The Efficacy of Active Conservative Treatment for Patients With Severe Sciatica. A Randomized Clinical Controlled Trial
Condition: Sciatica
MeSH terms: Sciatica
Study type: Interventional

Summary: 
      This Study si designed as a Prospective clinical controlled randomized trial.

      Background:

      Reviews have demonstrated no or little efficacy for passive conservative treatment modalities
      for patients suffering from sciatica. The results of surgery are conflicting. Cohort studies
      have shown a high efficacy for active treatment modalities in patients with sciatica. The
      current trend in treatment of low back pain without sciatica is focusing on active
      conservative treatment like information and advice to stay active and exercises.

      Aim: To evaluate the efficacy of two active conservative treatment programs for patients with
      severe sciatica.

      Methods: In a prospective clinical controlled randomized trial, 181 consecutive patients with
      radicular pain below the knee were examined at baseline, 8 weeks later at post treatment
      follow-up, and at one year follow-up and MR-scanned at baseline and one year follow-up. The
      treatment consisted of four elements: 1-3 were identical in both groups. 1. Thorough
      information concerning anatomy, pathogenesis, how discs heal without surgery, and
      encouragement to stay as active as possible but to reduce activity if an increase in leg pain
      occurs. 2." Tender love and care". 3. Medication; this was optional and only weak analgesic
      and NSAIDs were recommended.

      Element 4 consisted of two different exercise programs. Symptom guided exercises consisted of
      a variety of back related exercises and optional manual treatment. The exercises were given
      after an algorithm, where different symptoms or a response to exercises determined the
      exercises given. The other group, Sham exercises had voluntary not back related exercises.
      The exercises were aimed at increasing the general blood circulation and maintaining strength
      in the extremities. Outcome measures were functional status, pain, MRI findings, clinical
      findings, and history
    

Detailed description: 
      Summary of Background Data. Sciatica as a result of a herniated disk is a fairly common
      problem; studies have shown a life time prevalence of 4-5 % in the Scandinavian population.
      Though a herniated disk is a benign disease with a relatively good prognosis, the pain and
      functional loss, are in most patients rather considerable over a period of some months
      Reviews have demonstrated no or little efficacy for passive conservative treatment
      modalities. Results for surgery are conflicting. Cohort studies have shown a high efficacy
      for active treatment modalities in patients with sciatica.

      The current trend in back treatment is information and advice to stay active including active
      treatment modalities in which patients are given responsibility during the treatment process
      and the treatment assumes the role of a "coach".

      Objectives. To evaluate the efficacy of two active conservative treatment programs for
      patients with severe sciatica.

      Methods A prospective clinical controlled randomized trial including 181 consecutive patients
      with radicular pain below the knee. The patients were examined at baseline, 8 weeks later at
      post treatment follow-up, and, and MR-scanned at baseline and at the one year follow-up The
      treatment consisted of four elements; 1-3 were identical in both groups. 1. Thorough
      information concerning anatomy, pathogenesis, how discs heal without surgery, and
      encouragement to stay as active as possible but to reduce activity if an increase in leg pain
      occurs. 2. Tender love and care. 3. Medication, this was optional and only weak analgesic and
      NSAID'S were recommended.

      Element 4 was divided into a "Hands on" and "Hands off", utilizing two different exercise
      programs. "Hands on" consisted of a variety of back related exercises and optional manual
      treatment. The exercises were given after a strict algorithm, where different symptoms or a
      response to exercises determined the exercises given.

      "Hands off" exercises were optional and generally not back related. They were geared towards
      increasing general blood circulation and maintaining strength in the extremities.
    

Intervention name(s): Active conservative treatment of sciatica
Intervention type(s): Procedure
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single
Primary purpose: Treatment
Keywords: Physical therapy