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198 REVISTA ROMÂNĂ DE REUMATOLOGIE – VOL. XX NR. 3, An 2011
EFFECTS OF PHYSICAL AND VIBROACOUSTIC
THERAPY IN CHRONIC PAIN IN JUVENILE
ARTHRITIS
Laura Marinela Ailioaie1,2, C. Ailioaie1,3, Codrina Ancuta1,4, Rodica Chirieac1,4
1Faculty of Medicine, ”Gr. T. Popa” University of Medicine and Pharmacy, Iasi, Romania
2Dept. of Medical Physics, ”Al. I. Cuza“ University, Iasi, Romania
3Laser Clinic, Iasi, Romania
4Rehabilitation Hospital, Iasi, Romania
Abstract
Objectives. The study aimed to evaluate the response to physical and vibroacoustic therapy by studying the
Simplifi ed Disease Activity Index (SDAI), together with the psychobehavioral manifestations in moderate and
severe forms of juvenile idiopathic arthritis (JIA).
Material and method. 68 children with JIA were randomly divided into two groups. Group I (34 patients) received
physical and vibroacoustic therapy with type BRS-2 Bodysonic System. The protocol consisted in vibroacoustic
therapy, administrated for 20 minutes per day, 10 days consecutively, and then, one session of 20 minutes per
week, up to 12 weeks, together with individualized physical therapy and conventional drugs. Group II (34 patients,
witness group) received only conventional therapy (individualized physical and pharmacological therapy), as the
vibroacoustic therapy was performed in placebo mode.
Results. In Group I, changes in SDAI score resulted in the reduction of the disease activity from severe to
moderate, and the decrease in anxiety, chronic fatigability and depressive tendency, with statistically signifi cant
differences compared to the witness group.
Conclusions. Vibroacoustic therapy is a revolutionary tool in the fi eld of multidisciplinary management of chronic
pain in JIA and triggered a noticeable diminution of the SDAI score, decreasing the disease activity from severe
to moderate and the psycho-behavioral manifestations, with great statistically signifi cant difference to the witness
group (p<0.0001).
Key words: pain, vibroacoustic therapy, juvenile, arthritis
Rezumat
Obiective. Scopul studiului a fost evaluarea răspunsului la terapia fi zică şi vibroacustică prin utilizarea Indexului
Simplifi cat de Activitate a Bolii (ISAB) şi a manifestărilor psihocomportamentale în forme moderate şi severe de
artrită juvenilă idiopatică (AJI).
Material şi metodă. 68 de copii cu AJI au fost împărţiţi randomizat în două grupuri: Grupul I (34 de pacienţi) a
primit terapie vibroacoustică cu sistemul BRS-2 Bodysonic, administrată 20 de minute pe zi, 10 zile consecutiv,
iar apoi, o şedinţă pe săptămână, timp de 12 săptămâni, împreună cu kinetoterapie individualizată şi mijloace
farmacologice convenţionale. Grupul II (34 de pacienţi, martor) a fost tratat convenţional (kinetoterapie
individualizată şi medicaţie), împreună cu terapie vibroacustică placebo.
Rezultate. În grupul I, indexul simplifi cat de activitate a bolii a demonstrat reducerea activităţii de la severă
la moderată şi descreşterea anxietăţii, oboselii cronice şi a manifestărilor depresive, cu diferenţe statistic
semnifi cative faţă de lotul martor.
Concluzii. Terapia vibroacustică constituie o metodă revoluţionară în managementul multidisciplinar al durerii
cronice din AJI şi a determinat reducerea semnifi cativă a indexului simplifi cat de activitate a bolii şi a tulburărilor
psiho-comportamentale, comparativ cu grupul martor (p<0,0001).
Cuvinte cheie: durere, terapie vibroacustică, artrită, juvenilă
Adresă de corespondenţă:
Laura Marinela Ailioaie, Faculty of Medicine, ”Gr. T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, Iasi, Romania
e-mail: lauraailioaie@yahoo.com
INTRODUCTION
Juvenile idiopathic arthritis (JIA) is a chronic au-
toimmune disease of unknown etiology. It is esti-
mated that JIA affects up to 1 in 1,000 children
worldwide and is the most common cause of autoim-
mune musculoskeletal diseases in children (1).
By defi nition, children with JIA have disease on-
set prior to age 16 years, and present with joint pain,
LUCRĂRI ORIGINALE
199
REVISTA ROMÂNĂ DE REUMATOLOGIE – VOL. XX NR. 3, AN 2011
stiffness and swelling that persists for longer than 6
weeks (2).
At the moment, the multifactorial etiopathogenic
theory accepted by most authors indicates a subject
with certain genetic predisposition, associated with
the intervention of an environmental factor, which is
then self-sustained by immune mechanisms (3, 4).
Arthritis is characterized by synovial prolifera-
tion and the formation of granular tissue, which leads
to progressive destruction of the joint structures (5).
JIA is triggered by a multitude of pathogenic
events, which lead to the clinical symptoms of ar-
thritis, such as chronic pain and swelling, joint dam-
age and disability (6).
The treatment goal for JIA is to achieve disease
remission and facilitate normal childhood activities,
growth, and development (7).
The treatment should be performed by a multidis-
ciplinary team, together with the active participation
of the affected children and their families, from the
very beginning. The fundamental measures must
consist of diet, hygienic measures, pharmacologic
therapy, physical therapy, psycho-social integration
and somatic growth problems prevention (5, 7).
In order to control the chronic pain, it is essential
besides allopath medicine, to take advantage of some
complementary methods, like: vibroacoustic music
therapy, aromatherapy, refl exology, psycho-behav-
ioral therapy, in a holistic approach (8, 9).
In vibroacoustic (VA) therapy, the relaxing effect
music has on the soul and mind is amplifi ed by the
relaxing effect acoustic vibromassage has on the
body, producing a deep state of relaxation very
quickly. The principle of vibroacoustic therapy is the
conversion of musical melodies and rhythms into
waves that can be felt within the patient’s body.
Deeply soothing low frequency sounds (less than
120 Hz) are conducted to the body as vibrations,
while the same sounds are experienced by the pa-
tient’s auditory system (10, 11).
We aimed to evaluate the response to physical
and vibroacoustic therapy by studying the Simplifi ed
Disease Activity Index (SDAI) (12), together with
the psychobehavioral manifestations in moderate
and severe forms of JIA.
MATERIAL AND METHOD
Between 10.04.2009 – 11.10.2010, 68 children
were included in the study. The subjects were be-
tween 9 and 16 years of age, and were diagnosed
with JIA – extensive oligoarthritis and polyarthritis
types, moderate and severe forms. The diagnostic
criteria took into account the precise defi nitions for
the different types of JIA (13).
The patients were randomly divided into two
groups. Group I (34 patients) received physical and
vibroacoustic therapy with type BRS-2 Bodysonic
System (14). The protocol consisted in vibroacoustic
therapy, administrated for 20 minutes per day, 10
days consecutively, and then, one session of 20 min-
utes per week, up to 12 weeks, together with indi-
vidualized physical therapy and conventional drugs.
The vibrating probe was placed on the body, along
the spinal cord and on the painful areas of the af-
fected joints. The vibrations stimulated the cochlea,
respectively the cortex, by the use of headphones.
Group II (34 patients, witness group) received
only conventional therapy (individualized physical
and pharmacological therapy), as the vibroacoustic
therapy was performed in placebo mode.
As a disease activity quantifi cation (Table I), we
used the Simplifi ed Disease Activity Index (SDAI),
which is the numerical sum of fi ve outcome param-
eters: Tender Joint Count (TJC) and Swollen Joint
Count (SJC) – (based on a 28-joint assessment), Pa-
tient’s and Family’s Global Assessment (PGA) [vi-
sual analogue scale (VAS) 0–10 (0 = best health sta-
tus and 10 = worst possible health status)] and
Physician’s Global Assessment (MDGA) [visual an-
alogue scale (VAS) 0–10 (0 cm = absence of the dis-
ease and 10 = most severe disease)] and level of C-
reactive protein (CRP) [mg/dl, normal <1 mg/dl].
Formula of the SDAI is as follows: SDAI = TJC +
SJC + PGA + MDGA + CRP. An absolute SDAI
value of 5–20 relates to mild disease activity, while
an SDAI of 21 to 40 corresponds to moderate dis-
ease activity, and fi nally, an SDAI of >40 is associ-
ated with severe disease activity.
An important emphasis was put on how the pa-
tients reacted to the therapeutic trial, regarding psy-
chosocial integration and psychobehavioral mani-
festations (anxiety, introversion, chronic fatigability,
less sleep, depressive tendency). At the beginning
and at the end of the study all the patients from both
groups were asked to draw in pencils on a piece of
paper something of their own choice. The subjects
were evaluated by a professional psychologist at the
beginning of the study and in the end. The data were
analyzed at the initiation of the study and after the 12
weeks of treatment. The statistical analysis followed
200 REVISTA ROMÂNĂ DE REUMATOLOGIE – VOL. XX NR. 3, AN 2011
the comparison of the two groups, performing t-stu-
dent test and Fisher‘s exact test for a trust interval of
95%.
RESULTS
At the beginning of the treatment the clinical and
biological parameters displayed no signifi cant statis-
tical difference in the two groups taken into study
(Table 1).
TABLE 1. Initial clinical and biological parameters of patients in the two groups
Data Group I Group II
Patients (n) 34 34
Age (years; mean ± SD) 12.5±3.4 12.7±3.2(NS)
Sex (% female) 58.8 61.7(NS)
Polyarthritis Rheumatoid Factor (% positive) 44.1 41.1(NS)
Oligoarthritis extensive (%) 23.5 17.6(NS)
Disease duration at baseline (mo mean ± SD) 9.1±2.2 9.0± 2.6 (p=0.8559)
Disease activity characteristics
Tender joint count (0–28) 25.0±7.4 25.9±8.2 (p=0.3289)
Swollen joint count (0–28) 13.3± 4.6 13.8±2.0 (p=0.3040)
Patient’s/family’s global assessment 6.3 ±1.2 6.2±1.5 (p=0.8418)
Physician’s global assessment of activity 6.2± 1.4 5.9 ±1.7 (p=0.3441)
CRP (mg/dl; normal <1.0) 4.5± 0.9 4.2±1.2 (p=0.3036)
SDAI 55.5±4.7 56.3±3.2 (p= 0.275)
Behavioral/psychosocial/emotional characteristics
Anxiety 82.3%(28) 79.4% (27) (NS)
Introversion 76.4%(26) 85.2% (29) (NS)
Fatigue 58.8%(20) 58.8% (20) (NS)
Less sleep 55.8%(19) 52.9% (18) (NS)
Depression 44.1% (15) 41.1% (14) (NS)
SDAI – Simplifi ed Disease Activity Index; CRP, C-reactive protein; SD – standard deviation. NS – no
statistically signifi cant differences (p>0.05).
TABLE 2. The parameters of patients in the two groups after 12 weeks of treatment
Data Group I Group II
Patients (n) 34 34
Tender joint count (0–28) 10.3 ± 0.6 19.7 ± 1.1 (p=0.0001)
Swollen joint count (0–28) 2.5 ± 0.5 6.7± 2.8 (p=0.0001)
Patient’s/family’s global assessment of activity 3.7 ± 1.5 6.3± 1.8 (p=0.0001)
Physician’s global assessment of activity 3.0 ± 1.1 6.4 ± 0.8=0.0001)
CRP (mg/dl; normal <1.0) 1.2 ± 1.7 3.3± 2.1 (p=0.0001)
SDAI 21.0 ± 3.1 42.5±4.6 (p=0.0001)
Behavioral/psychosocial/emotional characteristics*
Anxiety 32.3% (11) 58.8%(20) (p=0.0177)
Introversion 20% (6) 56.0%(19) (p=0.0028)
Fatigue 20.6% (7) 44.1%(15) (p=0.0289)
Less sleep 14.7% (5) 38.2%(13) (p=0.0042)
Depression 8.8% (3) 29.4% (10) (p=0.0054)
SDAI – Simplifi ed Disease Activity Index; CRP, C-reactive protein; SD – standard deviation.
Statistically signifi cant differences: p < 0.05. Signifi cant: 0.01 < p < 0.05;
Very signifi cant: 0.001 < p < 0.01; Extremely signifi cant: p<0.001.
At the end of 12 weeks of treatment, the vibroa-
coustic therapy performed with Bodysonic System,
proved to be an effi cient non-pharmacological meth-
od for pain control, reduction of tender and swollen
joints, movement range improvement, in direct cor-
relation with the evolution of the biological param-
eters. One should also notice the decrease in anxiety,
introversion, chronic fatigability, less sleep, depres-
sive tendency in group I, compared to the witness
group. Data are recorded in Table 2.
201
REVISTA ROMÂNĂ DE REUMATOLOGIE – VOL. XX NR. 3, AN 2011
In Group I, changes in SDAI score resulted in the
decreasing of the classifi cation level of the disease
activity from severe to moderate, with statistically
signifi cant differences compared to the witness group
(p < 0.01).
DISCUSSIONS
Music is a combination of rhythmical, harmonic
and melodic sounds, and many peoples, throughout
history, have believed in its curative effects (15).
Music with therapeutic effects is as ancient as the
writings of Aristotle and Plato (16); but, only recent-
ly, has objective research been developed in order to
validate the healing effects of combined music and
vibrations (17, 18, 19).
Vibroacoustic (VA) therapy is a recently
recognized method, a more complex intervention
than music alone, which uses a physical stimulus in
the form of a pulsed sinusoidal low frequency wave
to produce mechanical vibrations that are applied
directly to the body (20, 21, 22, 23, 24).
With Bodysonic System, the musical sound
waves enter the body and stimulate the A10 nervous
system of the cerebral cortex (14). This stimulation
activates the body‘s natural self-healing abilities and
the capacity to recover, and brings the body and
mind in balance, which can lead to a state of homeo-
stasis, the reduction of infl ammation and of the
chronic pain (19, 22, 23, 24, 25).
Many patients with arthritis are seeking help with
disease management from alternative therapies.
When used along with allopathic medicine, these
therapies may, in fact, increase the quality of life for
patients with arthritis (26). The musical vibrations
harmoniously combine in order to produce a new
type of relaxation for the ill child.
Our study supports and validates the effi cacy of
physical and VA therapy, giving additional evidence
of the value of these therapies for JIA patients.
Music and pain are processed along the same
neuronal pathways. Stronger stimuli diminish the
perception of the weaker ones. This technique helped
the patient with arthritis to acquire a pain-free posi-
tive experience, modifying the threshold for nocice-
ptive stimuli, and as a consequence, the participation
in the physical therapy program was improved.
In Group I, the physical and VA therapy reduced
the number of tender and swollen joins and offered
the patients a feeling of consciousness for their per-
sonal experience towards pain and its control. It also
decreased anxiety, introversion, chronic fatigability,
adapting diffi culties, depressive tendency, with sta-
tistically signifi cant difference (p<0.05), compared
to Group II.
Not only was the VA therapy highly motivational
for the patients in group I, but it also had calming
and relaxing effects and helped the children to over-
come more easily the stress generated by the disease.
Independence, creativity development and the self-
identity feeling were other effects of this therapeutic
method. These aspects were revealed by the changed
perspective displayed in the drawings the patients in
Group I, in the end of treatment. The vibroacoustic
therapy encouraged self-confi dence, socialization,
communication and physical activity. Group I dis-
played an increased cohesion to family and friends,
together with a favorable social behavior and a gen-
eral positive attitude.
VA therapy in JIA patients was an effective treat-
ment for relaxation, anxiety reduction, muscle-ten-
sion reduction and pain management. The non-phar-
macologic nature of vibroacoustic waves makes this
treatment an important pain-management tool. It is a
promising complementary method that may reduce
the need for pain killers and provide a pleasant alter-
native to medication.
CONCLUSIONS
Vibroacoustic therapy is a revolutionary tool in
the fi eld of holistic pediatrics, for the multidisci-
plinary management of chronic pain in juvenile ar-
thritis; it triggered in Group I a noticeable diminu-
tion of the SDAI score, so reducing the disease
activity from severe to moderate and the psycho-be-
havioral manifestations, with great statistically sig-
nifi cant difference to the witness group (p<0.0001).
New research gives hope that early diagnosis,
proper medical treatment, and alternative pain man-
agement strategies can help optimize function, re-
duce pain, and improve quality of life in JIA pa-
tients.
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