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1 The Role of Electric Field Therapeutic Device (HEALTHTRON) in The Therapy of Acute Low Back Pain Fujio ITO Ito Orthopedic and Internal Medicine Clinic Summary Thirty-one outpatients with acute low back pain were all educated about activities of daily living. They also received spinal manipulation and SSP (TENS), and took NSAID for a certain period of time. Half of them were additionally exposed an electric field using HEAL THTRON, an electric field therapeutic decice, in order to analyze its efficacy. The patients were randomly divided (non-blind test) into two groups. Those who received ordinary treatment were called the Non-HEALTHTRON group (NH-group); those who received HEALTHTRON treatment in addition to ordinary treatment were called the HEALTHTRON Treatment group (H-group). During the 15-day study period, the patients were subjected to a total of four electric field exposures using HEALTHTRON. Efficacy of the treatment was measured as an objective evaluation by measuring range of motion (ROM) using an inclinometer, and Peak torque and Total work using a dynamometer. A subjective evaluation was performed using the Oswestry Low Back Pain Disability Questionnaire, ADL pain questionnaire, Visual analog scale for Patient global assessment, VAS (Patient) and Visual analog scale for Physician global assessment, VAS (Physician). After ordinary treatment, significant improvement was found in all 31 patients with acute low back pain. The VAS (Physician), ADL pain questionnaire and ROM were more significantly improved in the H-group than in the NH-group. Key words: Electric field therapeutic device (Healthtron), Acute low back pain, Inclinometer, Muscle relaxant effect, Calcium channel
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3 Fig. 1 Electric field therapeutic device. Healthtron HES-30 (Hakuju Institude for Health Science co., ltd., Japan) Using as one session is 20 minutes with sinusoidal field of 15,000 volts. Fig. 2 Dynamometer for assessment of Peak for que and Total work. side testing view with back attachment.
4 130 伊 藤 不二 夫 初 診 に よ る 外 来 患 者 か ら以 上 を 充 た す 急 性 腰 痛 患 者 を 選 択 後,無 く じ 方 式)に 14例 作 為 抽 出(ア ミダ 年 齢 はH群46±15.2才 JTECH社 製,米 前 屈 可 動 域Flexion range Flexion で あ り,Weltch's Extension 男 女 差 はH群 男3名,女11名,non-H群 で あ り,Fisher's ity testの 結 果,両 exact 男 probabil- 客 観 的 測 定 法 of motion, との 関連 を測 定 した 主観 的測 定項 目 ル で は あ る が,点 Dynamometer (NORM, 国)(Fig.2) 伸 展 瞬 間 最 大 トル クExtension 曲 瞬 間 最 大 トル クFlexion torque,伸 展 仕 事 量Extension 屈 曲 仕 事:量:Flexion total peak Oswestry peak naire) total work, workの4パ ラ メ 10項 変Oswestry腰 low back (Table 1) 目,各6段 痛 質 問 表(Modified pain disability 階 点 数 配 分,50点 question- 満 点, 総 合 点 数 を 百 分 率 で 表 示 した *The Dualer Fig.3 1nclinometerfor assesment of range of motion(rom) 類 行 うこ とで評 価 が 偏 らな い よ う に 配 慮 した 1)改 torque,屈 観 的 レベ 数 と して 数 量 的 に 表 現 し た 点 数 化 さ れ た 腰 痛 質 問 表 以 外 に12種 のVASを イ ベ ッ クス 動 作 時 生 活 仕 事 面 等 々 の 次 元 で 患 者 自 身 や 医 師 に よ り,主 化 を 客 観 的 数 量 的 に 測 定 し た 製,米 range を 測 定 す る こ と に よ り腰 椎 の 可 動 域 と腰 痛 4. 二 つ の 測 定 機 器 を用 い て腰 痛 の程 度 や 変 1)サ motion, ROM 腰 痛 を疼 痛 Cybex社 of 群 の 男女 差 に有 意差 は な か っ た(P 0.05) 3. 国)(Fig.3) ROM 伸 展 可 動 域Extension 群 の 年 齢 に有 意差 は な か っ た(P 0.05) 7名,女10名 椎 可 動 域 測 定 器 lnclinometer (DUALER. に分 け た t-testの 結 果,両 痛 の程 度 を 体 幹 屈 伸 筋 力 の 変 化 で 把 握 して み た 2)脊 よ り ヘ ル ス ト ロ ン 群(H群) と 非 ヘ ル ス ト ロ ン 群(non-H群)17例 の2群 ー タ ー を 計 測 す る こ と に よ り,腰 Medical 23,1992 instruction Industries,figure manual, Jtech 15-17,pp.22-
5 Modified Oswestry low back pain disability questionnaire Please answer every section, and mark in each section any one box which applies to you. Table 1. Modified Oswestry Low Back Pain Disability Questionnaire. The Oswestry low back questionnaire was modified for our purpose. The questionnaire consists of 10 sections with 6 choices for each section. Scales 5, 4, 3, 2, 1, 0 are assigned to the 6 choices, the largest number expressing the most adverse condition. Total points were 50. All points were added and converted to a percentage ratio. If the ratio obtained was not a whole number, the number was rounded up to the first decimal point. The 10 categories in the questionnaire are: sitting, lifting, walking, activities of daily living, standing, sleeping, playing sports and hobbies, travelling, medication, and sex life. Considering the cultural background of the patients, "no answer" as an answer for questions on sex life was considered as an effective answer. Example 1: If a patient answered all sections and scored 20 in total. [20 (5 ~10)] ~100=40%. Example 2: If a patient answered all sections except for sex life and scored 20 in total,
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7 Fig. 4 Visual analog scale (physician global assesment) : Non Healthtron treatment group : Healthtron treatment group There were significant differeces between the groups at 1st, 3rd, 5th, 8th and 15th day. **:P ƒ0.01 Fig. 5 Visual analog scale for physician global assessment (VAS (physician)) and patient global assessment (VAS (patient)). The score were divided to four groups (100-75: Very good, 75-50: Good, 50-25: Poor, 25-0: Very poor) on final session (15th day). A and A': VAS (physician), B and B': VAS (patient), A and B: Non-Healthton treatment group (NH-group), A' and B': Healthtron treatment group (H-group). In the H-group, "Very good" ratio was 100% for VAS (physician). In the NH-group for VAS (physician), the ratio obtained by adding "Very good" and "good" was 82%. For VAS (patient), the ratios after adding "good" to "Very good" was 86% and 71% for H and NH-groups, restpectively.
8 Fig. 6 Range of motion (Measured by Inclinometer) A: extension B: flexion : Non Healthtron group : Healthtron group For extension, there were significant differences between the groups at 8th day (P ƒ0.05), For flexion, there were significant differences between the groups at 8th day (p ƒ0.05) and 15th day (P ƒ0.01). *: P ƒ0.05 **: P ƒ0.01
9 Fig. 7 Remainder between post3 and pre treatment on pain questionnaire's score. : Non Healthtron treatment group : Healthtron treatment group *: P ƒ0.05 **: P ƒ0.01 pre-post3: Remainder of score between 1st and 8th day. pre-final: Remainder of score between 1st and 15th day. a. Vocational: there were significant differences between the groups at 8th (P ƒ0.01) and 15th day (P ƒ0.05). b. Sleeping: there were significant differences between the groups at 8th (P ƒ0.05) and 15th day (P ƒ0.05). c. Playing sports and hobbies: there were significant differences between the groups at 8th (P ƒ0.05) and 15th day (P ƒ0.05). d. Total score: there were significant differences between the groups at 15th day (P ƒ0.05).
10 Fig. 8 Peak torque (Measured by Dynamometer) On relieving low back pain, the peak torque was increasing in extension and flexion. It has potential that the measuring a peak torque is useful to evaluate low back pain.
11 5) Yago, Nagasumi et al.: Numerical Taxonomy Electro-potential therapy apparatuses for Family Use in Japan, Proceed. 14th Intern. Cong. Biometeorology: , Slovenia Sep. 1-8, 1996, 7) Mosaic Tech. Inc.: Report of Toranomon Clinic Data: Prepared for Hakuju Institute for Health Science CO. Ltd.: 1-233, 1998 Mar 8) U.S. Department of Health and Human Service, Acute Low Back Problems in Adults: assessment and Treatment. Agency for Health Care Policy and Research Clinical Practice Guideline Quick Reference Guide for Clinicians No.14: AHCPR Publication No.95-2) Yago, Nagasumi et al.: Electro-potential therapy 0643, 1994 Dec. apparatuses revisited-past and present of 9) International Commission on Non-Ionizing electropotential therapy apparatuses in Japan, Radiation Protection (ICNIRP): Guidelines Proceed. 14th Intern. Cong. Biometeorology: for limiting exposure to time-varying electric, , Sep. 1-8, 1996, Slovenia magnetic, and electromagnetic fields, Health physics, vol.74: , ) Fairbank J. C. T. et. al.: The Oswestry Low Back Pain Disabillty Questionnaire, Physio- 66: , therapy, 1980.
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