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Table of Contents
ORIGINAL ARTICLE
Year : 2019  |  Volume : 51  |  Issue : 4  |  Page : 121-124

Effect of dynamic muscular stabilization training over conventional exercise program on mechanical low back pain in office workers to improve the quality of life: A randomized controlled study


1 D.Y. Patil School of Occupational Therapy, Navi Mumbai, Maharashtra, India
2 OT Training School and Centre, LTMMC, Mumbai, Maharashtra, India

Date of Submission11-Aug-2019
Date of Acceptance16-Nov-2019
Date of Web Publication3-Jan-2020

Correspondence Address:
Dr. Mansi Manoj Mulye
31/A/502, Suyog CHS, Above SBI, Tilak Nagar, Chembur, Mumbai - 400 089, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijoth.ijoth_23_19

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  Abstract 


Background: Most jobs nowadays are sedentary in nature. Due to incorrect posture, strain on the spine, pelvis, muscles, tendons, joints, bones, and discs can lead to fatigue and deformation. Low back pain (LBP) is the most common one among all pains. It has a profound impact on the quality of life (QoL). Core training has emerged as a major trend in LBP management and prevention. In Dynamic Muscular Stabilization Training (DMST), adequate dynamic control of lumbar spine forces is achieved, which reduces the repetitive injury to the structures of the spinal segments and related tissues. Thus, the aim of the study is to assess the effectiveness of DMST on LBP in office workers. Objective: The aim of this study was to determine the effect of DMST in mechanical LBP to improve the QoL in office workers. Study Design: Prospective, experimental, randomized controlled, comparative study design was chosen for the research. Methods: One hundred and twenty-four office workers (male and female, aged 30-50 years) were screened on Cornell musculoskeletal discomfort questionnaire (CMDQ). Fifty office workers were selected after screening, those who met the inclusion criteria (mechanical LBP and CMDQ for lower back more than 1.5). Office workers were equally divided into two groups, namely study group which received DMST and control group which received conventional exercises. Follow-up assessments were conducted at the baseline, 4th week, and 8th week on Oswestry LBP disability questionnaire (OLBPDQ) and World Health Organization QoL-BREF. Results: Both the study (n = 25) and control (n = 25) groups equally improved with their respective intervention. In the study group, LBP reduced more (P < 0.001, 95% confidence interval [CI]: 10.636-14.764) postintervention. Whereas, a significant improvement in physical (P < 0.001, 95% CI: 86.099-91.301) and psychological (P < 0.001, 95% CI: 60.725-69.475) domains of QoL was found in the study group compared to the control group. The correlation between OLBPDQ score and QoL domains was significant. Conclusion: DMST improves QoL by a significant reduction in pain in office workers with mechanical LBP.

Keywords: Dynamic Muscular Stabilization Training, Low Back Pain, Quality of Life


How to cite this article:
Mulye MM, Yeradkar RS. Effect of dynamic muscular stabilization training over conventional exercise program on mechanical low back pain in office workers to improve the quality of life: A randomized controlled study. Indian J Occup Ther 2019;51:121-4

How to cite this URL:
Mulye MM, Yeradkar RS. Effect of dynamic muscular stabilization training over conventional exercise program on mechanical low back pain in office workers to improve the quality of life: A randomized controlled study. Indian J Occup Ther [serial online] 2019 [cited 2020 Feb 23];51:121-4. Available from: http://www.ijotonweb.org/text.asp?2019/51/4/121/274806




  Introduction Top


Most jobs nowadays are sedentary in nature. Incorrect posture leads to fatigue and deformation. Low back pain (LBP) is the most common one among all pains, which causes discomfort and it has a profound impact on the quality of life (QoL). The prevalence for LBP is 90%-95% in the early phase of the chronic condition. There is increased risk of musculoskeletal pain, cardiovascular disease, obesity, and diabetes which leads to absenteeism.[1] In sedentary workers, there is a repetitive stress on the specific vertebral region and core muscles such as transverse abdominis and multifidus. Core training has emerged as a major trend in LBP management and prevention.[2] In dynamic muscular stabilization training (DMST), adequate dynamic control of lumbar spine forces is achieved, which reduces repetitive injury to spinal structures, decreases pain, and improves strength and endurance of spinal musculature.[1] Therefore, it aimed to study the effect of DMST over conventional occupational therapy in mechanical LBP in office workers to improve the QoL.


  Methods Top


The study conducted using prospective, experimental, randomized controlled, comparative study and convenient sampling in the occupational therapy department. From a sample of 50, odd numbers were recruited in the study group and even numbers were recruited in the control group. Office workers were included in the study from Municipal Corporation of Greater Mumbai. The study was conducted from April 2016 to October 2017 in the occupational therapy department. Institutional Ethics Committee approval was obtained. Written informed consent was obtained from the office workers.

Inclusion and Exclusion Criteria

Office workers (males and females) with mechanical LBP and those who are scoring more than 1.5, i.e., pain for 1-2 times a week on Cornell musculoskeletal discomfort questionnaire (CMDQ) for lower back and those with the age group of 30-50 years were included in the study, whereas previous medical and surgical illness, pregnant women, and those who had working period <2 years in the same job were excluded from the study.

Procedure

Twenty-five office workers from the study group and control group each received DMST and conventional exercise program for 20 min per se ssion, 3 times a week for 8 weeks, respectively. Follow-up assessments were conducted at the baseline, 4th week, and 8th week on Oswestry LBP disability questionnaire (OLBPDQ) and WHO QoL-BREF.

Assessment Measures

Cornell musculoskeletal discomfort questionnaires

This questionnaire is used for the screening purposes. CMDQ has been developed by Dr. Alan Hedge.[3] The questionnaire is based on the previous published research studies of musculoskeletal discomfort among office workers.[3] The survey is a screening tool and not a diagnostic instrument. The validity of the CMDQ has been tested by Dr. Alan in English with good results.[4]

Oswestry Low Back Pain Disability Questionnaire

OLBPDQ is used to to assess the LBP-affecting ability to manage in everyday life. OLBPDQ comprises pain intensity, personal care (washing, dressing, etc.), lifting, walking, sitting, standing, sex life, social life, and traveling.[5]

World Health Organization Quality of Life-BREF

WHOQOL-BREF is used to assess the perception of QoL in each particular domain. QoL is defined as individuals' perceptions of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards, and concerns. The WHOQOL-BREF is therefore based on a four domain structure (physical, psychological, social, and environmental). The WHOQOL-BREF contains a total of 26 questions. To provide a broad and comprehensive assessment, one item from each of the 24 facets contained in the WHOQOL-100 has been included. In addition, two items from the overall QoL and general health facet have been included. Domain scores are scaled in a positive direction (i.e., higher scores denote higher QoL). The mean score of items within each domain is used to calculate the domain score. Then, this domain score should be convert into a transformed score to 0-100 scale.[6]

Intervention Protocol

The study group received Dynamic Muscular Stabilization Training[7] [Table 1]. The control group received a conventional exercise program:[8] 1st week - deep breath, straightening shoulders and flanks, calf stretching, and squat while seated and from 2nd to 8th weeks - pelvic tilt exercise, spine flexibility exercise, adductor muscle strengthening exercise, body stretching, lower muscle static strengthening exercise, Abdominal muscle strengthening exercise, head, and neck stretching.
Table 1: Dynamic Muscular Stabilization Training Program

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Data Analysis

The data was analyzed using windows-based IBM Corp. Released 2016. IBM SPSS Statistics for Windows, Version 24.0. (Armonk, NY: IBM Corp.). Repeated measures ANOVA with Bonferroni post hoc test and Pearson correlation test were used as statistical tests of significance. The value of P was set at 0.05 level of significance, and a 95% confidence interval (CI) values were computed.


  Results Top


Of the office workers who participated in the study, a statistically significant difference was found in the study group (P < 0.001, 95% CI: 10.636-14.764) when compared to the control group (P < 0.001, 95% CI: 17.999-23.201) for OLBPDQ score at the 8th week [Table 2].
Table 2: Comparison between Pre-and Postscore on Oswestry Low Back Pain Disability Questionnaire

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Whereas comparing all four domains of QoL in the office workers, physical domain was the highest at the 8th week for the study group (P < 0.001, 95% CI: 86.009-91.301) and control group (P < 0.001, 95% CI: 60.725-69.475), while environmental domain was the lowest at the 8th week for the study group (P < 0.001, 95% CI: 80.444-87.956) and control group (P < 0.001, 95% CI: 57.218-66.382) [Table 3] and [Table 4].
Table 3: Comparison between Pre-and Postscore for Physical and Psychological Domains of Quality of Life

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Table 4: Comparison between Pre-and Postscore for Social and Environmental Domains of Quality of Life

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A moderately negative correlation was found between the OLBPDQ score and all QoL domains (−0.527, −0.427, −0.152, −0.403), which showed a significant improvement in QoL domains with a reduction in LBP [Table 5].
Table 5: Correlation between Oswestry Low Back Pain Disability Questionnaire Score and Domains of Quality of Life

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  Discussion Top


Fifty subjects who met the inclusion criteria were included in the study. The evidence for improved functional outcome with conventional therapy for mechanical LBP is limited. Hence, in this study, the effectiveness of DMST was analyzed by how much the LBP was reduced and how well the QoL was achieved in office workers.

In this study, there was more reduction in the OLBPDQ score at 8 weeks in the study group. This can be supported by Moon et al. who conducted a study on the effect of lumbar stabilization and dynamic lumbar strengthening exercises in patients with chronic LBP, which shows that OLBPDQ scores improved significantly in both the groups after 8 weeks. Both lumbar stabilization and lumbar strengthening exercises were effective and thus reduced LBP.[9]

Increase in QOL score is significant in both the groups with more increase in the study group. This finding can be supported by comparison between DMST, yoga therapy, and hot packs in improving the general health status of postural LBP patients in a study proposed by Chhabra and Mrityunjay. The mean improvement overall on general health status was significantly better to DMST. More improvement may be due to the coactivation of transversus abdominis and multifidus muscles.[10]

There was a reduction in OLBPDQ score with a significant improvement in QOL domains. The above finding can be supported by a study on a comparison of QoL in LBP patients and healthy controls using WHOQOL-BREF by Darzi et al. who found that the scores of four domains and general QoL on WHOQOL-BREF were lower in LBP patients. These differences were statistically significant in physical health and environmental health. Minimal clinically significant variation in the degree of pain has perceived by subjects from both the groups as an improvement in their QoL.[11]


  Conclusion Top


The study concluded that there is a significant reduction in lower back pain with an improvement in QoL. Thus, DMST would allow a quicker and smoother road to health and pain-free living.

Acknowledgments

We sincerely thank Dr. Mrs. Mondkar, Dean LTMMC, and GH, for granting permission to conduct this study.

Financial Support and Sponsorship

Nil.

Conflicts of Interest

There are no conflicts of interest.



 
  References Top

1.
Kumar S, Sharma V, Shukla R, Dev R, Aggarwal A. Efficacy of Dynamic Muscular Stabilization Techniques in the management of lumbar disc disorders. Niger J Med Rehabil 2012;14:13-19.  Back to cited text no. 1
    
2.
Del Bello A. The Effects of CORE Exercises on Chronic Low Back Pain: A Small Review, Osteopathy: 2016. Available from: http://www.delbelloosteopathie.ca/en/the-effects-of-core-exercises-on-chronic-low-back-pain/. [Last accessed on 2017 Nov 19].  Back to cited text no. 2
    
3.
CUergo: Musculoskeletal Discomfort Questionnaires; 1999. Available from: http://www.ergo.human.cornell.edu/ahmsquest.html. [Last accessed on 2017 Dec 23].  Back to cited text no. 3
    
4.
Hedge A, Morimoto S, McCrobie D. Effects of keyboard tray geometry on upper body posture and comfort. Ergonomics 1999;42:1333-1349.  Back to cited text no. 4
    
5.
Davidson M, Keating JL. A comparison of five low back disability questionnaires: reliability and responsiveness. Phys Ther 2002;82:8-24.  Back to cited text no. 5
    
6.
WHO Quality of Life-BREF (WHOQOL-BREF)-Introduction, Administration, Scoring and Generic Version of the Assessment, Field Trial Version; December, 1996. Available from: http://www.who.int/mental_health/media/en/76.pdf. [Last accessed on 2017 Dec 26].  Back to cited text no. 6
    
7.
Kisner C, Colby LA, Therapeutic Exercise- Foundations and Techniques. 5th ed. Philadelphia: F.A. Davis Company; 2012. p. 451-477.  Back to cited text no. 7
    
8.
Kim D, Cho M, Park Y, Yang Y. Effect of an exercise program for posture correction on musculoskeletal pain. J Phys Ther Sci 2015;27:1791-1794.  Back to cited text no. 8
    
9.
Moon HJ, Choi KH, Kim DH, Kim HJ, Cho YK, Lee KH, et al. Effect of lumbar stabilization and dynamic lumbar strengthening exercises in patients with chronic low back pain. Ann Rehabil Med 2013;37:110-117.  Back to cited text no. 9
    
10.
Chhabra D, Mrityunjay K. Comparison between Dynamic Muscular Stabilization Technique (DMST), yoga therapy and hot packs in improving general health status of postural low back pain patients. Int J Physiother. 2015;3:1075-1080.  Back to cited text no. 10
    
11.
Darzi MT, Pourhadi S, Hosseinzadeh S, Ahmadi MH, Dadian M. Comparison of quality of life in low back pain patients and healthy subjects by using WHOQOL-BREF. J Back Musculoskelet Rehabil 2014;27:507-512.  Back to cited text no. 11
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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