The effect of sleep hygiene, breathing and stabilization exercises on pain, sleep quality and anxiety level in patients with non-specific chronic low back pain

The aim of this study was to investigate the effects of sleep hygiene training, breathing exercises, and core stabilization exercises given to individuals with chronic nonspecific low back pain on pain, sleep quality, and anxiety level and to add additional sleep hygiene and breathing exercises training given in addition to core stabilization training on the mentioned parameters. It was conducted to investigate whether the education training provided an additional contribution to the mentioned parameters. Individuals with non-specific chronic low back pain who met the inclusion criteria in our study were divided into three groups using simple random methods. Classical physiotherapy group (CPT) with the first group TENS and superficial heat, the second group is the lumbar stabilization exercises group (LSE) in which TENS, superficial heat, and stabilization exercises are applied, and the third group is the sleep hygiene breathing exercises group (SHBE) in which TENS, superficial heat, stabilization-breathing exercises, and sleep hygiene training are applied. The LSE and SHBE groups received a total of 3 weeks of treatment and exercise. The severity of pain was evaluated by the Visual Analogue Scale from 9 different regions (neck, shoulder, back, elbow, hand/wrist, low back, hip, knee, ankle) and with the McGill Melzack Pain Questionnaire, disability with the Oswestry Disability Index, sleep quality with the Pittsburgh Sleep Quality Index (PSQI) and with the Stop-Bang questionnaire, sleepiness with the Epworth Sleepiness Scale (ESS), fatigue with the Fatigue Severity Scale, anxiety was assessed with Spielberger's Trait-State Anxiety Inventory (STAI). Evaluations were made at baseline, after 3 weeks of treatment, and at week 8. After the training, pain and disability decreased significantly in the LSE and SHBE groups compared to the CPT group (p<0.05); however, it was found that there was no difference between these groups. There was a decrease in the LSE and SHBE groups in the post-training PSQI scores compared to the beginning of the training (p<0.05), but no significant decrease was found in the CPT group (p>0.05). In post-training evaluations compared to the beginning of the training, the SHBE group was effective in reducing the ESS scores (p<0.05). The CPT and LSE groups were ineffective in reducing ESS scores (p>0.05). While the decrease in the STAI state score was not significant in the CPT group at all comparison times (p>0.05), it was significant in the LSE and SHBE groups after the training (p<0.05). As a result, the LSE and SHBE groups gave better results than the CPT group in improving sleep, anxiety, and pain levels in the 3. and 8. weeks period (p<0.05). The LSE and SHBE groups were not superior to each other in improving sleep, anxiety, and pain levels in the short term (p>0.05). In the future, we recommend that different studies should be conducted with different treatment methods in individuals with non-specific chronic low back pain and breathing exercises and sleep hygiene education can be added to the treatment programs of individuals with nonspecific chronic low back pain.