Comparison of the efficacy of Acupuncture and Conventional Physiotherapy treatment in the management of SIJ dysfunction- A Randomised controlled trial (RCT)
Abstract
Background: The question of what form of non-invasive treatment is most effective for sacroiliac joint (SIJ) dysfunction has not been sufficiently addressed. The quality of evidence regarding the efficacy of a conservative treatment approach is low, and there is no evidence for sustained benefits.
Objectives: To compare the efficacy of acupuncture and conventional physiotherapy in the management of pain and functional disability in patients with SIJ dysfunction.
Methods: Forty women with SIJ dysfunction with a mean age of 29.3± 4.3 years participated in the study. Ten participants were randomised into each of three intervention groups (acupuncture (ACT); conventional physiotherapy (CPT); and acupuncture combined with conventional physiotherapy (ACPT)) and a control group (CG) (education and advice). Treatment interventions were provided three times a week for five weeks. The main outcome measures were pain intensity measured with visual analogue scale (VAS) and functional disability measured with Roland Morris Disability Questionnaire (RMDQ). Assessments were carried out by an independent examiner before and after the intervention and at 3 months follow-up.
Results: Baseline VAS and RMDQ scores did not show significant differences among the groups. After treatment, the participants in all the intervention groups had reduced pain scores on the VAS scale (ACT= 3.5±0.06, CPT =3.0±0.08 and ACPT=1.2±0.98) and improved function on RMDQ scores (ACT =7.0±1.53, CPT = 6.0±.01, ACPT = 3.0± 0.08) compared to those in the control group, who recorded 7.4±0.08 and 17.5± 4.32 for pain intensity and functional disability, respectively. However, pain reduction and improvement in function was greatest in the ACPT at the end of the 5-week treatment and at 3-month follow-up (VAS=1.0±0.04, RMDQ =2.0± 0.07) compared with the other intervention groups (VAS: ACT= 4.0±0.97, CPT = 3.5±1.00 and RMDQ: ACT=7.0±1.6, CPT=5.0±0.87). There was a significant difference in the pain scores on VAS (F =67.171, P=0.000) and functional disability on RMDQ scores (F=62.467, P=0.000) among the groups after 5 weeks of treatment and at 3-month post-treatment follow-up assessment VAS (F =79.903, P=0.000) and RMDQ (F =75.301, P=0.000), which was not present at the baseline.
Conclusion: Findings from this study showed that acupuncture or conventional physiotherapy alone or in combination is more effective than advice and education. The combination of acupuncture and conventional therapy is more effective than both treatments alone.
References
Acupuncture Code of practice (2015) by barnet.gov.uk viewed at https://www.barnet.gov.uk/dam/jcr:6f2c62bf.../COP_Acupuncture.pdf (dated accessed: May 15, 2014)
Chou, L.H., Slipman C.W., Bhagia, S.M., Tsaur, L., Bhat, A.L., and Isaac, Z. (2004). Inciting events initiating injection-proven sacroiliac joint syndrome. Pain Medicine Journal 5(1), pp 26-32
Deshpande, A., Furlan, A., Mailis-Gagnon, A., Atlas, S., and Turk, D. (2007) Opioids for chronic low-back pain. Cochrane Database Systematic Review (3): CD004959
Dreyfuss, P., Dreyer, S.J., Cole A., Mayo K. (2004) Sacroiliac Joint Pain, Journal of American Academy of Orthopedic Surgeon 12, pp 255-265.
Elden, H., Lars-Ladfors, L., Fagevik-Olsen, M., and Ostgaard, H., and Hagberg H. (2005). Effects of Acupuncture and exercises as adjunct to standard treatment in pregnant women with pelvic girdle pain: randomised single blind controlled trial. British Medical Journal; pp 330:761
Engers, A., J., Jellema, P., Wensing, M., van der Windt, D., Grol, R., and van Tulder, M.,W., (2011) Individual patient education for low back pain (Review). The Cochrane Collaboration viewed at www.update-software.com/pdf/CD004057.pdf (Date Accessed: March 15, 2015)
Frotin, J., D., Kissling R., O., O’Connor B., L., and Vilensky J.A. (1999) Sacroiliac Joint Innervation and Pain, America Journal of Orthopedics; 28: pp 687-690.
Furlan, A., D., van Tulder, M., Cherkin, D., Tsukayama, H., Lao, L., and Koes B. (2005). Acupuncture and dry-needling for low back pain: an updated systematic review within the framework of the cochrane collaboration. Spine; (8), pp 944-963
Guerreiro, S., Nakamura, M., Cordeiro, J., and Kulay L (2004). Acupuncture for low back pain in pregnancy—a prospective, quasi-randomised, controlled study. Acupuncture in Medicine. 22, pp 60–67
Hungerford, B., Gilleard, W., and Hodges P. (2003). Evidence of altered lumbopelvic muscle recruitment in the presence of sacroiliac joint pain. Spine; 28(14), pp 1593-600.
Kamali, F., and Shokri, E. (2012). The effect of two manipulative therapy techniques and their outcome in patients with sacroiliac joint syndrome. Journal of Bodywork and Movement Therapy; 16(1), pp 29-35
Kvorning, N., Holmberg, C., Grennert, L., Aberg, A., and Akeson, J. (2004) Acupuncture relieves pelvic and low-back pain in late pregnancy. Acta Obstetricia et Gynecologica Scandinavica.83, pp 246–250.
Laslett, M. (2008). Evidence-Based Diagnosis and Treatment of the Painful Sacroiliac Joint. Journal of manual and manipulative therapy; 16(3), pp 142-145
Maigne, J., Y., Aivaliklis A., and Pfefer, F. (1996). Results of Sacroiliac Joint Double Block And Value of Sacroiliac Joint Pain Provocation Tests in 54 Patients with Low Back Pain, Spine, 21, pp1889-1892.
McKee, M., D., Kligler B., Fletcher, J., Biryukov, F., and Casalaina, W. (2013) Anderson B. Outcomes of acupuncture for chronic pain in urban primary care. Journal of American Board of Family Medicine.26: pp 692-695.
Mens, J. M., Snijders C., J., and Stam, H., J. (2000). Diagonal trunk muscle exercises in peripartum pelvic pain: a randomized clinical trial. Physical Therapy; 80, pp 1164–1173
Ostgaard, H., C., Zetherstrom, G., and Roos-Hansson E. (1998). The posterior pelvic pain provocation test in pregnant women .European Spine Journal; 3: pp 258–260
Prather, H., and Hunt, D., (2004), Conservative management of low back pain. Part I. Sacroiliac joint pain. Disease- a- Month: 50 (12), pp 670-683.
Richardson, C.A., Snijders, C.J., Hides, J.A., Damen, L., Pas, M.S, and Storm J. (2002). The relation between the transversus abdominis muscles, sacroiliac joint mechanics, and low back pain. Spine; 27 (4):399-405
Shearar, K., A., Colloca, C.J., and White, H., L. (2005). A randomized clinical trial of manual versus mechanical force manipulation in the treatment of sacroiliac joint syndrome. Journal of Manipulative Physiological Therapeutics; (7), pp 493-501.
Slipman, C., W., Jackson, H.B., Lipetz, J.S., Chan, K.T., Lenrow, D., and Vresilovic, E., H. (2000). Sacroiliac joint pain referral zones. Archives of Physical Medicine and Rehabilitation; 81(3), pp 334-348
Smith C, and Grimmer-Somers K (2010). “The treatment effect of exercise programmes for chronic low back pain”. Journal of Evaluation in Clinical Practice; 16 pp 484–491
Sokunbi, O., G., and Kachalla F., G. (2015) Effects of Acupuncture, Core-stability Exercises, and Treadmill Walking Exercises in Treating a Patient with Postsurgical Lumbar Disc Herniation: A Clinical Case Report, Journal of Acupuncture and Meridian Studies 8(1), pp 48-52
Sokunbi, O.,G., Kachalla, F.,G., and Maduagwu S., M. (2014) The use of Alternate Side lying Manipulation, Acupuncture and Core stability exercises in the treatment of multiple level disc prolapse. IOSR Journal of Dental and Medical Sciences 13(10), pp 90-96.
Sokunbi, O., G., and Usman, M., B. (2014). Effects of Conventional and Acupuncture like Transcutaneous Electrical Nerve Stimulation [TENS] on Osteoarthritis of the Knee. Nigerian Journal of Experimental and Clinical Biosciences. 2(2), pp 69-74
Sokunbi O., Watt P., Moore A. (2002) Changes in plasma concentration of serotonin in response to spinal stabilisation exercise in chronic low back pain patient. Nigerian Quarterly Journal of Hospital Medicine; 17, pp 108-111.
Stuge, B., Veierod M., B., Laerum, E., and Vollestad, N. (2004). The efficacy of a treatment program focusing on specific stabilizing exercises for pelvic girdle pain after pregnancy: a two-year follow-up of a randomized clinical trial. Spine 29: pp E197–203
Stux, G., and Pomeranz, B. (1998) Basics of Acupuncture. New York, NY: Springer: pp 280-284.
Tukmachi, E., Jubb, R., Dempsey, E, and Jones P. (2004). The effect of acupuncture on the Symptoms of knee Osteoarthritis — An open randomised controlled study. Acupuncture in Medicine; 22, pp 14-22
Tullberg, T., Blomberg S., Branth, B., and Johnsson R. (1998). Manipulation does not alter the position of the sacroiliac joint. A roentgen stereophotogrammetric analysis. Spine; 10, pp 1124-1128.
Van der Wurff, P., Buiis, E., J., and Groen, G., J. (2006) A multitest regimen of pain provocation tests as an aid to reduce unnecessary minimally invasive sacroiliac joint procedures Archives of Physical Medicine and Rehabilitation:. 87(1), pp10-14.
Vleeming, A., Albert, H., B., Ostgaard, C., H., Sturesson, B., and Stuge, B (2008); European guidelines for the diagnosis and treatment of pelvic girdle pain. European Spine Journal; 17(6), pp 794–819
Von Korff, M., Jensen, M., P., and Karoly, P. (2000). Assessing global pain severity by self-report in clinical health service research Spine 25, pp 3140-3151
Wedenberg, K., Moen B., Norling, A. (2000). A prospective randomized study comparing acupuncture with physiotherapy for low-back and pelvic pain in pregnancy. Acta Obstetricia et Gynecologica Scandinavica; 79, pp 331–335
