Brizzi A, Giusti A, Giacchetti P, Stefanelli S, Provinciali L, Ceravolo M G
Department of Neuroscience, Azienda Ospedali Riuniti di Ancona, Polytechnic University of Marche, Italy.
Eura Medicophys. 2004 Dec;40(4):303-9.
Physical therapy efficacy in the treatment of low back pain (LBP) has been widely debated and is far from achieving high levels of evidence. Hydroelectrophoresis (Hydrofor) is a novel method of driving drugs through the dermal tissue, which has been proposed for muscle pain treatment. Aim of this randomised placebo-controlled study was to ascertain the efficacy of Hydrofor treatment on acute relapsing episodes of pain in chronic LBP subjects.
Eighteen under-50 adults (M/F: 7/11; age 35+/-8 years) suffering from chronic LBP were enrolled within 3 to 4 days of back pain relapse. After a complete clinical and functional assessment patients were randomly divided into 2 equal groups. Group A received 3 Hydrofor applications of a mixture containing both NSAIDs and muscle relaxants, whereas Group B received 3 Hydrofor applications of a drug-free solution. Afterwards, both groups performed the same rehabilitation treatment consisting of 7 group sessions of standard physiotherapy, including stretching, range of motion and extension exercises. The Oswestry disability index (ODI), the Million instrument scale and a visual analogue scale (VAS) were chosen as outcome measures and applied at baseline, after Hydrofor/placebo applications, after completion of rehabilitation sessions and, at last, 2 months later. The two-way Friedman test was used to analyse within-group (time effect) and between-group (time x group effect) differences.
All subjects declared a significant pain reduction since the first Hydrofor application. Pain evolution overlapped in the 2 groups until the 3rd session, after which Group A significantly diverged from Group B, as they affirmed a greater symptom reduction than controls (time x group effect: VAS: F = 7.4, p <0.01). Such difference disappeared after the physiotherapy sessions as well as 2 months later (time x group effect: VAS: F = 2.1, p =0.08). Pain-related disability showed a greater reduction in Group A than B immediately after Hydrofor application (time x group effect: ODI: F=3.9 p <0.05; Million: F=4.1 p<0.05), but the mean scores almost overlapped at the 2 month follow-up (time x group effect: ODI: F=2.3 p =0.08; Million: F=1.3 p=0.26).
Hydrofor treatment relieves relapsing LBP and could be recommended to active adults as a safe technique shortening the time needed to achieve functional restoration.
物理治疗在腰痛（LBP）治疗中的疗效一直存在广泛争议，且远未达到高水平的证据。水电泳疗法（Hydrofor）是一种通过真皮组织驱动药物的新方法，已被提议用于肌肉疼痛治疗。本随机安慰剂对照研究的目的是确定Hydrofor治疗对慢性腰痛患者急性复发性疼痛发作的疗效。
18名年龄在50岁以下（男/女：7/11；年龄35±8岁）的慢性腰痛患者在背痛复发的3至4天内入组。在进行全面的临床和功能评估后，患者被随机分为两组。A组接受3次Hydrofor治疗，使用含有非甾体抗炎药和肌肉松弛剂的混合物，而B组接受3次Hydrofor治疗，使用无药物溶液。之后，两组都进行相同的康复治疗，包括7次标准物理治疗小组课程，包括拉伸、活动范围和伸展运动。选择Oswestry功能障碍指数（ODI）、Million量表和视觉模拟量表（VAS）作为疗效指标，并在基线、Hydrofor/安慰剂治疗后、康复课程结束后以及最后2个月后应用。采用双向Friedman检验分析组内（时间效应）和组间（时间×组效应）差异。
所有受试者均表示自首次应用Hydrofor治疗后疼痛显著减轻。两组的疼痛进展在第3次治疗前重叠，此后A组与B组明显不同，因为他们确认症状减轻程度大于对照组（时间×组效应：VAS：F = 7.4，p <0.01）。这种差异在物理治疗课程结束后以及2个月后消失（时间×组效应：VAS：F = 2.1，p = 0.08）。在应用Hydrofor治疗后，A组与疼痛相关的功能障碍比B组有更大程度的减轻（时间×组效应：ODI：F = 3.9，p <0.05；Million：F = 4.1，p <0.05），但在2个月随访时平均得分几乎重叠（时间×组效应：ODI：F = 2.3，p = 0.08；Million：F = 1.3，p = 0.26）。
Hydrofor治疗可缓解复发性腰痛，对于活跃的成年人，可作为一种安全的技术推荐使用，它能缩短实现功能恢复所需的时间。
