Effects of low back pain stabilization or movement system impairment treatments on voluntary postural adjustments: a randomized controlled trial.
Effects of low back pain stabilization or movement system impairment treatments on voluntary postural adjustments: a randomized controlled trial.
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DOI：
10.1016/j.spinee.2014.10.020
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发表时间：
2015-04-01
期刊：
影响因子：
--
通讯作者：
Henry SM
中科院分区：
文献类型：
--
作者：
Lomond KV;Jacobs JV;Hitt JR;DeSarno MJ;Bunn JY;Henry SM
腰背痛(LBP)患者表现出预期姿势调整(APAs)受损。评估目前的运动再训练治疗是否解决了在需要和不需要APA的任务中与LBP相关的运动协调变化。前瞻性登记的随机对照试验，采用盲法评估者。结果评估在大学实验室进行；治疗在门诊理疗诊所进行。15例非LBP患者和33例慢性、复发、非特异性LBP患者。12名LBP患者接受了稳定治疗，21名患者接受了基于运动系统障碍(MSI)的治疗，每周超过6次，每次1小时，外加家庭锻炼。治疗前和治疗后，分别在不需要和不需要APA的支撑和支撑抬腿任务中，记录双侧躯干和腿部肌肉的表面肌电信号(EMG)。记录对侧小腿下方的垂直反作用力以确定APA的特征。还记录了奥斯威斯特里残疾评分和数字疼痛评级。与非LBP患者相比，LBP患者表现出APA受损，其特征是运动前对侧力的施加增加，运动后躯干肌电幅度增加，与任务无关。经过治疗后，两组在残疾和功能方面都有类似的改善；然而，在两个任务中，APA特征都没有改变(即用力或肌电幅度)。治疗临床医生对治疗分配不是盲目的，只评估了短期结果，治疗的主要效果不排除时间或重复暴露的非特异性影响。LBP患者的运动障碍并不局限于需要APA的任务。LBP的稳定化和基于微创的治疗并不能改善，而且可能会加剧APA损害(即过度用力和运动后躯干肌肉激活增加)。
People with low back pain (LBP) exhibit impaired anticipatory postural adjustment (APAs). To evaluate whether current motor retraining treatments address LBP-associated changes in movement coordination during tasks that do and do not require APAs. Prospectively registered, randomized controlled trial with a blinded assessor. Outcome evaluations occurred in a university laboratory; treatments, in outpatient physical therapy clinics. Fifteen subjects without LBP and 33 subjects with chronic, recurrent, non-specific LBP. Twelve subjects with LBP received stabilization treatment, 21 received Movement System Impairment (MSI)-based treatment, over 6 weekly 1-hour sessions plus home exercises. Pre- and post- treatment, surface electromyography (EMG) was recorded bilaterally from trunk and leg muscles during unsupported and supported leg-lifting tasks, which did and did not require an APA, respectively. Vertical reaction forces under the contralateral leg were recorded to characterize the APA. Oswestry disability scores and numeric pain ratings were also recorded. Persons with LBP demonstrated an impaired APA compared to persons without LBP, characterized by increased pre-movement contralateral force application and increased post-movement trunk EMG amplitude, regardless of the task. Following treatments, both groups similarly improved in disability and function; however, APA characteristics did not change (i.e. force application or EMG amplitude) in either task. Treating clinicians were not blinded to treatment allocation, only short-term outcomes were assessed, and main effects of treatment do not rule out non-specific effects of time or repeated exposure. Movement impairments in persons with LBP are not limited to tasks requiring an APA. Stabilization and MSI-based treatments for LBP do not ameliorate, and may exacerbate, APA impairments (i.e., excessive force application and increased post-movement trunk muscle activation).
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DOI：
10.1016/j.clinph.2009.11.076
发表时间：
2010-03
期刊：
Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology
影响因子：
--
作者：
Jacobs JV;Henry SM;Nagle KJ
通讯作者：
Nagle KJ
影响因子：
6.1
作者：
Allison, Garry T.;Morris, Sue L.;Lay, Brendan
通讯作者：
Lay, Brendan
影响因子：
3.2
作者：
Fritz, JM;Irrgang, JJ
通讯作者：
Irrgang, JJ
影响因子：
3
作者：
McGorry, RW;Webster, BS;Hsiang, SM
通讯作者：
Hsiang, SM
影响因子：
--
作者：
Freburger, Janet K.;Holmes, George M.;Agans, Robert P.;Jackman, Anne M.;Darter, Jane D.;Wallace, Andrea S.;Castel, Liana D.;Kalsbeek, William D.;Carey, Timothy S.
通讯作者：
Carey, Timothy S.