Evidenzbasierte Physiotherapie zur Behandlung akuter unspezifischer Kreuzschmerzen - auf der Europäischen Leitlinie basierender Bericht

Zusammenfassung

Hintergrund: Kreuzschmerzen gehören zu den vordringlichen Gesundheitsproblemen in industrialisierten Ländern. Vor kurzem wurde hierzu eine europäische Leitlinie verabschiedet.

Ziel: Die für die Physiotherapie relevanten Empfehlungen der Leitlinie sowie deren zugrunde liegende Evidenz werden dargestellt.

Methode: Die Empfehlungen der Leitlinie basieren auf systematischen Übersichtsarbeiten, internationalen Leitlinien und der Konsensbildung in einer europäischen Expertengruppe für Kreuzschmerzen. Für die Literatursuche wurde auf Cochrane Library, Medline und Embase zurückgegriffen (1966 bis Oktober 2003).

Ergebnisse: Für eine frühzeitige Aktivierung, gegebenenfalls unterstützt durch eine medikamentöse Schmerztherapie, existieren eindeutige Wirksamkeitsnachweise höchster Evidenzstufe. Für die Effektivität Manueller Therapie bzw. bei subakuten Beschwerden für multiprofessionelle Programme findet sich moderate Evidenz. Studien zu Bewegungsübungen oder Traktionsverfahren zeigen widersprüchliche Ergebnisse, und die Wirksamkeit von Rückenschulen und Massagen ist bislang unzureichend untersucht. Daher können diese Maßnahmen derzeit nicht empfohlen werden.

Schlussfolgerung: Mit Ausnahme der Manuellen Therapie sollten physiotherapeutische Maßnahmen in der Behandlung akuter unspezifischer Kreuzschmerzen nicht eingesetzt werden. Bei subakuten Beschwerden gewinnen sie an Bedeutung, vor allem als Bestandteil multiprofessioneller Behandlungsprogramme.

Abstract

Background: Low back pain is one major health problem in industrialised countries. Recently a European guideline referring to this topic was released.

Objective: The recommendations and the evidence of the guideline which are relevant for physiotherapists are presented.

Methods: The guideline’s recommendations are based on systematic reviews, international guidelines, and discussions of an European expert group for low back pain. Literature request covered the Cochrane library, Medline and Embase (1966 until October 2003).

Results: There is clear evidence for the effectiveness of early activation, if necessary supported by analgesic medication. The effectiveness of manipulative therapy and respectively of multiprofessional programs for patients with subacute pain showed moderate evidence. Studies on the effectiveness of exercise therapy or traction found contradictory results, and the evidence of back school and massage therapy is insufficient. Therefore these therapeutical measures cannot be recommended at present.

Conclusion: With the exception of manipulative therapy physiotherapy should not be used for patients with acute unspecific low back pain. Concerning the management of subacute pain, especially as part of multiprofessional programs it gains in importance.

Rückenschmerz - Leitlinie - Physiotherapie - Bewegungstherapie - Manuelle Therapie - Rückenschule - Massage - Traktionsbehandlung

Low back pain - guideline - physiotherapy - exercise therapy - manual therapy - back school - massage - traction

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