Short- or Long-Term Treatment of Spinal Disability in Older Adults With Manipulation and Exercise.
Short- or Long-Term Treatment of Spinal Disability in Older Adults With Manipulation and Exercise.
复制标题
通过手法和锻炼对老年人脊柱残疾进行短期或长期治疗。
DOI：
10.1002/acr.23798
复制
发表时间：
2019
影响因子：
4.7
通讯作者：
Bronfort,Gert
中科院分区：
文献类型：
--
作者：
Maiers,Michele;Hartvigsen,Jan;Evans,Roni;Westrom,Kristine;Wang,Qi;Schulz,Craig;Leininger,Brent;Bronfort,Gert
目的背部和颈部疼痛与老年人的残疾和丧失独立性有关。使用常用推荐治疗的长期治疗是否优于短期治疗尚不清楚。这项随机临床试验比较了使用脊柱手法治疗 (SMT) 结合监督康复锻炼 (SRE) 对老年人背部和颈部相关残疾的短期治疗（12 周）与长期治疗（36 周）。方法符合条件的参与者年龄≥65 岁，背部和颈部残疾≥12 周。共同主要结果是 36 周后 Oswestry 残疾指数 (ODI) 和颈部残疾指数 (NDI) 评分的变化。意向治疗方法使用线性混合模型分析来检测组间差异。二次分析包括其他自我报告的结果、不良事件和客观功能测量。结果共有 182 名参与者被随机分组。短期和长期组的背部残疾（ODI 评分 –3.9 [95% CI –5.8, –2.0] 对比 ODI 评分 –6.3 [95% CI –8.2, –4.4]）和颈部残疾（NDI 评分 –7.3 [95% CI –9.1, –5.5] 对比 NDI 评分 –9.0 [95% CI –10.8, –7.2]）36 周后，组间无差异（背部 ODI 评分 2.4 [95% CI –0.3, 5.1]；颈部 NDI 评分 1.7 [95% CI 0.8, 4.2]）。长期治疗组在第 36 周时颈部疼痛、第 36 周和第 52 周时的自我效能、功能能力和平衡能力都有较大改善。结论对于患有慢性背部和颈部残疾的老年人，将 SMT 和 SRE 治疗从 12 周延长至 36 周并没有导致残疾程度的任何额外显着减少。
ObjectiveBack and neck pain are associated with disability and loss of independence in older adults. Whether long‐term management using commonly recommended treatments is superior to shorter‐term treatment is unknown. This randomized clinical trial compared short‐term treatment (12 weeks) versus long‐term management (36 weeks) of back‐ and neck‐related disability in older adults using spinal manipulative therapy (SMT) combined with supervised rehabilitative exercises (SRE).MethodsEligible participants were ages ≥65 years with back and neck disability for ≥12 weeks. Coprimary outcomes were changes in Oswestry Disability Index (ODI) and Neck Disability Index (NDI) scores after 36 weeks. An intent‐to‐treat approach used linear mixed‐model analysis to detect between‐group differences. Secondary analyses included other self‐reported outcomes, adverse events, and objective functional measures.ResultsA total of 182 participants were randomized. The short‐term and long‐term groups demonstrated significant improvements in back disability (ODI score –3.9 [95% confidence interval (95% CI) –5.8, –2.0] versus ODI score –6.3 [95% CI –8.2, –4.4]) and neck disability (NDI score –7.3 [95% CI –9.1, –5.5] versus NDI score –9.0 [95% CI –10.8, –7.2]) after 36 weeks, with no difference between groups (back ODI score 2.4 [95% CI –0.3, 5.1]; neck NDI score 1.7 [95% CI 0.8, 4.2]). The long‐term management group experienced greater improvement in neck pain at week 36, in self‐efficacy at weeks 36 and 52, and in functional ability, and balance.ConclusionFor older adults with chronic back and neck disability, extending management with SMT and SRE from 12 to 36 weeks did not result in any additional important reduction in disability.