THE TREATMENT OF ACUTE LOW-BACK-PAIN - BED REST, EXERCISES, OR ORDINARY ACTIVITY
THE TREATMENT OF ACUTE LOW-BACK-PAIN - BED REST, EXERCISES, OR ORDINARY ACTIVITY
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DOI：
10.1056/nejm199502093320602
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发表时间：
1995-02-09
影响因子：
158.5
通讯作者：
HERNBERG, S
中科院分区：
文献类型：
--
作者：
MALMIVAARA, A;HAKKINEN, U;HERNBERG, S
背景。卧床休息和背部伸展运动通常是治疗急性腰痛的处方，但这两种相互竞争的治疗方法的有效性仍然存在争议。我们在芬兰赫尔辛基市的员工中进行了一项对照试验，这些员工因急性非特异性腰痛来到一家职业保健中心。患者被随机分配到三种治疗方法中的一种：卧床休息两天（67例患者），背部运动（52例患者），或在耐受范围内继续进行普通活动（对照组，67例患者）。在3周和12周后评估结果和成本。3周和12周后，对照组患者的恢复情况优于卧床休息或运动治疗组。在疼痛持续时间、疼痛强度、腰椎屈曲、主观测量的工作能力、Oswestry背部残疾指数和缺勤天数方面，对照组有统计学显著差异。卧床休息的病人恢复得最慢。三组患者的总体护理费用无显著差异。在急性腰痛患者中，在疼痛允许的范围内继续进行普通活动比卧床休息或背部活动更能迅速恢复。
Background. Bed rest and back-extension exercises are often prescribed for patients with acute low back pain, but the effectiveness of these two competing treatments remains controversial.Methods. We conducted a controlled trial among employees of the city of Helsinki, Finland, who presented to an occupational health care center with acute, nonspecific low back pain. The patients were randomly assigned to one of three treatments: bed rest for two days (67 patients), back-mobilizing exercises (52 patients), or the continuation of ordinary activities as tolerated (the control group; 67 patients). Outcomes and costs were assessed after 3 and 12 weeks.Results. After 3 and 12 weeks, the patients in the control group had better recovery than those prescribed either bed rest or exercises. There were statistically significant differences favoring the control group in the duration of pain, pain intensity, lumbar flexion, ability to work as measured subjectively, Oswestry back-disability index, and number of days absent from work. Recovery was slowest among the patients assigned to bed rest. The overall costs of care did not differ significantly among the three groups.Conclusions. Among patients with acute low back pain, continuing ordinary activities within the limits permitted by the pain leads to more rapid recovery than either bed rest or back-mobilizing exercises.