HOSPITAL

JOURNAL

THE EFFECT OF USING SEMIRIGID TYPE OF LUMBOSACRAL ORTHOSIS (LSO) ON THE

STRENGTH OF TRUNK MUSCLE STRENGTH IN THE CASE OF LOW BACK PAIN (LBP) E.C
SPONDYLOLISTHESIS
*
Sholeh Setiyawan1
1
Universitas Gadjah Mada Academic Hospital
*
Correspondence: [email protected]

Submitted: January 2021 Reviewed: February-August 2021 Publish: September 2021

ABSTRACT
Background: There were 80-90% of LBP patients stated that they did not make any effort to treat their disease.
It means that although LBP has a high prevalence, this disease can heal by itself. Spondylolisthesis (spon-dee-lo-
lis-thee-sis) is a spinal condition in which one vertebra slips forward or backward with the next vertebra.
Disturbances caused by this condition include the lumbar region, muscle spasms, decreased muscle strength,
limitation of motion, and radiating pain in the legs. The purpose of this study was to determine the effect of
using semirigid Lumbo Sacral Orthosis on the strength of the Trunk muscles in the case of Low Back Pain (LBP) e.c
Spondylolisthesis.
Materials and method: This study was quasi-experimental research using a pretest and posttest design
approach. It was conducted at the Yogyakarta General Hospital, UGM Academic Hospital, Dr. Soeradji
Tirtonegoro Klaten hospital, and Tugurejo Semarang Hospital. The number of participants was 35 patients with
purposive sampling.
Result: There was an effect of using LSO Type Semirigid on trunk flexion muscles before and after treatments
(Z = -5.099 with p-value = 0.000), trunk rotational muscle strength before and after treatment (Z = -4.600 with
p-value = 0.000), trunk extension strength before and after treatment (Z = -4.472 with p-value = 0.000).
Conclusion: There was an effect of semirigid Lumbo Sacral Orthosis on the strength of the trunk muscles in the
case of Low Back Pain (LBP), e.c Spondylolisthesis. As a result, the most significant effect that experienced a
decrease in trunk muscle strength after the patient used semi-rigid LSO was in the flexion muscle group (0.75),
then extension muscle (0.58), and rotation muscle (0.65).

Keywords: Low Back Pain (LBP) e.c Spondylolisthesis, Lumbo Sacral Orthosis semirigid type, Trunk muscle
strength.

1. INTRODUCTION effort to treat the disease, so it can be concluded

In Indonesia, LBP is found in the age group of 40 years. that although LBP has a high prevalence, this
Overall, LBP was the most common complaint (49%). disease can be cured by itself1.
In developed countries, people affected by LBP are In patients with LBP, e.c Spondylolisthesis can
around 70-80%. In workers in America, the fatigue of occur with or without pain. The incidence of lower
LBP increased by 68% between 1971-1981. Around 80- back pain is due to the fifth lumbar vertebral body
90% of LBP patients stated that they did not make any shifting forward above the lower vertebral body
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Sholeh Setiyawan Academic Hospital Journal 3(2), 2021, 15-19

by including the entire vertebral column above it. with reference number 10/KEPK/III/2018.
Spondylolisthesis affects 5%-6% of the male population
and 2%-3% of women2. In the case of spondylolisthesis, 3. RESULTS AND DISCUSSION
anti-inflammatory drugs are usually given in The subject of the study amounted to 35
combination with acetaminophen. So, if there is patients performing measurements with Manual
severe nerve pain, corticosteroids may be given, Muscle Testing to find out the strength of muscles
including oral prednisone. Moreover, the Lumbo of the trunk (trunk, flexion rotation, and extension
Sacral Orthosis (LSO) may be given not in too long of the trunk) before the intervention. After
period3. measuring trunk muscle strength, the research
A study conducted by Choelewicki et al. subjects were given an LSO Type Semi-Rigid
explained that the use of LSO for three consecutive intervention for four weeks. Then, muscle strength
weeks for 3 hours per day showed no clinically was measured again after the intervention. The
significant changes in neuromuscular control of the data obtained were then processed with
trunk. However, Lumbo Sacral Orthosis (LSO) descriptive statistics.
increases the trunk stiffness and the number of
The researchers used extension and rotation of
agonist's muscles that become quiescent in response
the trunk and the method of Daniels and
to pressure from the released LSO. Further research is
Worthingham's Manual Muscle Testing to
needed to determine the significance of these
measure the strength of the muscles in the flexion5.
effects4.
The muscle assessment criteria used are as follows:
2. MATERIALS AND METHODS Table 1. The Assessment Criteria of Muscle Testing
The present research was a quasi-experimental Numerical Score Qualitative score
type of research using a pretest and posttest design 5 Normal
4 Good
approach. It aimed to determine the effect of using
3 Fair
the Semi-rigid Lumbo Sacral Orthosis (LSO) on the 2 Poor
strength of the abdominal muscles in patients with 1 Trace activity
LBP e.c Spondylolisthesis. 0 Zero (No activity)

O1----------- X -----------------O2
Explanation of the general criteria for assessing
Description:
muscle strength:
O1 = Before treatment
Score 0: Muscle is completely stationary on
X = Giving LSO type Semirigid
palpation or visual inspection (no contraction)
O2 = After treatment
Grade 1: There is a muscle contraction, either
The research was conducted at the Yogyakarta visually or by palpation; there is a contraction of
General Hospital, UGM Academic Hospital, Dr. Soeradji one or more muscles
Tirtonegoro Klaten Hospital, and Tugurejo Hospital Value 2: Motion in a position that minimizes theforce
Semarang. Moreover, it was conducted in March-May of gravity. This position is often described as a
2018. These implementation stages included (1) horizontal plane of motion that is not full ROM
recording the subjects or samples, (2) conducting a (Range of Motion).
pretest on research subjects, (3) giving treatment in Value 3: Movement against gravity and full ROM
the form of using LSO Type Semirigid, and (5) Value 4: Minimum resistance (minimum resistance)
conducting the pot-test after four weeks. Value 5: Maximum Resistance (Maximum
Ethical clearance was obtained from Health resistance)
Research Ethical Committee/ Komite Etik Penelitian Characteristics of respondents in continuous data
Kesehatan (KEPK) Tugurejo Regional Public Hospital, research include age, trunk flexion muscle

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Sholeh Setiyawan Academic Hospital Journal 3(2), 2021, 15-19

strength, trunk rotational muscle strength, and trunk

extension muscle strength. It can be seen in Table 2 as
follows:

Table 2. Characteristics of respondents in continuous data research

Variable Min. Max. Mean Std. Dev
Age 34,00 74,00 57,49 8,89
Flexion trunk muscle strength (pre-test) 3,00 5,00 3,86 0,69
Flexion trunk muscle strength (post-test) 2,00 5,00 3,11 0,76
Rotation trunk muscle strength (pre-test) 2,00 5,00 3,74 0,74
Rotation trunk muscle strength (post-test) 2,00 5,00 3,09 0,66
Extension trunk muscle strength (pre-test) 2,00 5,00 3,49 0,66
Extension trunk muscle strength (post-test) 1,00 4,00 2,91 0,66
Source: primary data processed, 2018

Characteristics of respondents in categorical data Table 3 shows that the total research subjects were
research in this study based on gender. It can be seen 35 respondents. Moreover, most of the research
in Table 3 as follows: subjects were female, with several 26 people
(74.3%). The normality test of the dataselected was
Table 3. the characteristics of the subjects of the Data processed with Shapiro-Wilk because the research
categorical sample was less than 50. If a p-value obtained is
Sex N Percentage higher than 0.05 at the test, it means that it has
(%) normally distributed data. The results of the
Male 9 25,7 normality test for trunk muscle strength can be
Female 26 74,3
seenin Table 4 as follows:
Amount 35 100
Source: primary data processed, 2018

Table 4. Normality Data

Variable P-value α Description
Flexion trunkmuscle strength (pre-test) 0,000 0,05 Abnormal
Flexion trunk muscle strength (post-test) 0,000 0,05 Abnormal
Rotation trunk musclestrength (pre-test) 0,000 0,05 Abnormal
Rotation trunk musclestrength (post-test) 0,000 0,05 Abnormal
Extension trunk muscle strength (pre-test) 0,000 0,05 Abnormal
Extension trunk musclestrength (post-test) 0,000 0,05 Abnormal

Source: primary data processed, 2018

The normality test results with Shapiro Wiljk before Data analysis of this study was carried out
and after the intervention showed that the data were using the SPSS 21 program to determine the effect
not normally distributed. It was because the p-value of using LSO Type Semirigid on trunk muscle
was less than 0.05. strength (trunk flexion, trunk rotation, and trunk
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Sholeh Setiyawan Academic Hospital Journal 3(2), 2021, 15-19

extension). The hypothesis test in this study was Spondylolisthesis will reduce trunk muscle
tested using the Wilcoxon test because the data were strength, trunk flexion muscle strength, trunk
not normally distributed. The results of the Wilcoxon rotation, and trunk extension. It is in line with
test can be seen in Table 5 as follows: research from Borenstein, which states that the
use of a lumbar girdle will provide passive
Table 5. the Effect of using Semi-rigid Lso on Trunk stabilization of the vertebrae. Thereby, it will limit
Muscle Strength (Trunk Flexion, Trunk Rotation, and the movements that cause muscular pain6. Using a
Trunk Extension) lumbar corset is less effective if it is more than two
Variable Mean Z P- weeks because it can lead to a decrease in
Pretest Post- value strength7.
test The use of a lumbar corset can significantly
Flexion trunk 3,86 3,11 -5,099 0,000 reduce pain complaints after the first two weeks.
muscle However, if there is no significant decrease in pain
strength
Rotation trunk 3,74 3,09 -4,600 0,000 after the second two-week period, it can be
muscle concluded that the decrease in pain complaints
strength only occurred in the use of the lumbar corset for
Extension 3,49 2,91 -4,472 0,000 the first two weeks. On the other hand, there was
trunk muscle
strength no significant decrease in pain complaints after the
Source: primary data processed, 2018 next two weeks8. Therefore, the dose or time of
using the corset must be adjusted to the conditions
The Wilcoxon analysis results of using a Semi- and needs.Furthermore, the lumbar corset can be
rigid Type of LSO on trunk muscle strength given by an orthotist. It is generally recommended
showed some findings. The variable treatment to be worn when the patients awake and are active
before and after the intervention had a p-value of and thenremoved again when sleeping.2
0.000 (< 0.05). It means that there is an effect of The research subjects were tested using
using LSO of Semirigid Type on trunk flexion muscle ManualMuscle Testing to determine the strength of
strength before and after the intervention. Second, the trunk muscles (trunk flexion, trunk rotation,
the variable of trunk rotational muscle strength and trunk extension) before being given the
before and after the intervention obtained a p-value intervention. Afterthat, the research subjects were
of 0.000 (<0.05). It means that using LSO of given a semirigid type of LSO Type intervention for
Semirigid type was an effect on the strength of the four weeks. Then, muscle strength was measured
trunk rotation muscle before and after the again after the intervention. The data obtained
intervention. Third, the variable strength of the trunk were then processed with descriptive statistics.
extension muscle before and after the intervention Moreover, it showed that the average value of
had a p-value of 0.000 (<0.05). It means that there trunk flexion muscle strength beforetreatment was
was an effect of using LSO Type Semirigid on the (3.68) and after treatment (3.11); trunk rotational
strength of the trunk extension muscle before and muscle strength before treatment was (3.74) and
after the intervention. after treatment was (3.09); and trunk extension
The Wilcoxon test results showed three effects before treatment was (3.49) and after treatment
of the Semirigid type of LSO before and after the was (2.91).
treatments including trunk flexion muscle strength (Z Limitations in the implementation of this
= -5.099 with p-value = 0.000), trunk rotational muscle research include the following: a) There are still a
strength (Z = -4,600 with p-value = 0.000), and trunk limited number of research subjects who can meet
extension muscle strength (Z = -4,600 with p-value = the inclusion criteria; b) Activities carried out by
0.000). It means that the longer use of the Semirigid research subjects cannot be controlled by
type of LSO in the case of Low Back Pain (LBP) e.c researchers because the research is only

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Sholeh Setiyawan Academic Hospital Journal 3(2), 2021, 15-19

observational; c) The majority of the gender of the will increase the number and the
research subjects were women, so the study results characteristics of research subjects, including
were difficult togeneralize to all genders; d) There is physical activity or work in detail, the duration
no standard model and material for the Lumbo Sacral of use. and the effectiveness of using LSO in
Orthosis (LSO). certain activities.

4. CONCLUSION REFERENCES
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Painmanagement. 2015 [cited 5 January 2018].
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