Effectiveness of a home-based therapeutic exercise program on lower back pain and functionality in Sickle Cell Disease (SCD) patients

Zanoni, Camila Tatiana; Galvão, Fábio; Maria, Renata Manzano; Zulli, Roberto; Ricciardi, Janaina Bosso; Cliquet Junior, Alberto; Saad, Sara Teresinha Olalla

doi:10.1016/j.htct.2020.05.004

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Hematology, Transfusion and Cell Therapy

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Original article • Hematol., Transfus. Cell Ther. 43 (03) • Jul-Sep 2021 • https://doi.org/10.1016/j.htct.2020.05.004 copy

Effectiveness of a home-based therapeutic exercise program on lower back pain and functionality in Sickle Cell Disease (SCD) patients

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To investigate the effectiveness of a home-based therapeutic exercise program on lower back pain and functionality of SCD patients.

Setting:

A Hematology and Transfusion Medicine Center, University of Campinas (HEMOCENTRO-UNICAMP).

Methods:

This was a prospective study, with a three-month follow-up of SCD patients with lower back pain. The lumbar spine functionality was evaluated by questionnaires, trunk flexion and extension analyses by fiber-optic-electrogoniometry and measurements of muscle strength of trunk flexor and extensors. The Intervention Group (IG) comprised 18 volunteers, median age 44y (28–58) and the control group (CG) comprised 15 volunteers, median age 42y (19–58), who did not perform exercises. The protocol consisted of daily home-based exercises with two evaluations: at the beginning and end of a three-month program. In order to compare the groups at baseline, the Fishers´ exact test and Mann–Whitney test were used for categorical and numeric variables, respectively. The Wilcoxon test was used for related samples comparing numeric measures of each group over time with a 5% (p < 0.05) significance level.

Results:

After the intervention, patients demonstrated a significant improvement, according to the Visual-Analog-Scale (VAS; p = 0.01), Rolland Morris Disability questionnaire (RMDQ; p < 0.01) and trunk flexion and extension muscle strength (p < 0.01). No significant differences were found for the Start-Back-Screening-Tool-Brazil (SBST) and in measures of trunk flexion and extension range-of-motion (RoM).

Conclusion:

Results suggest that daily home-based exercises for a three-month period ameliorate pain and improve disability related to lower back pain and muscle strength.

Keywords:
Sickle Cell Disease; Exercise therapy; Exercise; Physical therapy; Back pain

Variable	Characteristic	IG	CG	p-Value
Gender	Male	07 (38.89%)	05 (33.33%)	1.00
	Female	11 (61.11%)	10 (66.67%)
Genotype	HbSS	12 (66.67%)	08 (53.33%)	0.19
	HbSC	04 (22.22%)	07 (46.67%)
	HbSβ	02 (11.11%)	0
Age	Median (min–max)	44.50 (28.00–58.00)	42.00 (19.00–58.00)	0.35
Hemoglobin	Median (min–max)	10.2 (6.8–15.9)	9.2 (5–13)	0.29
Reticulocytes	Median (min–max)	6.98% (2.75%–16.28%)	8.65% (3.32%–32.93%)	0.16
Neutrophils	Median (min–max)	3.44 (1.2–6.79)	3.32 (2.06–7.64)	0.53
Platelets	Median (min–max)	315 (97–646)	344 (77–697)	0.34
Transfusions	Total	3/18	1/15	0.60
Hydrea	Total	10/18	10/15	0.72
Aseptic necrosis	Total	5/18	7/15	0.30
Hip prosthesis	Total	1/18	1/15	1.00

Patient	Age	Gender	Genotype	Hemoglobin	Reticulocytes	Neutrophils	Platelets	Transfusions	Hydrea	Aseptic necrosis	Hip prosthesis
1	41	F	SS	6.8	14.48%	1.68	303	No	Yes	No	No
2	44	M	SS	10.3	6.86%	2.98	220	No	Yes	Femur Bilateral	No
3	49	M	SC	15.9	6.59%	4.93	158	No	No	Femur	No
4	28	M	SS	6.9	16.28%	2.46	334	No	Yes	No	No
5	58	F	SC	11.0	4.52%	3.90	133	No	No	No	No
6	58	M	SC	11.2	4.08%	3.82	97	No	No	No	No
7	45	M	Sβ0	10.9	5.39%	5.39	348	No	No	Lumbar	No
8	55	F	Sβ0	8.2	12.10%	1.66	380	Yes	Yes	No	No
9	57	F	SC	10.4	4.33%	3.80	170	No	No	No	No
10	37	F	SS	7.8	7.10%	1.20	375	No	Yes	No	No
11	38	F	SC	13.6	3.44%	2.74	164	No	No	No	No
12	38	F	Sβ+	10.3	8.72%	3.75	378	Yes	Yes	No	No
13	57	F	SC	9.6	9.18%	2.34	327	Yes	Yes	No	No
14	41	M	SS	10.1	9.23%	4.28	388	No	Yes	No	No
15	53	F	SS	7.7	5.59%	3.13	180	No	Yes	No	No
16	52	F	SS	8.1	7.60%	6.79	646	No	Yes	Femur	Yes
17	37	F	SS	9.2	10.00%	4.87	415	No	No	No	No
18	28	M	Sβ+	12.3	2.75%	2.68	116	No	No	Femur and humerus	No

Patient	Age	Gender	Genotype	Hemoglobin	Reticulocytes	Neutrophils	Platelets	Transfusions	Hydrea	Aseptic necrosis	Hip prosthesis
1	37	F	SS	7.3	19.40%	2.99	306	No	Yes	No	Yes
2	53	F	SC	11.0	7.59%	3.33	414	Yes	No	Knees	No
3	40	M	SS	8.7	8.89%	3.32	697	No	Yes	Hip	No
4	46	F	SS	9.2	8.65%	2.06	412	No	Yes	No	No
5	36	F	SS	7.8	32.93%	3.71	441	No	Yes	Femur, humerus and knees	No
6	39	M	SS	9.2	10.53%	2.70	316	No	Yes	Knee	No
7	47	F	SC	8.9	7.09%	3.23	102	No	No	No	No
8	52	F	SS	8.2	7.77%	4.95	344	No	Yes	No	No
9	43	F	SC	13.0	3.32%	5.69	215	No	No	No	No
10	42	M	SS	5.0	13.23%	6.67	279	No	Yes	No	No
11	30	F	SS	8.0	21.12%	7.64	349	No	Yes	No	No
12	50	M	SC	10.8	8.52%	2.10	77	No	Yes	Hip	No
13	34	F	SS	9.3	15.95%	3.08	381	No	Yes	Femur	No
14	19	M	SC	9.5	4.73%	2.41	427	No	No	No	No
15	58	F	SC	10.3	3.55%	5.65	176	No	No	Humerus and knees	No

		VAS 1	VAS 2	RMDQ 1	RMDQ 2	RoM Flex 1	RoM Flex 2	RoM Ext 1	RoM Ext 2	MS Flex 1	MS Flex 2	MS Ext 1	MS Ext 2
IG	Minimum	0	0	0	0	37	42	11.4	13	0.19	0.3	0.39	1.68
	Median	3	0	10.5	3.5	56.5	52.25	23.75	33	1.67	5.1	4.51	7.36
	Maximum	9	7	22	21	127	135	40	64	11.79	17.11	12.48	20.12
	p-Value Wilcoxon’s test	0.01		<0.01		0.67		0.15		<0.01		<0.01
CG	Minimum	0	0	0	0	34	33	12.5	9	0.24	1.18	0.23	1.39
	Median	4	4	7	12	55	50	20	26	3.32	5.29	5.18	5.64
	Maximum	10	10	24	23	90	106	45	44	11.48	7.97	15.99	15.84
	p-Value Wilcoxon’s test	0.73		0.78		0.48		0.38		0.10		0.06

Group	Variable	Low risk (%)	Medium risk (%)	High risk (%)	p-Value Wilcoxon’s test
IG	SBST 1	44.44	33.33	22.22	0.37
	SBST 2	55.56	27.78	16.67
CG	SBST 1	26.67	40.00	33.33	0.25
	SBST 2	40.00	40.00	20.00

Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular (ABHH) R. Dr. Diogo de Faria, 775 cj 133, 04037-002, São Paulo / SP - Brasil - São Paulo - SP - Brazil
E-mail: htct@abhh.org.br

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[1] *Corresponding author at: Hematology and Transfusion Medicine Center, Universidade Estadual de Campinas (Unicamp), Universitária Zeferino Vaz, Rua Carlos Chagas, 480, Cidade, Barão Geraldo, Campinas, SP, CEP: 13083-878, Brazil. E-mail address: sara@unicamp.br (S.T. Saad).