Introduction Low back pain (LBP) is a major cause of visits to ambulatory care, missed duty time, and disability discharge. The subacute phase of LBP presents an opportune time to prevent chronicity and lessen recurrence. The goal of this randomized controlled trial (RCT) was to determine the relative effectiveness of neuromuscular electrical stimulation (NMES) training and a progressive exercise program (PEP) on improving physical performance, pain, and torso strength in U.S. service members with subacute LBP, compared to standard primary care management (PCM) alone. Methods This is an Institutional Review Board–approved protocol for an RCT conducted with active duty military personnel (n = 128) at Fort Campbell, Kentucky, between April 2018 and March 2020. Participants were randomized to receive NMES (n = 43), PEP (n = 42), or PCM (n = 43) for 9 weeks. Outcome measures of physical performance (sit-ups, push-ups, walking, and torso endurance), torso muscle strength (flexion and extension), and pain were assessed at baseline and after 3, 6, and 9 weeks. Analysis was intent-to-treat using linear mixed effects models. A sensitivity analysis was performed to address the protocol deviations that occurred in response to coronavirus disease 2019 pandemic, which required rescheduling 17 in-person study visits to home assessments at 9-week testing. Results Evidence was found for group differences in physical performance for sit-ups and push-ups, with NMES showing greater improvement than PCM. The two groups showed similar improvements in torso muscle strength, although the NMES groups may show better improvement during early treatment. No group differences in pain levels were observed during the intervention, and all groups improved during the course of the study period. The amount of NMES muscle stimulation was directly related to the level of improvement, which was not the case for the hours reported for PEP exercise. Conclusion In an active duty population with subacute LBP, integrating NMES strength training into the rehabilitation therapy may offer a modest benefit for increasing sit-ups and push-ups and improving torso strength.

中文翻译：

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现役军人亚急性腰痛的非药物家庭疗法：一项随机对照试验

简介 腰痛 (LBP) 是门诊就诊、误工和伤残出院的主要原因。LBP 的亚急性期是预防慢性化和减少复发的好时机。这项随机对照试验 (RCT) 的目的是确定神经肌肉电刺激 (NMES) 训练和渐进式锻炼计划 (PEP) 对改善患有亚急性 LBP 的美国服役人员的身体表现、疼痛和躯干力量的相对有效性，与单独的标准初级保健管理 (PCM) 相比。方(n = 42), 或 PCM (n = 43) 9 周。在基线和 3、6 和 9 周后评估身体表现（仰卧起坐、俯卧撑、步行和躯干耐力）、躯干肌肉力量（屈曲和伸展）和疼痛的结果测量。使用线性混合效应模型进行意向治疗分析。进行了一项敏感性分析，以解决为应对 2019 年冠状病毒病大流行而发生的方案偏差，这需要在为期 9 周的测试中重新安排 17 次面对面研究访问以进行家庭评估。结果 发现了仰卧起坐和俯卧撑的身体表现存在组间差异的证据，NMES 比 PCM 表现出更大的改善。两组在躯干肌肉力量方面表现出相似的改善，尽管 NMES 组在早期治疗期间可能表现出更好的改善。在干预期间没有观察到疼痛水平的组别差异，并且所有组在研究期间都有所改善。NMES 肌肉刺激量与改善程度直接相关，而 PEP 锻炼报告的小时数则并非如此。结论 在患有亚急性 LBP 的现役人群中，将 NMES 力量训练整合到康复治疗中可能对增加仰卧起坐和俯卧撑以及提高躯干力量提供适度的益处。