Does it matter which exercise? A randomized control trial of exercise for low back pain
Does it matter which exercise? A randomized control trial of exercise for low back pain
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DOI：
10.1097/01.brs.0000146464.23007.2a
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发表时间：
2004-12-01
期刊：
影响因子：
3
通讯作者：
Fung, T
中科院分区：
文献类型：
--
作者：
Long, A;Donelson, R;Fung, T
研究设计。多中心随机对照试验。为了确定先前证实的下腰痛(LBP)亚组对不同的运动处方是否有不同的反应。背景数据摘要。“针对患者的”练习在管理LBP中的作用是有争议的。共有312名急性、亚急性和慢性患者，包括仅有LBP和坐骨神经痛的患者，接受了标准化的机械评估，根据他们的疼痛反应对他们进行分类，特别是引起“方向性偏好”(DP)(即，通过重复执行腰椎屈曲、伸展或侧滑/旋转测试，疼痛立即、持久地改善)，或没有DP。只有DP受试者被随机分为：1)定向运动与他们的首选方向(DP)“匹配”，2)定向“相反”(DP)，或3)“非定向”练习。测量结果包括疼痛强度、部位、残疾、用药情况、恢复程度、抑郁和工作干扰。74%(230)的受试者出现DP。相反和非定向治疗的受试者中，有三分之一的人在2周内因为没有改善或恶化而退出(没有匹配的受试者退出)。与其他两个治疗组相比，配对受试者在每个结果上都有显著的改善(P值和lt；0.001)，包括药物使用减少了三倍。与先前的证据一致，标准化的机械评估发现了一大群患有DP的LBP患者。无论受试者的偏好方向如何，对不同运动处方的反应显著不同：与受试者DP匹配的运动显著且迅速地减少疼痛和药物使用，并在所有其他结果中改善。如果可重复，这种亚组验证对LBP管理具有重要意义。
Study Design. Multicentered randomized controlled trial.Objectives. To determine if previously validated low back pain (LBP) subgroups respond differently to contrasting exercise prescriptions.Summary of Background Data. The role of "patient-specific" exercises in managing LBP is controversial.Methods. A total of 312 acute, subacute, and chronic patients, including LBP-only and sciatica, underwent a standardized mechanical assessment classifying them by their pain response, specifically eliciting either a "directional preference" (DP) ( i.e., an immediate, lasting improvement in pain from performing either repeated lumbar flexion, extension, or sideglide/rotation tests), or no DP. Only DP subjects were randomized to: 1) directional exercises "matching" their preferred direction ( DP), 2) exercises directionally "opposite" their DP, or 3) "nondirectional" exercises. Outcome measures included pain intensity, location, disability, medication use, degree of recovery, depression, and work interference.Results. A DP was elicited in 74% ( 230) of subjects. One third of both the opposite and non-directionally treated subjects withdrew within 2 weeks because of no improvement or worsening ( no matched subject withdrew). Significantly greater improvements occurred in matched subjects compared with both other treatment groups in every outcome ( P values < 0.001), including a threefold decrease in medication use.Conclusions. Consistent with prior evidence, a standardized mechanical assessment identified a large subgroup of LBP patients with a DP. Regardless of subjects' direction of preference, the response to contrasting exercise prescriptions was significantly different: exercises matching subjects' DP significantly and rapidly decreased pain and medication use and improved in all other outcomes. If repeatable, such subgroup validation has important implications for LBP management.