국내 비특이적 만성 요통 환자에게 적용한 비약물적 중재의 효과: 체계적 문헌고찰 및 메타분석
The Effectiveness of Non-pharmacologic Interventions for Chronic Nonspecific Low Back Pain: A Systematic Review and Meta-analysis
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본 연구의 목적은 비특이적 만성 요통 성인 환자를 대상으로 적용된 비약물적 중재의 효과를 체계적 문헌고찰 및 메타분석을 통해 파악하는 것이다. 국내 주요 데이터베이스 5개(한국학술정보원[KISS], 학술연구정보서비스[RISS], 한국의학논문데이터베이스[Kmbase], 대한의학학술지편집인협의회[KoreaMed], 국회도서관[Nanet])를 이용하여 최근 10년간 국내 학술지에 출판된 논문을 검색하였다. 두 연구자가 연구의 선정·배제 기준에 근거하여 독립적으로 문헌을 검토 및 추출하였다. 본 연구에서 효과크기 산출 및 이질성 검정을 위해 Comprehensive Meta Analysis 3.3을 사용하였다. 검색된 10,151편의 연구 중 최종적으로 26편의 연구가 포함되었고 그 중 메타분석이 가능한 연구는 15편이었다. 통증 및 요통장애지수 감소에 대한 비약물적 중재의 효과크기는 각각 -1.33(95% Confidence Interval[CI]: -1.81∼-0.85, p<.001)와 -0.94 (95% CI: -1.42∼-0.46, p<.001)로 큰 효과크기를 보였다. 효과크기의 이질성에 대한 탐색을 위해 중재방법에 따라 하위그룹 분석을 시행하였다. 운동은 통증(Hedges’s g=-1.53, 95% CI: -2.22∼-0.85, p<.001)과 요통장애지수(Hedges’s g=-0.92, 95% CI: -1.40∼-0.45, p<.001) 감소에 유의한 효과를 보였고 테이핑도 통증(Hedges’s g=-1.12, 95% CI: -1.51∼-0.73, p<.001)과 요통장애지수(Hedges’s g=-0.50, 95% CI: -0.93∼-0.07, p=.021) 감소에 유의한 효과를 보였다. 도수는 통증 감소에 미치는 효과크기는 약한 유의성을 보였고(Hedges’s g=-2.32, 95% CI: -4.64∼0.00, p=.050), 요통장애지수 감소에 유의한 영향을 미치지 않았다. 이러한 결과에 근거해 임상이나 지역사회의 간호사가 만성 요통 환자의 통증 관리를 위해 운동이나 테이핑을 활용한 독자적인 비약물적 중재 프로그램을 개발하고 적용할 필요가 있다. 본 연구 결과는 만성 요통 성인 환자를 대상의 효율적인 비약물적 중재 적용에 대한 근거자료를 제공하였다는 점에서 의의가 있다.
Abstract
Purpose: The purpose of this study was to evaluate the effectiveness of non-pharmacologic interventions for chronic nonspecific low back pain (CLBP) in adults aged 18-64 years. Methods: We searched for potentially relevant randomized controlled trials and nonrandomized controlled trials through five Korean electronic databases (i.e., Korean Studies Information Service System, Research Information Sharing Service, Korean Medical Database, KoreaMed, and National Assembly Library) published from January 2010 to May 2019. Two investigators independently selected the studies based on the criteria and assessed risk of bias in the included studies. We estimated the effect size of interventions using Comprehensive Meta Analysis 3.3. Results: Of 10,151 studies, 26 studies met the inclusion criteria and 15 studies were included in the meta-analysis. Exercise reduced low back pain (Hedges’s g=-1.53, 95% CI: -2.22 to -0.85) and pain-related disabilities (Hedges’s g=-0.92, 95% CI: -1.40 to -0.45). We found that taping was effective in decreasing low back pain (Hedges’s g=-1.12, 95% CI: -1.51 to -0.73) and pain-related disabilities (Hedges’s g=-0.50, 95% CI: -0.93 to -0.07). Manual therapy yielded a marginally significant reduction in low back pain (Hedges’s g=-2.32, 95% CI: -4.64 to 0.00), the therapy was not effective in decreasing pain-related disabilities. Conclusion: Although there was little evidence for the effectiveness of manual therapy in adults with CLBP, exercise and taping were effective to relieve pain and pain-related disabilities. Based on these findings, we suggest the development of non-pharmacologic interventions or a nursing intervention protocol for the CLBP management. Also, nurses should consider implementation of effective non-pharmacologic interventions for CLBP.
참고문헌 (37)
- "Health/disease search" (2013)[URL]
- Walker BF, "The prevalence of low back pain : A systematic review of the literature from 1966 to 1998", Journal of Spinal Disorders, 13(3), pp.205~217 (2000)
- Parthan A, "Chronic low back pain : Epidemiology, economic burden and patient-reported outcomes in the USA", Expert Review of Pharmacoeconomics & Outcomes Research, 6(3), pp.359~369 (2006)[DOI]
- Hoy D, "The epidemiology of low back pain", Best Practice & Research Clinical Rheumatology, 24(6), pp.769~781 (2010)[DOI]
- Hoy D, "A systematic review of the global prevalence of low back pain", Arthritis & Rheumatism, 64(6), pp.2028~2037 (2012)[DOI]
- 정의균, "만성 통증이 한국의 의료 이용 행태에 미치는 영향", 한국콘텐츠학회 논문지, 15(2), pp.363~369 (2015), 한국콘텐츠학회[DOI]
- Grabois M, "Management of chronic low back pain", American Journal of Physical Medicine & Rehabilitation, 84(3), pp.S29~41 (2005)[DOI]
- Clinical practice guideline for opioid therapy for chronic pain, "Department of Veterans Affairs, Department of Defense", U.S. Department of Veterans Affairs, ~ (2017)
- Chou R, "Nonpharmacologic therapies for low back pain : A systematic review for an American college of physicians clinical practice guideline", Annals of Internal Medicine, 166(7), pp.493~505 (2017)[DOI]
- 임경태, "요통에 대한 도인운동요법의 효과 : 체계적 문헌 고찰", 척추신경추나의학회지, 13(1), pp.23~33 (2018), 척추신경추나의학회[DOI]
- 남대진, "요통 치료의 빈용 경혈과 자가 운동 요법에 대한 체계적 문헌 고찰", 한방재활의학과학회지, 23(4), pp.59~71 (2013), 한방재활의학과학회
- 곽혜원, "만성요통을 가진 중년 여성의 운동요법에 대한 국내 연구논문 분석", 한국산학기술학회논문지, 17(6), pp.389~399 (2016), 한국산학기술학회[DOI]
- "Medical Law" (2009)[URL]
- Ko HY, "Diagnosis and treatment of low back pain: A clinical practice guideline from Korean Association of Pain Medicine", Clinical Pain, 10(1), pp.1~37 (2011)
- Koes BW, "An updated overview of clinical guidelines for the management of non-specific low back pain in primary care", European Spine Journal, 19(12), pp.2075~2094 (2010)[DOI]
- Moher D, "Preferred reporting items for systematic reviews and meta-analyses : The PRISMA statement", Annals of Internal Medicine, 151(4), pp.264~269 (2009)[DOI]
- "Cochrane handbook for systematic reviews of interventions of interventions version 5.1.0" (2011)[URL]
- Kim SY, "NECA’s guidance for undertaking systematic reviews and meta-analyses for intervention", National Evidence-based Healthcare Collaborating Agency, ~ (2011)
- Cooper H, "Research synthesis and meta-analysis: A step-by-step approach" (2017), Sage
- Duval S, "A nonparametric"trim and fill"method of accounting for publication bias in meta-analysis", Journal of the American Statistical Association, 95(449), pp.89~98 (2000)[DOI]
- "Quantifying replicability in systematic reviews: The r-value" (2015)[URL]
- Hedges LV, "Statistical methods for meta-analysis" (1985), Academic Press
- Cohen J, "Statistical power analysis for the behavioral sciences" (1988), Lawrence Erlbaum Associates
- Littell JH, "Systematic reviews and meta-analysis" (2008), Oxford University Press;
- van Tulder MW, "Exercise therapy for low back pain", Cochrane Database of Systematic Reviews, (2), pp.CD000335~ (2000)[DOI]
- Searle A, "Exercise interventions for the treatment of chronic low back pain : A systematic review and meta-analysis of randomised controlled trials", Clinical Rehabilitation, 29(12), pp.1155~1167 (2015)[DOI]
- Kankaanpää M, "Back and hip extensor fatigability in chronic low back pain patients and controls", Archives of Physical Medicine and Rehabilitation, 79(4), pp.412~417 (1998)[DOI]
- 방현수, "요부안정화 운동이 만성요통여성 환자의 근활성도와 등속성 근력에 미치는 영향", 대한물리의학회지, 10(2), pp.63~71 (2015), 대한물리의학회
- 서영택, "Effects of Lumbar Stabilization Using Pressure Biofeedback Unit During Hip Abduction in Side-Lying in Patients With Low Back Pain", 한국전문물리치료학회지, 23(2), pp.67~74 (2016), 한국전문물리치료학회[DOI]
- 전은영, "요통이 있는 여성을 위한 수지요법과 요부강화 운동 프로그램 적용효과", 동서간호학연구지, 19(2), pp.63~70 (2013), 동서간호학연구소[DOI]
- Sheng Y, "Kinesio taping in treatment of chronic non-specific low back pain : A systematic review and metaanalysis", Journal of Rehabilitation Medicine, 51(10), pp.734~740 (2019)[DOI]
- Vanti C, "Effect of taping on spinal pain and disability : Systematic review and meta-analysis of randomized trials", Physical Therapy, 95(4), pp.493~506 (2015)[DOI]
- Nelson NL, "Kinesio taping for chronic low back pain : A systematic review", Journal of Bodywork and Movement Therapies, 20(3), pp.672~681 (2016)[DOI]
- 양순옥, "맞춤형 방문간호사의 재가노인 만성 근골격계 통증 사정 및 관리에 대한 실태조사", 지역사회간호학회지, 21(3), pp.311~320 (2010), 한국지역사회간호학회
- Rubinstein SM, "Benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain: Systematic review and meta-analysis of randomised controlled trials", BMJ, 364, pp.l689~ (2019)[DOI]
- 차현규, "좌골신경가동화기법이 만성 요통 환자의 통증과 슬관절 신전근력에 미치는 영향", 한국전문물리치료학회지, 17(3), pp.31~39 (2010), 한국전문물리치료학회
- Jeong EY, "The effects of hip mobilization on pain, trunk flexibility, function for chronic low back pain patients", The Journal of Korean Academy of Orthopecic Manual Therapy, 24(1), pp.23~29 (2018)