EFFECT OF VOJTA METHOD ON QUALITY OF LIFE IN PATIENTS WITH CHRONIC NON-SPECIFIC LOW BACK PAIN

EFFECT OF VOJTA METHOD ON QUALITY OF LIFE
IN PATIENTS WITH CHRONIC NON-SPECIFIC
LOW BACK PAIN
Walaa M. Hamed1* ; Amal H. Ibrahim 2 and Amr S. Shalaby 3
1- Teaching assistant at Department of Basic Sciences, Faculty of Physical Therapy,
Modern University for Technology and Information Egypt.
2- Professor of Physical Therapy, Basic Sciences Department, Faculty of Physical
Therapy, Cairo University, Egypt
3- Lecturer of Physical Therapy, Basic Sciences Department, Faculty of Physical
Therapy, Cairo University, Egypt
1*Email - Dr-walaamohamed@hotmail.com
Key Words: Vojta method, quality of life, chronic non-specific low
back pain.
ABSTRACT:
Background: Vojta is a neurophysiological method used to obtain
reflex responses in muscles following stimulation of particular activation
zones
Objective: This study was designed to determine the impact of Vojta
method on quality of life in chronic non-specific low back pain. Method:
40 patients (19 males and 21 females), Their mean ± SD age, weight,
height and BMI were 26.45 ± 4.75 years, 67.15 ± 7.72 Kg, 171.1 ± 8.09
cm and 22.94 ± 1.92 kg/m² respectively. and chronic non-specific low
back pain were recruited in the study and randomly assigned into two
equal groups. Both groups received twelve sessions for four weeks.
Group "A" received conventional TENS and hot application, Group "B"
received conventional TENS and hot application in addition to Vojta
method. Results: Within-group comparisons revealed that post-treatment
Oswestry Low Back Pain Disability Index (ODI) scores in both groups
were significantly lower than pre-treatment scores (p > 0.001). In pretreatment
scores, there was no substantial difference between groups
(p>0.05), but post-treatment scores of both groups indicated a significant
decrease in group B's ODI. Conclusion: We concluded that Vojta
method is a safe and effective modality, and had superior improvements
on quality of life in chronic non-specific low back pain compared to
traditional physical therapy treatment .
INTRODUCTION
Nearly 90% of the patients presenting to primary care have a complain
of chronic non-specific low back pain, that compel them to seek
physiotherapy intervention for their low back pain.. (1)
Quality of life (QOL) is the Person and societal well-being, which
includes both negative and positive aspects of life. (2) Being a pivotal
Egypt. J. of Appl. Sci., 36 (5-6) 2021 29-40
concern in life, multitude of aspects in life might impact or be impacted by
different aspects of QOL including physical health, family, education, jobs,
income, safety, and protection, as well are rights, religious values, and the
environment. (3) Health-related quality of life HRQOL is a measurement of
QOL and its affection as a consequence to health issues.(4)
Chronic non-specific low back pain (CNLBP) has an impact on
Health Related Quality of Life (HRQL) in a variety of life domains,
including physical and mental well-being, social relationships, and
functional capacity. (5) HRQL has become a valuable outcome in health care
that can provide an estimate of how the disease influences people’s lives and
how they manage to live with CNLBP, and is currently used as a measure of
treatment efficacy. It is important to assess the quality of life of people with
CNLBP in order to set care goals and develop a treatment plan that is
focused on tracking the progression of the disease. (6)
Vojta "Dynamic Neuromuscular Stabilization (DNS)" reflex
locomotion is a neurophysiological approach for obtaining reflex responses
in back muscles following stimulation of specific activation zones. (7)
Vojta reflex locomotion’s concept is basically based on preserving
postures through isometric muscle contractions during point stimulation, that
result in consistent muscle contraction patterns and stimulation of muscles,
joints, and tendons. Furthermore, Exteroceptors and enteroceptors are
connected to the Vojta reflex locomotion, which acts as a source of afferent
stimulation to the CNS. (8)
In Vojta technique, the therapist administers goal-directed pressure to
defined zones on the patient’s body .Regardless of the patient’s age, such
stimuli lead automatically and involuntarily to two movement complexes,
reflex creeping and reflex rolling. (9)
MATERIAL AND METHODS
Study Design
This study is a pre-test post-test randomized controlled study
design that was conducted at the outpatient clinic, Faculty of Physical
Therapy, Modern University for Technology and Information from May
2020 to February 2021 to determine the impact of Vojta method on
quality of life in chronic non-specific low back pain.
G*POWER statistical software (version3.1.9.2; Franz Faul,
Universitt Kiel, Germany) was used to calculate sample size prior to the
analysis. The appropriate sample size for this study was N=40, with
observed power equal to0.8, according to sample size estimates. (10)
Subjects:
Forty patients (19 male and 21 female), complaining of CNLBP
were recruited and randomly assigned into two equal groups, control
group (A) and experimental group (B). All patients signed a written
consent form before engaging in the study. Their mean ± SD age, weight,
30 Egypt. J. of Appl. Sci., 36 (5-6) 2021
height and BMI were 26.45 ± 4.75 years, 67.15 ± 7.72 Kg, 171.1 ± 8.09
cm and 22.94 ± 1.92 kg/m² respectively.
Study recruitment eligibility:
42 patients who met the current study's inclusion requirements
were evaluated for recruitment eligibility; two patients were removed
from the study because they refused to participate. The remaining 40
patients of the eligible candidates, were randomized to either of the study
groups. All recruited patients at the beginning of the study completed the
study and their data had been collected and analyzed using parametric
testing.
Figure (1): CONSORT Flow chart for patients in the study
Analysis
Assessed for eligibility
n=42
Group b (n=20)
Received conventional physical therapy
treatment and vojta method
Group a (n=20)
Received conventional physical
therapy treatment
Group B (n=20) completed the
analysis
Group A (n=20) completed the
analysis
Excluded n = 2
decline to participate n=2
Randomization n = 40
Allocation
Egypt. J. of Appl. Sci., 36 (5-6) 2021 31
Randomization
Simple randomization was done using sealed envelope method
before recruiting patients in the study. Patients meeting all inclusion
criteria were instructed to select one of the 40 sealed envelopes. Each of
the sealed envelopes included a slip of paper with either the letter (A) or
(B) which refer to the group the patient is assigned to.
Group A: included twenty patients who received conventional treatment
of back pain for three sessions per week for four weeks which
consisted of conventional TENS for 20 minutes and hot packs
for 10 minutes. The total duration of the treatment session
was 30 minutes.
Group B: included twenty patients who received conventional treatment
of back pain in addition to Vojta method for three sessions
per week for four weeks. The total duration of the treatment
session was 40 minutes.
Outcome measures
Oswestry Low Back Pain Disability Index (ODI)
The Oswestry Low Back Pain Disability index is critical instrument
used by researchers and disability evaluators to assess patients' long-term
functional disability and quality of life. The test regarded as the ‘gold
standard’ method for determining low back functional outcome. (11) Each
scale object is a six-point scale, with the first statement denoting 0 and
the last denoting 5, The results of the completed 10 sections of the
questionnaire were used to calculate the overall score. The final result is
a ranking of 50. (12)
Interpretation of scores
A score of 0% to 20% on the questionnaire indicates that the patient
has no disabilities and is capable of performing most daily activities.
Aside from recommendations on lifting, sitting, and exercise, there is
usually no treatment recommended. Patients with scores of 21% to 40%
have mild impairment, meaning they have more pain and trouble
performing tasks of daily life such as sitting, lifting, and standing. It is
more difficult for them to travel and socialise, and they may be unable to
work. Personal hygiene, sexual activity, and sleeping patterns are
unaffected, and the patient can normally be treated with minimal
intervention. Scores of 41%-60% indicate severe disability, implying
that pain is the patient's main source of distress and that daily activities
are significantly impacted. These patients need to be helped. Patients
with scores of 61 percent to 80 percent are disabled, and their back pain
32 Egypt. J. of Appl. Sci., 36 (5-6) 2021
affects every aspect of their lives, necessitating positive action. Scores
ranging from 81 percent to 100 percent indicate that these patients are
either bed-bound or exaggerating their symptoms. (13)
Interventions
a) Conventional physical therapy program:
 Conventional TENS
Conventional high frequency TENS was applied using four
electrodes on the back with pulse duration of 60e 100 μsec. frequency of
(80 Hz) and total treatment time of 20 min. (14)
 Hot Packs
Hot packs were applied on the back region for 10 minutes. (15)
b) Vojta method
Every patient in group B was asked to assume the starting position
for this technique. He or she lie prone on an examination table, shoulders
kidnapped, elbows flexed to around 80-90 degrees, and forearms
dangling over the table's edge. (16)
In the postural location "reflex creeping," pressure-like stimulation
of the calcaneus and anterior superior iliac spine (ASIS) was performed.
The subject is in the starting position, with the head turned 30 degrees
and assisted on the frontal eminence, and the cervical spine extended
passively. (17)
The patient was instructed to the flex the glenohumeral joint of the
face side to more than 120º and less than 135º, with maintaining 30º of
abduction with elbow flexed 45º and supported on medial epicondyle, as
support point. (17, 18)
On the occipital side, the upper extremity, as well as hand and
fingers, was free to travel around the trunk. The lower extremity on
occipital side was lying supported on the medial femoral epicondyle with
hip and knee joints flexed. (18)
Statistical analysis
To compare subject characteristics between classes, descriptive
statistics and an unpaired t-test were used. The sex distribution between
groups was compared using Chi-squared. The Shapiro-Wilk test was
used to ensure that the data had a normal distribution. To determine
group homogeneity, Levene's test for homogeneity of variances was
used. To compare the mean ODI values between the two classes, an
unpaired t-test was used. For each category, a paired t-test was used to
compare pre- and post-treatment scores. For all statistical analyses, the
significance level was set at p 0.05. The statistical package for social
Egypt. J. of Appl. Sci., 36 (5-6) 2021 33
studies (SPSS) version 22 for Windows was used for all statistical
analysis (IBM SPSS, Chicago, IL, USA)
Outcome
Characteristics of the subjects:
This research enlisted the participation of forty patients. The
subject characteristics of groups A and B were shown in Table 1. The
mean age, weight, height, BMI, and sex distribution did not significantly
differ between the two groups (p > 0.05).
Table 1: Shows the differences in subject characteristics between
groups A and B:
Group A Group B
P-value
Mean ± SD Mean ± SD
Age (years) 26.45 ± 4.75 26.05 ± 4.6 0.87
Weight 67.15 ± 7.72 68.85 ± 8 0.94
Height 171.1 ± 8.09 172.75 ± 7.45 0.5
BMI (kg/m²) 22.94 ± 1.92 23.04 ± 1.76 0.75
Females/males 10/10 11/9 0.75
SD, Standard deviation; p value, Probability value
Effect of Vojta method on ODI:
- Within group comparison:
In both groups A and B, the ODI post-treatment scores were
significantly lower than the pre-treatment scores (p > 0.001). Group A
had a 20.22 percent decrease in ODI, while group B had a 35.56 percent
decrease. (Table 2).
- Between groups comparison:
Pre-treatment, there was no substantial difference in ODI between
the two groups (p > 0.05). When the ODI of groups B and A were
compared after treatment, group B had a significantly lower ODI than
group A (p 0.01).
Table 2: Shows the mean ODI of groups A and B before and after
treatment:
Group (A) Group (B)
ODI (%) Mean ± SD Mean ± SD MD t- value p value
Pre treatment 49 ± 8.28 49.89 ± 9.02 -0.89 -0.32 0.74
Post treatment 39.09 ± 8.83 32.15 ± 7.89 6.94 2.61 0.01
MD 9.91 17.73
% of change 20.22 35.56
t- value 17.21 22.98
p = 0.001 p = 0.001
SD stands for standard deviation; MD stands for mean difference; and p-value
stands for significance level.
34 Egypt. J. of Appl. Sci., 36 (5-6) 2021
Figure (2). Group A and B mean ODI before and after treatment.
DISCUSSION:
The aim of this research was to see how the Vojta approach
affected the quality of life of patients with chronic non-specific low back
pain. According to our findings, post-treatment ODI in groups A and B
decreased statistically significantly as compared to pre-treatment ODI.
The findings of the current study agree with those of Juárez-
Albuixech et al., who concluded that the Vojta procedure and TENS
were effective in treating lumbosciatica. However, when the Vojta
technique was used alone, patients indicated that their suffering,
weakness, and degree of flexibility had all improved.(19)
Moreover, Son, in conclusion explained the improvement in
postural control efficiency to be attributed to the activation of trunk
muscles and deep muscles of the spine during Vojta reflex locomotion
application that regulate trunk stability and increase spinal rotation force.
(20)
Lozinska et al., in their study have reported that using Vojta
technique can restore proper movement patterns and hence minimize the
manifestations of discomfort in low back pain (LBP), and eventually help
LBP patients to improve their gait and hence their functional abilities .
In addition to being effective in improving back pain, Vojta technique is
thought to have a conservative and long-lasting pain relief effect since it
stimulates the muscles to regain normal contraction pattern and muscular
balance, through stimulating autochthonous muscles, abdominal muscles
Egypt. J. of Appl. Sci., 36 (5-6) 2021 35
and pelvic floor muscles, which help to sustain muscle tropism and axial
extension of the spine. (21)
The study of Jung et al., comparing Vojta method versus neurodevelopmental
treatment (NDT) as per Bobath approach, has shown
better impact of Vojta method on muscle activation that is attributed to
the specifically guided motor reactions to the activated reflexes. (8)
Ewa et al., The concept that dynamic neuromuscular stabilization
reflex locomotion or Vojta technique elicit reflex responses in muscles
after stimulation of unique activation zones, explains the permanent long
term improvement in back pain symptoms. (9)
The basic principle of Vojta reflex locomotion, according to Vojta,
is the maintenance of postures by isometric muscle contraction during
point stimulation, resulting in consistent muscle contraction patterns and
stimulation of muscles, joints, ligaments, and tendons. Furthermore,
exteroceptors and enteroceptors are believed to be involved in Vojta
reflex locomotion. (7)
Hok et al. discovered that the reflex locomotion elicited by Vojta
therapy is associated with specific changes in cortical and subcortical
brain activity during the stimulation and voluntary motor task
performance before and after the procedure as compared to the sham
treatment. (22)
Sanz-Esteban et al. found that the Vojta group had greater
activation in the right frontal perisylvian and insular cortex, bilateral
basal ganglia, thalami, cerebellum, and brainstem. These areas are
responsible for balance and motor control, participating in the planning
and execution of voluntary movements, improvement of movement,
posture and motor control can surely positively affect self-esteem and
quality of life. (23)
In normal adults, Ha, S et al. found that using the Vojta method to
stimulate the breast zone increases activation of the transversus
abdominis ( TrA) and diaphragm while inhibiting activation of the
External abdominal oblique (EO). (16)
Study Limitation
The limitations of this study were a lack of opportunity for further
long-term treatment.
Conclusion
We concluded that the Vojta approach is a safe and reliable
modality that has superior improvements in quality of life in patients with
chronic non-specific low back pain as compared to traditional
intervention alone, based on the scope and results of this research.
Recommendations
Further studies are required with a larger sample, longer posttreatment
follow-up, and using ultrasonography and electromyography to
36 Egypt. J. of Appl. Sci., 36 (5-6) 2021
explain the possible mechanisms.
Source of funding
Nil.
Conflict of interest
The authors have no conflicts of interest.
Author's contributions
W.M.H came up with the concept, performed the analysis, and
arranged the data. A.H.I. was in charge of the clinical assessment and the
statistical analysis. A.S.S. gathered the literature and helped write the
first draught. The manuscript's content and similarity index is the
responsibility of all contributors.
Acknowledgment
The authors express their gratitude to all of the study participants
for their cooperation.
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تأثير طريقو ڤويتا عمى جودة الحياه في المرضى الذين يعانون من اّلام أسفل
الظير المزمنو الغير محدده
ولاء محمد حامد 1 ، امال حسن اب ا رىيم 2 ، عمرو سعدالدين محمد شمبي 3
-1 معيد بقسم العموم الاساسيو کميو العلاج الطبيعي، الجامعو الحديثو لمتکنولوجيا والمعمومات.
-2 استاذ العلاج الطبيعي ،قسم العموم الاساسيو ، کمية العلاج الطبيعي ، جامعة القاىرة.
-3 مدرس العلاج الطبيعي ، قسم العموم الاساسيو ،کمية العلاج الطبيعي ، جامعة القاىرة.
نبذه مختصره
خمفيو : فويتا ىي عباره عن طريقو فسيولوجيو عصبيو تستخدم لمحصول عمى استجابو انعکاسيو
من العضلات بعد تنبيو بعض المناطق المحفزه .
اليدف : تحديد تاثير طريقو فويتا عمي جوده الحياه في مرضى الالام اسفل الظير المزمن.
الطريقو : قد اجريت ىذه الد ا رسو عمى 44 شخص ) 11 رجل و 21 ام ا ره ( يعانون من الالام
اسفل الظير المزمن تم اختيارىم وتعيينيم بطريقو عشوئيو في مجموعين بالتساوى . وقد بمغ
± 4.75 سنو ‘ 67.15 ± متوسط العمر والوزن والطول ومؤشر کتمة الجسم المتوسطة 26.45
1.92 کجم / متر مربع.وقد حصمت کل ± 8.09 سم ‘ 22.94 ± 7.72 کجم ‘ 171.1
Egypt. J. of Appl. Sci., 36 (5-6) 2021 39
مجموعو عمي 12 جمسو لمده اربع اسابيع .المجموعو ) ا ( حصمت عمي تحفيز کيربائي عبر
الجمد وکمدات ساخنو وحصمت المجموعو )ب( عمي تحفيز کيربائي عبر الجمد و کمدات
ساخنو اضافا الي طريقو فويتا.
النتائج : کشفت المقا ا رنات بين المجموعات ان درجو اوسويتري مؤشر العجز لألام اسفل الظير
بعد العلاج في کمتا المجموعتين کانت اقل بکثير من درجو ما قبل العلاج .قبل العلاج لم يکن
ىناک فرق کبير بين المجموعات لکن المحصمو بعد العلاج في المجموعتين اشا ا رت الي
انخفاض کبيرفي المجموعو )ب(.
الخلاصو : طريقو فويتا امنو وفعالو وقد سببت تحسن اعمي في جوده الحياه في المرضي الذين
يعانون من الالام اسفل الظير المزمنو مقارنو بالطريقو التقميديو لمعلاج.
الکممات الدالو : طريقو فويتا – جوده الحياه – الالام اسفل الظير المزمن
40 Egypt. J. of Appl. Sci., 36 (5-6) 2021