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160 APPENDICES Physiotherapy KCE reports vol.40 Table 9 Acute low back pain: treatment modalities applied by Belgian ambulatory physiotherapists and evidence-based literature Treatment modality Frequency (proportion ± accuracy) Spinal tractions 18 ± 5% Type of evidence Evidence against (moderate to strong) Evidence available in the literature on physiotherapy of acute low back pain (LBP) There is moderate to strong evidence that intermittent and continuous traction is ineffective to treat low back pain in general, with or without sciatica. Muscle chains 18 ± 5% ? No information available in the literature review. Proprioceptive rehabilitation 16 ± 4% ? No information available in the literature review. Reflexotherapy 09 ± 4% ? (only chronic LBP) Relaxation 08 ± 3% ? Behavioural therapy 05 ± 3% Biofeedback (EMG) 00 ± 0% No evidence for nor against (only chronic LBP) Evidence against (moderate to strong) (only chronic LBP) Reflexotherapy seems efficient at short- (5 minutes) and intermediate- (30 to 45 days) terms. Other studies are however required as the available literature is based on the scientific work of only one team. Effectiveness of reflexotherapy is less clear for patients with subacute low back pain. There is moderate evidence that massage has a superior positive effect on low back pain as compared to passive therapeutic modalities such as relaxation, acupuncture and self-care education. There is strong evidence that most behavioural interventions are more effective that no treatment in reducing pain and improving function in patients with chronic low back pain. There is weak evidence that behavioural interventions are equivalent in terms of effectiveness as compared with exercise therapy. There is moderate evidence that adding a behavioural intervention to more traditional treatments is not effective in improving function as compared to the traditional treatment alone. There is a moderate to strong evidence that EMG biofeedback is not effective in patients with chronic low back pain.
KCE reports vol. 40 APPENDICES Physiotherapy 161 Table 9 Acute low back pain: treatment modalities applied by Belgian ambulatory physiotherapists and evidence-based literature Treatment modality Frequency (proportion ± accuracy) Hydrotherapy 00 ± 0% Type of evidence Evidence for (weak) Evidence available in the literature on physiotherapy of acute low back pain (LBP) There is weak evidence that hydrotherapy improves the function and is as efficient as floor exercises.
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