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Das Göttinger Rücken Intensiv Programm (GRIP)—ein multimodales Behandlungsprogramm für Patienten mit chronischen Rückenschmerzen, Teil 2

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Zusammenfassung

Problem

Untersuchungen von Patienten mit chronischen Rückenschmerzen zeigen, daß es im Laufe des Chronifizierungsprozesses zu erheblichen körperlichen Funktionsdefiziten einerseits sowie Angst-, Schon- und Vermeidungsverhalten (wegen der Schmerzen) andererseits kommt. Bei der Therapie dieser Patienten haben sich deshalb in den USA und skandinavischen Ländern aktive Behandlungskonzepte durchgesetzt, die beides berücksichtigen und in dieser Form in Deutschland bisher noch nicht durchgeführt worden sind.

Methode

90 Patienten mit chronischen Rückenschmerzen und mehrmonatiger aktueller oder unmittelbar zurückliegender Arbeitsunfähigkeit wurden hinsichtlich ihrer körperlichen Funktionsdefizite zu Beginn, nach Abschluß der Behandlung sowie 6 und 12 Monate später untersucht; Das Behandlungsprogramm bestand aus einer 3-wöchigen Vorbereitung (Unterricht, Dehnung, kalisthenische Übungen) und einer 5-wöchigen Hauptphase, in der Aerobic, funktionelles Krafttraining, Ausdauer- sowie Haltungs-und Bewegungstraining sowie kognitive Verhaltenstherapie durchgeführt wurde. Evaluiert wurden Beweglichkeit von Rumpf, LWS und Becken mittels Inklinometer, Länge der Ischiocruralen Muskulatur, Kraft und Ausdauer der Rumpfmuskulatur mittels standardisierter Übungen sowie isokinetischer Testung (LIDOTM Back), Hebevermögen (LIDOTM Lift) sowie z. T. Herz-Kreislaufausdauer mittels Fahrradergometer. Die Validität der Funktionsdefizite wurde anhand der Untersuchung von 109 gesunden Personen ohne Rückenschmerzen, die Reliabilität der Teste durch Wiederholung der Evaluation durch verschiedene Untersucher durchgeführt.

Ergebnisse

Patienten mit chronischen Rückenschmerzen hatten gegenüber einer Normstichprobe erhebliche körperliche Funktionsdefizite. Nur die Rumpfbeugemuskulatur war nicht signifikant abgeschwächt. Nach Abschluß der Behandlung waren alle funktionellen Defizite signifikant verbessert und in vielen Fällen mit der Normstich-probe vergleichbar. Im Laufe der Zeit verschlechterten sich die Werte wieder und erreichten teilweise die Ausgangswerte.

Schlußfolgerung

Patienten mit chronifizierten Rückenschmerzen haben erhebliche körperliche Defizite, können aber durch ein intensives körperliches Training erfolgreich behandelt werden. Da sich die Funktionsdefizite aber über die Zeit wieder einstellen, ist eine Kontrolle der Befunde, bzw. der Heimübungs-programme auch nach Abschluß der Therapie notwendig.

Abstract

Problem

There is a great need to expand current knowledge of the various functional capacity measurements used in the rehabilitation of chronic low back pain (CLBP) patients. The literature on these patients reports that mobility, endurance, trunk strength and lifting capacity decrease during the process of chronicity. Chronically disabled patients appear to have lower functional capacity than asymptomatic persons.

Methods

Our study group consisted of 90 disabled CLBP patients (44 female, 46 male; average age 42 years) who underwent a multidisciplinary 8-week daily treatment program of functional restoration with behavioral support (instruction, endurance training, strength exercises, behavioral and treatment to facilitate return to work therapy). Initially these patients where compared with 107 asymptomatic persons (44 female, 63 male, average age 41 years). The patients were investigated before and after treatment, and at intervals of 6 and 12 months. The reliability of the functional measurements was evaluated by inter-rater comparison. Physical assessment included a medical examination (mainly diagnosis of radicular or nonradicular pain), changes in the lumbar spine revealed by X-ray studies according to Herron and Turner [50], rating of physical impairment according to Waddell [117], flexibility, length of hamstrings muscles (SLR), test of power and endurance of trunk movement by standardized exercises according to the Swiss group of Spring [102] and isokinetic measurements (LIDO Back), tests of lifting capacity (LIDO Lift), and (in part) of general endurance on a cycle ergometer (CASE 15 Marquette).

Results

Physical findings showed that mobility was reduced substantially in patients suffering from back pain due to reduced SLR (shortened hamstrings) and decreased spinal mobility.

Patients also demonstrated significant reductions in their ability to perform lifting tasks in comparison to healthy individuals. The results of trunk flexion showed no significant differences between patients and the control group, whereas the ability to perform trunk extension was much better in the control group. In principle we found the same results with isokinetic measurements as in the exercises without machines. Cardiovascular endurance was also much better in the control group than it was in the back pain patients. At the end of the treatment program all physical deficits were improved significantly. In many cases performance was comparable with that of the control group. With time, however, training effects gradually decreased. The success of treatment (return to work, absence from work, pain reduction, use of medical care) was independent of the functional status of the patients before and after treatment.

Conclusion

Study results showed that physical capacity in disabled patients with low back pain is substantially reduced in comparison to persons who do not suffer from back pain. The only exception was in trunk flexor strength and endurance, in which measurements did not differ between the patients and the control group. However, even CLBP- patients with long-term pain and sevee physical illness can successfully improve their physical condition by participating in an active treatment program. Back extensor muscle training has to be included in physical therapy. Because of loss of condition during the time after treatment, regular monitoring of papients and their home training programs is necessary. Overall, treatment of CLBP has to include physical trainingand psychosocial treatment to achieve satisfactory results.

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  1. Schwerpunkt Algesiologie, Zentrum Anaesthesiologie, Rettungs- und Intensivmedizin, Georg-August-Universität Göttingen, Robert-Koch-Strasse 40, D-37075, Göttingen

    P. Saur

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  1. P. Saur
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Additional information

Das diesem Bericht zugrundeliegende Vorhaben wurde mit Mitteln des Bundesministers für Bildung, Wissenschaft, Forschung und Technologie unter dem Kennzeichen 0701506 gefördert.

An dieser Studie waren des weiteren beteiligt: Beate Choroba-Mehnen, Franz-Bernd Ensink, Carmen Franz, Tülün Fleer, Eva-Maria Katiofsky, Iris Padur, Andrea Reiche, Gudrun Schwibbe und Stefani v.Westernhagen

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Saur, P., Hildebrandt, J., Pfingsten, M. et al. Das Göttinger Rücken Intensiv Programm (GRIP)—ein multimodales Behandlungsprogramm für Patienten mit chronischen Rückenschmerzen, Teil 2. Schmerz 10, 237–253 (1996). https://doi.org/10.1007/s004820050046

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  • DOI: https://doi.org/10.1007/s004820050046

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