Trunk postural adjustments: Medium-term reliability and correlation with changes of clinical outcomes following an 8-week lumbar stabilization exercise program
Trunk postural adjustments: Medium-term reliability and correlation with changes of clinical outcomes following an 8-week lumbar stabilization exercise program
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DOI：
10.1016/j.jelekin.2018.04.006
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发表时间：
2018-08-01
影响因子：
2.5
通讯作者：
Lariviere, Christian
中科院分区：
文献类型：
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作者：
Boucher, Jean-Alexandre;Preuss, Richard;Lariviere, Christian
背景资料：下背痛（LBP）以前与躯干肌肉激活决定的延迟预期姿势调整（APA）有关。LBP患者的腰椎稳定锻炼计划（LSEP）可以恢复腰椎的躯干神经肌肉控制，并使APA正常化。这项探索性研究的目的是在测试的可靠性，肌电图和运动学为基础的姿势调整措施超过8周的时间间隔，评估其敏感性LBP的状态和治疗，并检查其与临床outcome.Methods：肌肉激活10躯干肌肉，使用表面肌电图（EMG），和腰椎角运动学记录在一个快速的手臂抬起/降低任务。LBP患者在8周LSEP之前和之后进行测试。在相同的时间间隔内评估未接受治疗的健康对照组，以确定测量的可靠性，并作为基线对照组。使用t检验评估了LBP患者基线和治疗前后的肌肉激活起始和反应性运动范围、速度和加速度范围的组间差异。这些因变量之间的相关性和临床结果（疼痛，残疾）的变化超过treatment.Results：运动学为基础的措施表现出可比的可靠性，以肌电图为基础的措施。在基线时发现腰椎侧屈ROM存在组间差异（患者<对照组）。在LBP患者中，LSEP后侧屈速度和加速度显著增加。相关性分析表明，腰椎角度运动学更敏感的变化，疼痛强度的LSEP相比，肌电图的措施。这些研究结果解释的角度来看，守卫行为和腰椎稳定性hypothes.Conclusion：未来的临床试验需要针对患者和不延迟的APA在基线和探索的敏感性不同的结果措施相关的APA。可能需要探索对姿势稳定性更具挑战性的不同任务，以更有效地揭示阿帕功能障碍。
Background: Low back pain (LBP) has been previously associated with delayed anticipatory postural adjustments (APAs) determined by trunk muscle activation. Lumbar stabilization exercise programs (LSEP) for patients with LBP may restore the trunk neuromuscular control of the lumbar spine, and normalize APAs. This exploratory study aimed at testing the reliability of EMG and kinematics-based postural adjustment measures over an 8-week interval, assessing their sensitivity to LBP status and treatment and examining their relationship with clinical outcomes.Methods: Muscle activation of 10 trunk muscles, using surface electromyography (EMG), and lumbar angular kinematics were recorded during a rapid arm-raising/lowering task. Patients with LBP were tested before and after an 8-week LSEP. Healthy controls receiving no treatment were assessed over the same interval to determine the reliability of the measures and act as a control group at baseline. Muscle activation onsets and reactive range of motion, range of velocities and accelerations were assessed for between group differences at baseline and preto post-treatment effects within patients with LBP using t-tests. Correlations between these dependent variables and the change of clinical outcomes (pain, disability) over treatment were also explored.Results: Kinematic-based measures showed comparable reliability to EMG-based measures. Between-group differences were found in lumbar lateral flexion ROM at baseline (patients < controls). In the patients with LBP, lateral flexion velocity and acceleration significantly increased following the LSEP. Correlational analyses revealed that lumbar angular kinematics were more sensitive to changes in pain intensity following the LSEP compared to EMG measures. These findings are interpreted in from the perspective of guarding behaviors and lumbar stability hypotheses.Conclusion: Future clinical trials are needed to target patients with and without delayed APAs at baseline and to explore the sensitivity of different outcome measures related to APAs. Different tasks more challenging to postural stability may need to be explored to more effectively reveal APA dysfunction.