TECHNOLOGY-SUPPORTED REHABILITATION IN CHRONIC LOW BACK PAIN: A REVIEW

Abstract

Introduction In Europe, 24.7 % of the population suffers from chronic low back pain. A raise of 14% is expected between 2000-2020 because of demographic changes and a sedentary lifestyle. Rehabilitation may reduce pain and improve the activity level in chronic low back pain patients. In the light of increasing pressures on the health system, technology supported rehabilitation may empower patients and may reduce the costs of therapy and absence from work. Aim The aim of this study is to investigate to which extent technology supported solutions have been used for the treatment of chronic low back pain, and to which extent they may influence treatment outcome. Materials and methods A systematic literature search (Pubmed, IEEE Xplore, ACM, Cochrane), a quality assessment and descriptive analyses were performed. Results 19 studies were eligible: 11 randomized clinical trials, 5 clinical trials, and 3 systematic reviews. The following technology supported rehabilitation systems were identified: electrical nerve stimulation to activate abdominal and paraspinal musculature in order to support exercise therapy, electrical nerve stimulation in order to obtain pain relief, and vibratory stimulation in order to obtain pain relief. The evidence for electrical nerve stimulation with regard to pain relief was not unequivocal. Vibratory stimulation was unable to prove clinical effectiveness for pain relief. Electrical stimulation of abdominal and paraspinal musculature in support of exercise therapy seems promising: significant benefits are found with regard to pain relief and muscle strength. However, the level of evidence for the latter findings is still low, as to date no RCT evidence is available. Conclusion Technological systems in support of the rehabilitation of low back pain mainly pertain to electrical stimulation. No clinically tested rehabilitation systems were identified that offer exercise therapy for low back pain patients. Discussion In other fields, such as neurorehabilitation, a myriad of technological systems exist that offer exercise therapy to support active rehabilitation approaches. In the field of musculoskeletal rehabilitation, limited clinical evidence is available on the feasibility and effectiveness of technology supported rehabilitation systems with regard to exercise therapy for chronic low back pain. Existing technology-supported training systems are mostly offering nerve stimulation of abdominal and paraspinal musculature, as well as nerve stimulation for obtaining regional pain reduction. Future research should aim to clinically test the value of rehabilitation technologies for patients with musculoskeletal problems.