腰痛患者に対する外来リハビリテーションアルゴリズムの有効性に関する比較分析

Lumbosacral dorsopathy (LSD) with moderate exacerbation of pain remains one of the leading causes of temporary disability and decreased quality of life for patients. During the third (outpatient) stage of rehabilitation, it becomes necessary to select optimal rehabilitation care algorithms, especially in the context of the rapid growth of telemedicine technologies. It is important to determine which algorithm is most effective for patients with different baseline pain intensities and associated functional impairments.

To conduct a comparative analysis of the effectiveness of various outpatient rehabilitation algorithms for patients with exacerbation of LSD depending on the baseline pain severity.

The study included 120 patients (ICD-10: M54.5), divided into three groups and two subgroups within each group. Patients of the first group (n=40) received comprehensive rehabilitation, including therapeutic exercise (TE) in the form of group sessions; magnetic therapy; electrophoresis with 2% euphyllin solution; classical therapeutic massage of the PCOP area, the course duration was 10 days. Patients of the second group (n=40) received physiotherapy treatment and massage according to the standard program carried out in the first group, the course duration was 10 procedures; followed by a course of therapeutic exercise in the form of online sessions with an exercise therapy instructor-methodologist, lasting 10 procedures. Patients of the third group (n=40), due to paramedical reasons, did not receive a course of physiotherapy and massage; the rehabilitation course included only TE sessions in the form of telemedicine services, lasting 10 procedures. All patients received basic drug therapy with drugs from the group of non-steroidal anti-inflammatory drugs (NSAIDs) and centrally acting muscle relaxants. Each patient group was stratified by baseline pain using the visual analog scale (VAS) into subgroup A (VAS 2-3 cm, n=20) and subgroup B (VAS 4-5 cm, n=20). Assessments were made before treatment (T0), after a 10-day course (T1), and after 1 month (T2) using the VAS, Oswestry Disability Index (ODI), EQ-5D-3L, SF-36, and Hospital Anxiety and Depression Scale (HADS). Statistical analysis included ANOVA, the Mann-Whitney test, and adjustment for covariates (age, disease duration, physical activity level).

As a result of the study, in patients of subgroup B, the greatest reduction in pain and improvement in functional status were recorded in group 1: VAS decreased from 4.7±0.5 to 1.2±0.4 cm (p<0.001), ODI - from 68.1 to 33.1% (p<0.001). In group 2, the changes were moderate (VAS: 2.5±0.7 cm; ODI: 47.6%), in group 3 - minimal (VAS: 4.1±0.6 cm; ODI: 59.5%). After a month, the effect in group 1 was maintained, in others - partial recurrence was observed. In patients of subgroup A (VAS 2-3 cm), the results in groups 1 and 2 were comparable and significantly better than the baseline (p<0.01), while in group 3 the improvement was less pronounced, but statistically insignificant compared to other groups (p>0.05). Quality of life (EQ-5D, SF-36) and anxiety (HADS) scores correlated with changes in pain and function.

Comprehensive outpatient rehabilitation is the most effective model for patients with high baseline pain intensity (4-5 cm on the VAS scale). For patients with moderate pain (2-3 cm), telemedicine-based physical therapy demonstrates comparable efficacy to traditional group physical therapy and can be considered a rational alternative. A personalized approach to selecting a rehabilitation model based on baseline pain severity improves its clinical effectiveness, cost-effectiveness, and accessibility.