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The Efficacy of Systematic Active Conservative Treatment for Patients With Severe Sciatica: A Single-Blind, Randomized, Clinical, Controlled Trial

Albert, Hanne B. PT, MPH, PhD; Manniche, Claus MD, PhD, Med Sci

doi: 10.1097/BRS.0b013e31821ace7f
Randomized Trial
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Study Design. Prospective single-blind, randomized, clinical, controlled trial.

Objective. To evaluate the efficacy of active conservative treatment and to compare 2 active conservative treatment programs for patients with severe sciatica.

Summary of Background Data. Reviews have demonstrated little or no efficacy for passive conservative treatment modalities in patients suffering from sciatica. The results for surgery are conflicting. Cohort studies have shown excellent results for active treatment modalities in patients with sciatica.

Methods. One hundred eighty-one consecutive patients with radicular pain below the knee were examined at the baseline, at 8 weeks, and at 1 year after the treatment. Participants were randomized into 2 groups: (1) symptom-guided exercises + information + advice to stay active and (2) sham exercises + information + advice to stay active. Symptom-guided exercises consisted of a variety of back-related exercises given in accordance with a written algorithm in which symptoms or response to exercises determined the exercises given (http://www.sygehuslillebaelt.dk/wm345075, click exercises). Sham exercises were optional, designed to increase general blood circulation, and had no targeted effect on the back. The information was comprehensive and included anatomy, pathogenesis, and how discs heal without surgery. The advice included encouragement to stay as active as possible but to reduce activity if leg pain increased. The use of medication was optional, but only paracetamol and nonsteroidal anti-inflammatory drugs were recommended.

Results. A mean of 4.8 treatment sessions were provided. All patients experienced statistically significant and clinically important improvements in global assessment, functional status, pain, vocational status, and clinical findings. The symptom-guided exercise group improved significantly more than the sham exercise group in most outcomes.

Conclusion. Active conservative treatment was effective for patients who had symptoms and clinical findings that would normally qualify them for surgery. Although participating patients had greater faith in the sham exercises before treatment, the symptom-guided exercises were superior for most outcomes.

In a randomized controlled trial, 181 patients with severe sciatica received active conservative treatment for 8 weeks, average of 4.8 treatments. All patients experienced statistically significant and clinically important improvement. Before treatment, patients had greater faith in the sham exercise treatment than the symptom-guided treatment; however, for most outcomes, symptom-guided exercises were superior.

From the Back Research Centre, Funen, University of Southern Denmark, Ringe, Denmark.

Address correspondence and reprint requests to Hanne B. Albert, PT, MPH, PhD, The Back Research Centre, Lindevej 5, DK-5750 Ringe, Denmark; E-mail: hanne.birgit.albert@slb.regionsyddanmark.dk

Acknowledgment date: October 23, 2006. First revision date: February 10, 2009. Second revision date: January 27, 2011. Acceptance date: March 7, 2011.

The legal regulatory status of the device(s)/drug(s) that is/are the subject of this manuscript is not applicable in my country.

Federal, institutional, and foundation funds were received in support of this work. Although one or more of the author(s) has/have received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this manuscript, benefits will be directed solely to a research fund, foundation, educational institution, or other nonprofit organization which the author(s) has/have been associated.

© 2012 Lippincott Williams & Wilkins, Inc.