Abstract
Background: Reviews have showed none or little efficacy of passive conservative treatment modalities for patients with sciatica, reviews on surgery are conflicting. Cohort studies have shown high efficacy of active conservative treatment for patients with sciatica.
The aim was to evaluate the efficacy of two active conservative treatment programs to patients with severe sciatica.
Methods: The study was a prospective single-blind randomized clinical controlled trial of 181 consecutive patients with radicular pain below the knee. The patients were examined at baseline, 8 weeks later at post treatment follow-up, and at one year follow-up.
In both groups treatment consisted of thorough Information concerning anatomy, pathogenesis, how discs heal without surgery, and Advice and encouragement to stay as active as possible, and optional medication. Then either Symptom guided exercises or Sham exercises.
Results: All patients experienced a highly significant and clinically important improvement in global assessment, functional status, pain, vocational status, and clinical findings. The Symptom guided exercises + Information + Advice to stay active group (SYMIA) was significantly superior to the Sham exercises + Information + Advice to stay active group (SHAMIA) with regards to global assessment, clinical findings, sick leave and vocational status both at end of treatment and one year follow-up. There was a borderline significant difference in leg pain at end of treatment, and no difference was found in RMQ and EQ-5D.
Conclusion: Patients who had symptoms and clinical findings which would qualify them for surgery in most hospitals improved greatly with active conservative treatment. Although the patients had greater faith in the SHAMIA before treatment, the SYMIA treatment was superior in most outcomes.
Correspondence should be addressed to Mr J. O’Dowd, Honorary Secretary at SBPR c/o BOA, Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London, WC2A 3PE.
