Author Names
Kasimis, K., Iakovidis, P., Lytras, D., Koutras, G., Chatziprodromidou, I. P., Fetlis, A., Ntinou, S. R., Keklikoglou, N. M., Samiotaki, A., Chasapis, G., Tarfali, G., & Apostolou, T.
Reviewer Name
Joshua Copeland, SPT
Reviewer Affiliation(s)
Duke University School of Medicine Doctor of Physical Therapy Division
Paper Abstract
Background and Objectives: Chronic non-specific low back pain (CNSLBP) is defined as back pain that lasts longer than 12 weeks. Capacitive and resistive electric transfer (TECAR) therapy utilizes radiant energy to generate endogenous heat and is widely used for the treatment of chronic musculoskeletal pain. The aim of this study was to investigate the efficacy of manual therapy (MT) program combined with TECAR therapy in individuals with CNSLBP. Materials and Methods: Sixty adults with CNSLBP were randomly divided equally into three groups. The first group followed an MT protocol in the lumbar region (MT group), the second group followed the same MT protocol combined with TECAR therapy (MT + TECAR group) using a conventional capacitive electrode as well as a special resistive electrode bracelet, and the third group (control group) received no treatment. Both intervention programs included six treatments over two weeks. Pain in the last 24 h with the Numeric Pain Rating Scale (NPRS), functional ability with the Roland–Morris Disability Questionnaire (RMDQ), pressure pain threshold (PPT) in the lumbar region with pressure algometry, and mobility of the lumbo-pelvic region through fingertip-to-floor distance (FFD) test were evaluated before and after the intervention period with a one-month follow-up. Analysis of variance with repeated measures was applied. Results: In the NPRS score, both intervention groups showed statistically significant differences compared to the control group both during the second week and the one-month follow-up (p < 0.001). Between-group differences were also noticed between the two intervention groups in the second week (p < 0.05). Differences in the RMDQ score were detected between the intervention groups and the control group in the second week and at the one-month follow-up (p < 0.001), while differences between the two intervention groups were only detected at the one-month follow-up (p < 0.001). Regarding the PPT values, differences were found mainly between the MT + TECAR group and the control group and between the MT + TECAR group and the MT group (p < 0.05), with the MT + TECAR group in most cases showing the greatest improvement compared to the other two groups, which remained statistically significant at the one-month follow-up (p < 0.05). Finally, both intervention groups improved the mobility of the lumbo-pelvic region at both time points compared to the control group without, however, statistically significant differences between them (p > 0.05). Conclusions: The application of an MT protocol with TECAR therapy appeared more effective than conventional MT as well as compared to the control group in reducing pain and disability and improving PPT in individuals with CNSLBP. No further improvement was noted in the mobility of the lumbo-pelvic region by adding TECAR to the MT intervention.
NIH Risk of Bias Tool
Quality Assessment of Controlled Intervention Studies
- Was the study described as randomized, a randomized trial, a randomized clinical trial, or an RCT
- Yes
- Was the method of randomization adequate (i.e., use of randomly generated assignment)?
- Yes
- Was the treatment allocation concealed (so that assignments could not be predicted)?
- No
- Were study participants and providers blinded to treatment group assignment?
- Cannot Determine, Not Reported, or Not Applicable
- Were the people assessing the outcomes blinded to the participants’ group assignments?
- No
- Were the groups similar at baseline on important characteristics that could affect outcomes (e.g., demographics, risk factors, co-morbid conditions)?
- Yes
- Was the overall drop-out rate from the study at endpoint 20% or lower of the number allocated to treatment?
- Yes
- Was the differential drop-out rate (between treatment groups) at endpoint 15 percentage points or lower?
- Yes
- Was there high adherence to the intervention protocols for each treatment group?
- Cannot Determine, Not Reported, or Not Applicable
- Were other interventions avoided or similar in the groups (e.g., similar background treatments)?
- Cannot Determine, Not Reported, or Not Applicable
- Were outcomes assessed using valid and reliable measures, implemented consistently across all study participants?
- Yes
- Did the authors report that the sample size was sufficiently large to be able to detect a difference in the main outcome between groups with at least 80% power?
- No
- Were outcomes reported or subgroups analyzed prespecified (i.e., identified before analyses were conducted)?
- No
- Were all randomized participants analyzed in the group to which they were originally assigned, i.e., did they use an intention-to-treat analysis?
- Yes
Key Finding #1
Applying the same manual therapy techniques using capacitive and a resistive electrode bracelet demonstrated improved pain rating outcomes which were maintained one month following treatment when compared to just manual therapy and no treatment.
Key Finding #2
Improvements were observed in pressure pain threshold for both the sacroiliac joint and L4-L5 paraspinal intervertebral space.
Key Finding #3
Manual therapy using capacitive and a resistive electrode bracelet resulted in no significant difference in the quadratus lumborum musculature when compared to just manual therapy.
Key Finding #4
Improved fingertip-to-floor test for both intervention groups (MT and MT + TECAR) in the second week and maintained for one month follow-up when compared to the control group.
Please provide your summary of the paper
This randomized clinical trial examined the efficacy of manual therapy combined with capacitive and resistive electric transfer (TECAR) therapy for individuals with chronic non-specific low back pain to just manual therapy and no treatment. Chronic non-specific low back pain, as defined in the study, is any low back pain that lasts longer than 12 weeks and TECAR therapy is a therapeutic technique that uses electrical current with medium frequency to trigger physiological processes in the underlying tissue. The results showed that manual therapy can be beneficial when coupled up with TECAR therapy to improve pain rating outcomes in patients. Similarly, improvements were made in pressure pain threshold following treatment for both the sacroiliac joint and L4-L5 paraspinal intervertebral space. Even though there were improvements in the MT+TECAR group in relation to pain, this study does consist of a small sample size of participants and a small time frame in which data was collected. TECAR therapy is a widely accepted intervention used in physical therapy but not much research has been completed analyzing its effectiveness on soft tissue. There is low reliability on the fingertip-to-floor outcome measure due to other variables such as sacroiliac dysfunction or hamstring tightness. While there is further research to be conducted in the near future, it appears that manual therapy can be beneficial for chronic non-specific low back pain, especially when combined with capacitive and resistive electric transfer therapy.
Please provide your clinical interpretation of this paper. Include how this study may impact clinical practice and how the results can be implemented.
This study demonstrates that manual therapy combined with other modalities may improve outcomes for specific musculoskeletal conditions. Further research is needed to determine the long-term effects of using manual therapy combined with another modality, such as TECAR therapy, to determine its impact on long-term pain management. However, this study does demonstrate that manual therapy can be combined with TECAR therapy to help improve pressure pain threshold, improvements in L4-L5 paraspinal intervertebral space and sacroiliac joint for short-term pain relief. In order to improve long-term pain relief, manual therapy and TECAR therapy shouldn’t be the only intervention implemented for all therapeutic sessions. Instead, using manual therapy and TECAR therapy can be used adjacent to an individualized strength training program.
