen von Rückenschmerzen, wie z. B. Rückfallquote, Behandlungsbedarf, Grad der Behinderung und Arbeitsverlust.

Ziel: Der Artikel fasst die auf dem englischen Originaltext (European Guidelines for Prevention of Low Back Pain) basierenden European Guidelines - Prävention von Rückenschmerzen zusammen. Diese Leitlinien sind das Resultat umfassender Literatursuche in verschiedenen Datenbanken zum Thema Prävention von Rückenschmerzen im weitesten Sinne.

Methode: Die Literaturrecherche erfolgte anhand detaillierter Suchstrategien. Anschließend wurden die Artikel in Themengruppen zusammengefasst und ausgewertet. Dabei lag der Schwerpunkt auf den Empfehlungen für die allgemeine und Arbeiterbevölkerung. Die Evidenz für die physiotherapeutisch relevanten Interventionen wurde detaillierter aufgezeichnet, z. B. für Bewegungstherapie, Manuelle Therapie und Informationen. Die Evidenz für orthopädisch geprägte Interventionen (Schuheinlagen, Beckengurte, Mobiliar, organisatorische Dimensionen) ebenso wie für die Prävention von Rückenschmerzen im Schulalter ist in Form kurzer Empfehlungen dargestellt.

Ergebnisse: Die viel versprechendsten Ansätze beinhalten körperliche Aktivität/Übungen und (biopsychosoziale) Informationen (zumindest bei Erwachsenen), jedoch sind die Effektgrößen der Interventionen mit akzeptabler Evidenz eher klein. Außerdem gibt es keine alleinige Intervention, die effektiv das generelle Problem „Rückenschmerzen” verhindern kann, da diese von Natur aus multidimensional sind.

Einzelne Rückenschmerzpatienten werden immer wieder von hilfreichen Strategien berichten, die jedoch nicht für die Allgemeinheit empfohlen werden, solange es keine wissenschaftliche Evidenz für deren präventive Effektivität gibt. Es ist auch nicht bekannt, ob solche Strategien eventuell negative Langzeiteffekte nach sich ziehen.

Schlussfolgerungen: Die Prävention von Rückenschmerzen betrifft sowohl den einzelnen Menschen als auch die gesamte Gesellschaft. Um optimale Fortschritte zu erzielen, muss die Vorstellung der Gesellschaft bezüglich des Problems Rückenschmerz verändert werden. Es gilt insbesondere, den Zusammenhang zwischen Rückenschmerz und Aktivität/Arbeit, wie mit Rückenschmerzen umzugehen und was vernünftigerweise von Prävention zu erwarten ist, neu zu überdenken.

Abstract

Background: The primary causes of low back pain vary and are often difficult to identify which limits the prevention of its first incidence. The modification of known risk factors can only prevent the occurrence to a certain extent. However, there is the possibility to control the consequences of low back pain, such as recurrence rate, care seeking, disability degree and loss of work.

Objective: The article summarizes the European Guidelines - Prevention of Low Back Pain. The guidelines represent the results of a literature research in different data bases with view to the topic Prevention of back pain in a wide sense.

Methods: The literature investigation emloyed detailed searching strategies. Then the articles were compiled in thematic groups and evaluated. In this the focus was set on recommendations for general and working population. The evidence for physiotherapeutically relevant interventions are recorded in more detail, i. e. kinesitherapy, manual therapy and information. The evidence for orthopedically affected interventions (shoe insoles, pelvis belts, furniture, organisational dimensions) as well as for the prevention of back pain in school age is portrayed in form of short recommendations.

Results: The most promising approaches seem to involve physical activity/exercise and appropriate (biopsychosocial) education (at least for adults). However the effect sizes of the interventions with acceptable evidence are rather modest. In addition, no single intervention is likely to be effective to prevent the overall problem of LBP, owing to its multidimensional nature.

Individuals may constantly report of helpful strategies, which with view to the absence of scientific evidence of their preventive effect cannot be recommended in general. It is also not known whether some of these strategies have negative long-term effects.

Conclusions: Prevention of LBP is a societal as well as an individual concern. In order to achieve optimum progress a shift of the society’s view concerning the attitude towards LBP is required. Above all it is necessary to rethink the relationship between back pain and activity/work, how back pain might best be tackled, and what is reasonable to expect from preventive strategies.

Schlüsselwörter

Rückenschmerz - Leitlinien - Physiotherapie - Prävention - Arbeitsplatzintervention

Key words

Low back pain - guidelines - physiotherapy - prevention - workplace intervention

1 Einleitung und Diskussion von Kerstin Lüdtke, PT, MSc

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1 Einleitung und Diskussion von Kerstin Lüdtke, PT, MSc