การศึกษาเปรียบเทียบผลของโปรแกรม William's Flexion Exercise และ Core Stability Training ร่วมกับการดึงหลังต่อการฟื้นฟูของผู้ป่วย Lumbar Spinal Stenosis

Peanyanunt Rueanrudipirom

Authors

Peanyanunt Rueanrudipirom Physical therapy Department, Samutprakan Hospital

Keywords:

lumbar spinal stenosis, lumbar traction, William's Flexion Exercise, core stability training, randomized controlled trial

Abstract

Background: Lumbar spinal stenosis (LSS) is a major cause of low back pain and functional limitations in older adults. Lumbar traction combined with exercise therapy is widely used in physical therapy practice; however, comparative evidence regarding different exercise approaches remains limited. This study aims to compare the effects of William's Flexion Exercise (WFE) combined with lumbar traction, Core Stability Training (CST) combined with lumbar traction, and lumbar traction alone on pain intensity, functional disability, and lumbar range of motion in patients with LSS.

Methods: A randomized controlled trial was conducted among 39 patients diagnosed with LSS. Participants were randomly allocated into three groups (n = 13 per group). The intervention groups received either WFE or CST under the supervision of a physical therapist in addition to lumbar traction and a home exercise program. The control group received lumbar traction alone. Outcomes were assessed after four weeks of intervention.

Results: After four weeks, all groups demonstrated significant within-group improvements in pain intensity and disability scores. The CST group showed the lowest mean Thai Roland Morris Disability Questionnaire (Thai RMDQ) score (5.92 ± 0.84), compared with the WFE group (7.43 ± 0.84) and the control group (8.88 ± 0.84), although the difference did not reach statistical significance (p = 0.056). Multivariable logistic regression analysis demonstrated that participants in the CST group (adjusted odds ratio [aOR] = 9.27, 95% confidence interval [CI]: 1.20–71.55, p = 0.033) and the WFE group (aOR = 7.97, 95% CI: 1.09–58.23, p = 0.041) had significantly higher odds of achieving an overall treatment response than those in the control group.

References

Wu AM, Zou F, Cao Y, Xia DD, He W, Zhu B, et al. Lumbar spinal stenosis: an update on the epidemiology, diagnosis and treatment. AME Med J. 2017;2:63.

Young I, Dunning J, Butts R, Bliton P, Zacharko N, Garcia J, et al. Spinal manipulation and electrical dry needling as an adjunct to conventional physical therapy in patients with lumbar spinal stenosis: a multi-center randomized clinical trial. Spine J. 2024;24(4):590-600.

Kwon JW, Moon SH, Park SY, Park SJ, Park SR, Suk KS, et al. Lumbar spinal stenosis: review update 2022. Asian Spine J. 2022;16(5):789-98.

Comer C, Williamson E, McIlroy S, Srikesavan C, Dalton S, Melendez-Torres GJ, et al. Exercise treatments for lumbar spinal stenosis: a systematic review and intervention component analysis of randomised controlled trials. Clin Rehabil. 2024;38(3):361-74.

Backstrom KM, Whitman JM, Flynn TW. Lumbar spinal stenosis-diagnosis and management of the aging spine. Man Ther. 2011;16(4):308-17.

Bera A, Vijay AK, Kumar K, Ambedkar DBR. Effectiveness of William's flexion exercises on non-specific low back pain among nurses. Int J Physiother Res. 2024;12(2):4676-80.

Park CH, Beom J, Chung CK, Kim CH, Lee MY, Park MW, et al. Long-term effects of lumbar flexion versus extension exercises for chronic axial low back pain: a randomized controlled trial. Sci Rep. 2024;14(1):2714.

Hodges PW. Core stability exercise in chronic low back pain. Orthop Clin North Am. 2003;34(2):245-54.

Mu W, Shang Y, Mo Z, Tang S. Comparison of two types of exercises in the treatment of lumbar spinal stenosis. Pak J Med Sci. 2018;34(4):897-900.

Saragiotto BT, Maher CG, Yamato TP, Costa LO, Menezes Costa LC, Ostelo RW, et al. Motor control exercise for chronic non-specific low-back pain. Cochrane Database Syst Rev. 2016;2016(1):CD012004.

Sharma DS, Shah DR, Shah DH. Effectiveness of flexion based core strengthening exercises on patients with lumbar canal stenosis: a series of case report. Int J Sci Res. 2023;12(9):517-21.

Kumari A, Quddus N, Meena PR, Alghadir AH, Khan M. Effects of one-fifth, one-third, and one-half of the bodyweight lumbar traction on the straight leg raise test and pain in prolapsed intervertebral disc patients: a randomized controlled trial. Biomed Res Int. 2021;2021:2561502.

Kamanli A, Karaca-Acet G, Kaya A, Koc M, Yildirim H. Conventional physical therapy with lumbar traction; clinical evaluation and magnetic resonance imaging for lumbar disc herniation. Bratisl Lek Listy. 2010;111(10):541-4.

Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39(2):175-91.

Ostelo RW, de Vet HC. Clinically important outcomes in low back pain. Best Pract Res Clin Rheumatol. 2005;19(4):593-607.

Jirarattanaphochai K, Jung S, Sumananont C, Saengnipanthkul S. Reliability of the Roland-Morris Disability Questionnaire (Thai version) for the evaluation of low back pain patients. J Med Assoc Thai. 2005;88(3):407-11.

Jordan K, Dunn KM, Lewis M, Croft P. A minimal clinically important difference was derived for the Roland-Morris Disability Questionnaire for low back pain. J Clin Epidemiol. 2006;59(1):45-52.

Tousignant M, Poulin L, Marchand S, Viau A, Place C. The modified-modified Schober test for range of motion assessment of lumbar flexion in patients with low back pain: a study of criterion validity, intra- and inter-rater reliability and minimum metrically detectable change. Disabil Rehabil. 2005;27(10):553-9.

Fuming Z, Weihui X, Jiajia Y, Shufeng L, Yiyi Z, Wenjian L, et al. Effect of m-health based core stability exercise combined with self-compassion training for patients with non-specific chronic low back pain: study protocol for a randomized controlled trial. Trials. 2022;23(1):265.

Vickers AJ, Altman DG. Statistics notes: analysing controlled trials with baseline and follow up measurements. BMJ. 2001;323(7321):1123-4.

Whitman JM, Flynn TW, Childs JD, Wainner RS, Gill HE, Ryder MG, et al. A comparison between two physical therapy treatment programs for patients with lumbar spinal stenosis: a randomized clinical trial. Spine (Phila Pa 1976). 2006;31(22):2541-9.

Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2nd ed. Hillsdale (NJ): Lawrence Erlbaum Associates; 1988.