Analysis of combined shockwave therapy and aquatic exercise for chronic nonspecific low back pain

Abstract

This study evaluates the clinical efficacy of combined shockwave therapy and aquatic exercise therapy in patients with chronic nonspecific low back pain (CNLBP) and compares it with conventional treatments to provide evidence for clinical practice. A retrospective cohort study was conducted with 108 CNLBP patients who visited our hospital from April 2022 to April 2023. Patients were divided into a combined therapy group (41 cases) and a conventional therapy group (67 cases). Propensity score matching adjusted for baseline characteristics. The combined therapy group received both shockwave therapy and aquatic exercise, while the conventional therapy group received traditional physical therapy. Patient outcomes were assessed using the visual analog scale, Oswestry disability index, and short form 36-item health survey quality of life questionnaire. After matching, there were no significant differences in baseline characteristics between the 2 groups (P > .05). The combined therapy group showed better results in several clinical measures. Visual analog scale scores decreased from 6.9 ± 1.3 to 3.2 ± 1.1 in the combined therapy group, compared to 7.1 ± 1.4 to 4.5 ± 1.3 in the conventional group (P = .021). The combined therapy group's Oswestry disability index (ODI) score decreased from 38.5 ± 6.8 to 20.3 ± 5.2, better than the conventional group, which decreased from 39.1 ± 6.9 to 25.1 ± 6.3 (P = .045). The combined therapy group's Berg balance scale improved from 42.5 ± 5.2 to 51.2 ± 3.4, while the conventional group improved from 43.0 ± 5.5 to 47.8 ± 4.6 (P = .029). Significant improvements were also observed in anxiety (hospital anxiety and depression scale) and sleep quality (Pittsburgh sleep quality index). In quality of life, the short form 36-item health survey score in the combined therapy group increased from 45.3 ± 8.2 to 75.1 ± 7.6, significantly better than the conventional group's increase from 43.7 ± 7.9 to 68.2 ± 8.4 (P = .038). Combined shockwave therapy and aquatic exercise therapy significantly improve pain, function, posture control, psychological health, and quality of life in CNLBP patients, outperforming conventional physical therapy. This noninvasive and effective rehabilitation method is recommended for wider clinical use to enhance recovery and quality of life.

Keywords: aquatic exercise therapy; chronic nonspecific low back pain; functional recovery; pain management; quality of life; shockwave therapy.