Randomised controlled trial of exercise for low back pain: clinical outcomes, costs, and preferences
Randomised controlled trial of exercise for low back pain: clinical outcomes, costs, and preferences
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DOI：
10.1136/bmj.319.7205.279
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发表时间：
1999-07-31
影响因子：
--
通讯作者：
Barber, J
中科院分区：
文献类型：
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作者：
Moffett, JK;Torgerson, D;Barber, J
目的评价社区环境下腰痛患者运动计划的有效性，以鼓励患者恢复正常活动。设计渐进式运动计划与常规初级保健管理相比的随机对照试验。患者对管理类型的偏好独立于随机分组。参与者187名18岁至18岁的患者。60岁的机械性腰痛4周至6个月的持续时间。干预措施由物理治疗师领导的锻炼课程，包括所有主要肌肉群的加强锻炼，伸展运动，放松课程和背部护理的简短教育。一个认知行为的approaches.Main结果措施评估衰弱的影响，背部疼痛干预前和干预后，在6个月和1年后。措施包括波兰残疾问卷，阿伯丁背部疼痛量表，疼痛日记，和使用的医疗服务。结果在6周后随机分组，干预组改善略高于对照组的残疾问卷和报告的痛苦。在6个月和1年时，干预组在残疾问卷评分方面表现出显著的改善（变化的平均差异为1.35，95%置信区间为0.13至2.57）。在1年时，干预组在Aberdeen背痛量表（4.44，1.01至7.87）上也显示出显著的改善，并且与对照组的607天相比，仅报告了378天的休假。干预组使用较少的医疗资源。结果是不受患者的preference.Conclusions运动类是更临床有效的比传统的全科医生管理，无论患者的喜好，是符合成本效益的。
Objective To evaluate effectiveness of an exercise programme in a community setting for patients with low back pain to encourage a return to normal activities.Design Randomised controlled trial of progressive exercise programme compared with usual primary care management Patients' preferences for type of management were elicited independently of randomisation.Participants 187 patients aged 18-60 years with mechanical low back pain of 4 weeks to 6 months' duration.Interventions Exercise classes led by a physiotherapist that included strengthening exercises for all main muscle groups, stretching exercises, relaxation session, and brief education on back care. A cognitive-behavioural approach was used.Main outcome measures Assessments of debilitating effects of back pain before and after intervention and at 6 months and 1 year later. Measures included Poland disability questionnaire, Aberdeen back pain scale, pain diaries, and use of healthcare services.Results At 6 weeks after randomisation, the intervention group improved marginally more than the control group on the disability questionnaire and reported less distressing pain. At 6 months and 1 year, the intervention group showed significantly greater improvement in the disability questionnaire score (mean difference in changes 1.35, 95% confidence interval 0.13 to 2.57). At 1 year, the intervention group also showed significantly greater improvement in the Aberdeen back pain scale (4.44, 1.01 to 7.87) and reported only 378 days off work compared with 607 in the control group. The intervention group used fewer healthcare resources. Outcome was not influenced by patients' preferences.Conclusions The exercise class was more clinically effective than traditional general practitioner management, regardless of patient preference, and was cost effective.