Effectiveness and Safety of Progressive Loading-Motion Style Acupuncture Treatment for Acute Low Back Pain after Traffic Accidents: A Randomized Controlled Trial

Abstract

Background: Traffic injuries include acute low back pain (LBP) needing active treatment to prevent chronicity. This two-armed, parallel, assessor-blinded, randomized controlled trial evaluated the effectiveness and safety of progressive loading-motion style acupuncture treatment (PL-MSAT) for acute LBP following traffic accidents.

Methods: Based on an effect size of 1.03, 104 participants were recruited and divided in a 1:1 ratio into PL-MAST and control groups using block randomization. Both groups underwent integrative Korean medicine treatment (IKMT) daily; only the PL-MSAT group underwent three PL-MSAT sessions. The outcomes were assessed before and after the treatment sessions and at 1 and 3 months post-discharge. The primary outcome was the difference in the numeric rating scale (NRS) for LBP. The secondary outcomes included a visual analog scale for LBP, leg pain status, the Oswestry disability index, lumbar active range of motion (ROM), quality of life, Patient Global Impression of Change, and Post-Traumatic Stress Disorder Checklist adverse events.

Results: In the modified intention-to-treat analysis, 50 and 51 participants were included in the PL-MSAT and control groups. On Day 4, the mean LBP NRS score was 3.67 (3.44-3.90) in the PL-MSAT group, indicating a significantly lower NRS 0.77 (0.44-1.11) compared to 4.44 (4.20-4.68) for the control group (p < 0.001). The PL-MSAT group exhibited greater ROM flexion (-5.31; -8.15 to -2.48) and extension (-2.09; -3.39 to -0.80). No significant differences were found for the secondary outcomes and follow-ups.

Conclusions: Compared with IKMT alone, PL-MSAT plus IKMT showed significantly better outcomes for reducing pain and increasing the ROM in acute LBP.

Keywords: Korean traditional medicine; acupuncture; exercise therapy; low back pain; progressive loading–motion style acupuncture treatment; randomized controlled trial.

Figure 1

Progressive loading–motion style acupuncture treatment. (A) Perpendicular needling into GV4 (命門, Myeong-Mun) or GV3 (腰陽關, Yoyang-gwan) is performed by the physician, but approximately 3 mm of the body of the needle is not inserted. (B) With the patient in a cross-legged position with the needle partially inserted, the physician gently rocks the participant’s upper body 15 times on either side. (C-1,C-2) The participant is asked to stand with the partially inserted needle, and another needle is inserted into bilateral LR2 (行間, Haeng-gan). (D) The participant walks in place for 15 s, followed by walking forward for a certain distance. (E) The participant is asked to fold their arms, atop which the physician places one sandbag. The participant then walks back and forth twice in a straight line over a distance of 10 m. (F) The physician adds one more sandbag on top until the participant has three sandbags, and the participant walks back and forth twice between each bag. (G) The physician removes the sandbags one by one, and the participant walks back and forth once between each bag. (H) The participant walks in place for 15 s without a sandbag, and then the needles are removed.

Figure 1

Progressive loading–motion style acupuncture treatment. (A) Perpendicular needling into GV4 (命門, Myeong-Mun) or GV3 (腰陽關, Yoyang-gwan) is performed by the physician, but approximately 3 mm of the body of the needle is not inserted. (B) With the patient in a cross-legged position with the needle partially inserted, the physician gently rocks the participant’s upper body 15 times on either side. (C-1,C-2) The participant is asked to stand with the partially inserted needle, and another needle is inserted into bilateral LR2 (行間, Haeng-gan). (D) The participant walks in place for 15 s, followed by walking forward for a certain distance. (E) The participant is asked to fold their arms, atop which the physician places one sandbag. The participant then walks back and forth twice in a straight line over a distance of 10 m. (F) The physician adds one more sandbag on top until the participant has three sandbags, and the participant walks back and forth twice between each bag. (G) The physician removes the sandbags one by one, and the participant walks back and forth once between each bag. (H) The participant walks in place for 15 s without a sandbag, and then the needles are removed.

Figure 2

Flow chart of the participant enrollment process.

Figure 3

Comparison of NRS and range of motion between the PL-MSAT and control groups. All figures show curves for the treatment period (baseline to discharge), with 95% confidence intervals represented by vertical bars. The plots and 95% confidence intervals are presented with least squares estimates and their 95% confidence intervals. From the timepoint of visit 2-2 (after one session of PL-MSAT), the NRS and VAS scores were lower in the PL-MSAT group than in the control group; for all types of ROM, the measurements were larger in the PL-MSAT group than in the control group. Abbreviations: V, visit; D/C, discharge; M, month; PL-MSAT, progressive loading–motion style acupuncture treatment; IKMT, integrative Korean medicine treatment; NRS, numeric rating scale; VAS, visual analog scale; ROM, range of motion; Rt., right; Lt., left.

Figure 4

Subgroup analysis. Abbreviations: PL-MSAT, progressive loading–motion style acupuncture treatment; BMI, body mass index; NRS, numeric rating scale; ODI, Oswestry disability index.