Eficacia de los ejercicios terapéuticos de espalda y Pilates en la mejora clínica de la intensidad del dolor lumbar crónico y determinación del umbral mínimo de mejora clínicamente importante de los tratamientos en el ámbito hospitalario (Effectiveness of back therapeutic exercises and Pilates on the clinical improvement of the intensity of chronic low back pain and determination of the minimal clinically important improvement threshold from treatments in a hospital setting)

Autores/as

  • Mario Manuel López Mesa Universidad Alfonso X el Sabio https://orcid.org/0000-0002-0452-1570
  • Javier j. Cabrerizo Fernández Henares University Hospital
  • Yolanda Robledo do Nascimento Henares University Hospital
  • Mario Manuel López Mesa Henares University Hospital

DOI:

https://doi.org/10.47197/retos.v61.109841

Palabras clave:

Ejercicios terapéuticos para la espalda, Pilates, dolor lumbar crónico, Escala Visual Analógica del Dolor, Cambio Mínimo Clínicamente Importante.

Resumen

La finalidad principal fue comparar la efectividad de ejercicios terapéuticos para la espalda y Pilates en la reducción del dolor lumbar crónico y determinar el umbral de mejora y la diferencia en las puntuaciones pre y postratamiento que se considera clínicamente relevante para los pacientes. Metodología: Se incluyeron 53 pacientes con dolor lumbar crónico, quienes fueron asignados aleatoriamente a dos grupos: uno con 27 participantes que realizó Pilates y otro con 26 que siguió un programa de ejercicios para la espalda. El tratamiento consistió en sesiones dos veces por semana durante tres meses. La intensidad del dolor se evaluó antes y después del tratamiento mediante la Escala Visual Analógica del Dolor. Se definió un umbral clínicamente relevante como una reducción suficiente en la puntuación de dolor para que los pacientes se sintieran "muy satisfechos". Un análisis de la Receiver Operating Characteristic Curve se utilizó para determinar la sensibilidad y especificidad del umbral de mejora. Además, se aplicó un modelo de regresión lineal para analizar la relación entre la diferencia en las puntuaciones y el porcentaje de mejora. Resultados Tras los tratamientos, aunque ambos grupos mostraron mejoras significativas en la reducción del dolor, no hubo diferencias estadísticamente significativas entre ellos. Las reducciones promedio de ambos grupos no superaron los dos puntos (Grupo ejercicios de espalda=1.43 puntos, Grupo Pilates=1.82 puntos) , por lo que no alcanzaron los dos puntos de promedio de mejora que marca el umbral de mejora clínicamente relevante. Sin embargo, a nivel individual, el 45,83% de los pacientes del grupo de Pilates y el 37,5% del grupo de ejercicios de espalda lograron una mejora clínicamente relevante (porcentaje de mejora≥30%). El umbral de mejora del 31,4%, equivalente a una reducción de dos puntos, se correlacionó con una mayor satisfacción clínica (sensibilidad 84%, especificidad 87%).Conclusiones: Ambos tratamientos produjeron efectos beneficiosos en la reducción del dolor lumbar crónico. Sin embargo, la mejora promedio no fue clínicamente relevante en la muestra total. A nivel individual, una proporción importante de pacientes alcanzó una mejora clínicamente relevante, especialmente en el grupo de Pilates. El umbral de mejora del 31,4% constituye un indicador adicional para evaluar la relevancia clínica de los tratamientos.

Palabras claves: Ejercicios terapéuticos para la espalda, Pilates, dolor lumbar crónico, Escala Visual Analógica del Dolor, Cambio Mínimo Clínicamente Importante.

Abstract. The primary aim was to compare the effectiveness of therapeutic back exercises and Pilates in reducing chronic low back pain and to determine the threshold of improvement and the difference in pre- and post-treatment scores considered clinically relevant for patients. Methodology: A total of 53 patients with chronic low back pain were randomly assigned to two groups: one with 27 participants performing Pilates and another with 26 participants following a back exercise program. The treatment consisted of sessions twice a week for three months. Pain intensity was assessed before and after treatment using the Visual Analog Pain Scale. A clinically relevant threshold was defined as a sufficient reduction in pain score for patients to feel "very satisfied." A Receiver Operating Characteristic Curve analysis was used to determine the sensitivity and specificity of the improvement threshold. Additionally, a linear regression model was applied to analyze the relationship between score difference and the percentage of improvement. Results: Although both groups showed significant improvements in pain reduction after treatment, there were no statistically significant differences between them. The average reductions in both groups did not exceed two points (Back Exercise Group = 1.43 points, Pilates Group = 1.82 points), thus not reaching the two-point average improvement required to meet the clinically relevant improvement threshold. However, at an individual level, 45.83% of the Pilates group and 37.5% of the back exercise group achieved a clinically relevant improvement (≥30% improvement). The improvement threshold of 31.4%, equivalent to a two-point reduction, was correlated with greater clinical satisfaction (sensitivity 84%, specificity 87%). Conclusions: Both treatments produced beneficial effects in reducing chronic low back pain. However, the average improvement was not clinically relevant for the overall sample. At an individual level, a significant proportion of patients achieved clinically relevant improvement, particularly in the Pilates group. The 31.4% improvement threshold serves as an additional indicator for evaluating the clinical relevance of treatments.

Keywords: Therapeutic back exercises, Pilates, chronic low back pain, Visual Analog Scale for Pain, Minimal Clinically Important Change.

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2024-10-02

Cómo citar

López Mesa, M. M., Cabrerizo Fernández, J. j., Robledo do Nascimento, Y., & López Mesa, M. M. (2024). Eficacia de los ejercicios terapéuticos de espalda y Pilates en la mejora clínica de la intensidad del dolor lumbar crónico y determinación del umbral mínimo de mejora clínicamente importante de los tratamientos en el ámbito hospitalario (Effectiveness of back therapeutic exercises and Pilates on the clinical improvement of the intensity of chronic low back pain and determination of the minimal clinically important improvement threshold from treatments in a hospital setting). Retos, 61, 173–184. https://doi.org/10.47197/retos.v61.109841

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