Bedrust en fysiotherapie geen meerwaarde bij acute lumbosacrale radiculaire pijn; een gerandomiseerde, klinische studie

To compare the efficacies of three non-surgical treatment strategies in patients with sciatica.

Design

Randomised, open.

Method

Patients younger than 60 years, with sciatica of less than one month's duration and not yet treated with bed rest or physiotherapy, were prescribed: bed rest for seven days, physiotherapy for 4-8 weeks, or a control treatment (continuation of the normal daily activities as much as possible). Primary outcome measures were the degree of radicular pain (Visual Analogue Pain Scale, VAPS) and the severity of the impairment of daily activities (Quebec Disability Scale, QDS). Secondary outcome measures were the percentages of patients in whom the conservative management failed and surgery became necessary. The measures were assessed at baseline and during follow-up at one, two and six months.

Results

A total of 250 patients (150 men (60) and 100 women (40), average age 39 years) were included in the study. The mean differences in VAPS and QDS scores between bed rest and control treatment were 0.9 (95 CI: –8.7-10.4) and –2.7 (–9.9-4.4) at two months and 0.5 (–8.4-9.3) and –2.7 (–10.2-4.8) at 6 months. The mean differences in VAPS and QDS scores between physiotherapy and control treatment were –0.3 (–9.4-10.0) and 0.0 (–7.2-7.3) at two months and –1.0 (–10.0-8.0) and –0.7 (–8.4-6.9) at 6 months. Odds ratios for failure of conservative treatment and required surgery at six months versus control treatment were 1.6 (0.8-3.5 and 1.5 (0.7-3.6) for bed rest and 1.5 (0.7-3.2) and 1.2 (0.5-2.9) for physiotherapy.

Conclusion

In patients with acute sciatica, bed rest and physiotherapy were no more effective than continuation of normal daily activities as much as possible, without specific treatment.