Rev. Soc. Esp. Dolor. 2023; 30(2): 95-108 / DOI: 10.20986/resed.2023.4034/2022
Carolina Ramírez, Paula Ramírez
ABSTRACT
Background and objective: Sacroiliac joint dysfunction can explain 40 % of the cases of non-specific low back pain. Therapeutic exercise (TE) is a recommended treatment modality for the rehabilitation of this cases. The objective was to assess the effect of TE versus another interventions, on disability and pain intensity in people with sacroiliac pain or dysfunction.
Methods: Systematic review and meta-analysis of randomized clinical trials comparing the effect of any therapeutic exercise modality on pain intensity and/or disability. The risk of bias was determined with PEDro scale and the level of evidence according to GRADE.
Results: Eight studies with 422 participants were analyzed. TE was compared with manual therapy, surgical fixation of the sacroiliac joint, physical modalities, education, and the use of a pelvic belt. Overall, the risk of bias was moderate. In the quantitative analysis, low quality of evidence was found about whether the exercise and manual therapy achieve the same effect on pain intensity (MD -0.25 [IC 95 % -2.60 a 2.09]); likewise, low quality of evidence was observed for the estimated superior effect in favor of ET compared to manual therapy on disability (MD -8,74 [IC 95 % -10.92 a - 6.67]).
Conclusion: Low and very low-quality evidence suggests that TE is effective in reducing pain and disability in people with DASI or sacroiliac pain.
RESUMEN
Antecedentes y objetivo: La disfunción de la articulación sacroilíaca puede explicar el 40 % de los casos de dolor lumbar inespecífico. El ejercicio terapéutico (ET) es una modalidad de tratamiento recomendada para la rehabilitación de estos casos. El objetivo de este estudio fue evaluar el efecto del ET comparado con otras intervenciones, sobre la discapacidad y la intensidad del dolor en personas con disfunción o dolor sacroilíaco.
Materiales y métodos: Revisión sistemática y metanálisis de ensayos clínicos aleatorios en los que se comparara el efecto de cualquier modalidad de ejercicio terapéutico sobre la intensidad del dolor o la discapacidad. Se determinó el riesgo de sesgo con la escala PEDro y la calidad de la evidencia según GRADE.
Resultados: Se analizaron ocho estudios con 422 participantes en total. El ET se comparó con la terapia manual, la fijación quirúrgica de la articulación sacroilíaca, las modalidades físicas, la educación y el uso de cinturón pélvico. En general, el riesgo de sesgo en las publicaciones fue moderado. En el análisis cuantitativo, se encontró baja calidad de evidencia de que el ejercicio y la terapia manual logran el mismo efecto sobre la intensidad del dolor (MD-0,25 [IC 95 % -2,60 a 2,09]); asimismo, se registró baja calidad de evidencia para el efecto superior estimado a favor del ET comparado con la terapia manual sobre la discapacidad (MD -8,74 [IC 95 % -10,92 a - 6,67]).
Conclusión: Existe evidencia de calidad baja y muy baja que sugiere que el ET es efectivo para reducir el dolor y la discapacidad en personas con DASI o dolor sacroilíaco.
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Bibliografía
1. Buchbindera R, Underwood M, Hartvigsene J, Maher CG. The Lancet Series call to action to reduce low value care for low back pain: an update. Pain. 2020;161(9):S57-S63.
2. Danneskiold-Samsøe B, Bartels E. Idiopathic Low Back Pain: Classification and Differential Diagnosis. J Musculoskelet Pain. 2004;12(3):93-9.
3. DonTigny RL. Function and pathomechanics of the sacroiliac joint. Phys Ther. 1985;65(1):35-44.
4. DonTigny RL. Anterior dysfunction of the sacroiliac joint as a major factor in the etiology of idiopathic low back pain syndrome. Phys Ther. 1990;70(4):250-60.
5. Murakami E. Sacroiliac Joint Disorder: Accurately Diagnosing Low Back Pain. Singapore: Springer Nature Singapore Pte Ltd.; 2019.
6. Telli H, Telli S, Topal M. The Validity and Reliability of Provocation Tests in the Diagnosis of Sacroiliac Joint Dysfunction. Pain Physician. 2018;21(4):367-76.
7. Ramírez CR, Lemus DMC. Disfunção da articulação sacro-iliaca em jovens com dor lombar. Fisioter em Mov. 2010;23(3):419-28.
8. Cher D, Polly D, Berven S. Sacroiliac joint pain: Burden of disease. Med Devices Evid Res. 2014;7(1):73-81.
9. Polly DW, Cher D. Ignoring the sacroiliac joint in chronic low back pain is costly. Clin Outcomes Res. 2016;8:23-31.
10. Cohen SP, Chen Y, Neufeld NJ. Sacroiliac joint pain: a comprehensive review of epidemiology, diagnosis and treatment. Expert Rev. Neurother. 2013;13(1):99-116.
11. Hall C, Brody LT, Therapeutic exercise: moving toward function. Third Edition. Philadelphia: William & Wilkins; 2011.
12. Vleeming A, Albert HB, Östgaard HC, Sturesson B, Stuge B. European guidelines for the diagnosis and treatment of pelvic girdle pain. Eur Spine J. 2008;17(6):794-819.
13. Leibenson C. The relationship of the sacroiliac joint, stabilization musculature and lumbo-pelvic instability. J Bodyw Mov Ther. 2004;8(1):42-45.
14. Morton NA. The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study. Aust J Physiother. 2009;55(2):129-33.
15. Guyatt GH, Oxman AD, Kunz R, Woodcock J, Brozek J, Helfand M, et al. GRADE guidelines: 7. Rating the quality of evidence-inconsistency. J Clin Epidemiol. 2011;64(12):1294-302.
16. Kamali F, Zamanlou M, Ghanbari A, Alipour A, Bervis S. Comparison of manipulation and stabilization exercises in patients with sacroiliac joint dysfunction patients: A randomized clinical trial. J Bodyw Mov Ther. 2019;23(1):177-82.
17. Nejati P, Safarcherati A, Karimi F. Effectiveness of Exercise Therapy and Manipulation on Sacroiliac Joint Dysfunction: A Randomized Controlled Trial. Pain Physician. 2019;22(1):53-61.
18. Teymuri Z, Hosseinifar M, Sirousi M. The Effect of Stabilization Exercises on Pain, Disability, and Pelvic Floor Muscle Function in Postpartum Lumbopelvic Pain: A Randomized Controlled Trial. Am J Phys Med Rehabil. 2018;97(12):885-91.
19. ElDeeb AM, Abd-Ghafar KS, Ayad WA, Sabbour AA. Effect of segmental stabilizing exercises augmented by pelvic floor muscles training on women with postpartum pelvic girdle pain: A randomized controlled trial. J Back and Musculoskelet Rehabil. 2019;32(5):693-700.
20. Visser LH, Woudenberg NP, de Bont J, Van Eijs F, Verwer K, Jenniskens H, et al. Treatment of the sacroiliac joint in patients with leg pain: a randomized-controlled trial. Eur Spine J. 2013;22(10):2310-7.
21. Dengler J, Kools D, Pflugmacher R, Gasbarrini A, Prestamburgo D, Gaetani P, et al. 1-Year Results of a Randomized Controlled Trial of Conservative Management vs. Minimally Invasive Surgical Treatment for Sacroiliac Joint Pain. Pain Physician. 2017;20(6):537-50.
22. Gutke A, Sjödahl J, Öberg B. Specific muscle stabilizing as home exercises for persistent pelvic girdle pain after pregnancy: a randomized, controlled clinical trial. J Rehabil Med 2010;42(10):929-35.
23. Brizzolara KJ, Wang S, Roddey TS, Medley A. Effectiveness of adding a pelvic compression belt to lumbopelvic stabilization exercises for women with sacroiliac joint pain: a feasibility randomized clinical trial. J Womens Health Phys Therap. 2018;42(2):1-11.
24. Ramírez C, Ramírez P, Casas AS. Perspectiva de la práctica clínica de fisioterapeutas colombianos en el manejo de la disfunción de la articulación sacroilíaca. Estudio descriptivo. Fisioterapia. 2021;43:192-200.
25. Al-Subahi M, Alayat M, Alshehri MA, Helal O, Alhasan H, Alalawi A, et al. The effectiveness of physiotherapy interventions for sacroiliac joint dysfunction: a systematic review. J Phys Ther Sci. 2017;29(9):1689-94.
26. Sharma A, Sharma S, Steiner LA, Brudvig TJ. Identification and effectiveness of physical therapy interventions for sacroiliac joint dysfunction in pregnant and nonpregnant adults: A systematic review. J Womens Health Phys Therap. 2014;38(3):110-7.
27. Stanton T, Kawchuk G. The effect of abdominal stabilization contractions on posteroanterior spinal stiffness. Spine. 2008;33(6):694-701.
28. Stuge B. Evidence of stabilizing exercises for low back- and pelvic girdle pain - a critical review. Braz J Phys Ther. 2019;23(2):181-6.
29. Richardson C, Hodges PW and Hides J. Therapeutic Exercise for Lumbopelvic Stabilization: A Motor Control Approach for the Treatment and Prevention of Low Back Pain. 2nd edition. United Kingdom: Churchill Livingstone; 2004.
30. Essery R, Geraghty A, Kirby S, Yardley L. Predictors of adherence to home-based physical therapies: a systematic review. Disabil Rehabil. 2017;39(6):519-34.