Efficacy of Therapeutic Exercise for Recurrent Back Pain

运动治疗对复发性背痛的疗效

• 批准号: 7097165
• 负责人: DEBORAH LYNN GIVENS
• 金额: $ 20.41万
• 依托单位: OHIO STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-05-01 至 2008-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7097165
• 关键词: backache; biomechanics; clinical research; clinical trials; electromyography; exercise; functional ability; human subject; human therapy evaluation; medical rehabilitation related tag; musculoskeletal disorder therapy; musculoskeletal imaging /visualization /scanning; neuromuscular function; patient oriented research; physical therapy; questionnaires; relapse /recurrence; spinal reflex; ultrasonography; vertebrae

DESCRIPTION (provided by applicant): Low back disorders are the leading cause of activity limitation and affect up to 47% of injured workers. While the majority (80% to 90%) of individuals with acute low back pain (LBP) recover by four weeks post injury, 60% to 86% of these patients will experience recurrent back pain during the year after the acute episode. Lumbar stabilization exercises are commonly used in rehabilitation programs for LBP, based on the theory that a source of pain and recurrent injury is inadequate neuromuscular control of the spine resulting from muscle damage, weakness, altered muscle coactivation patterns, and delayed responses. Therefore, it is necessary to determine whether stability can be improved by therapeutic exercise and determine whether neuromuscular control factors targeted by treatment contribute to stability. Specific Stabilization Exercise (SSE) involves a progression of training which initially emphasizes recruitment and coactivation of the deep muscles attached to the spine (multifidus and transverse abdominis) for local, lumbar segmental control. Later, exercises focus on recruitment of larger trunk muscles in neutral postures for trunk equilibrium control. Emerging evidence on a small cohort of patients indicates that SSE training reduces pain, improves function, and reduces the risk of low back pain recurrence up to 3 years post treatment. In the proposed investigation, 51 persons with acute, recurrent LBP who meet indications for stabilization exercise therapy will undergo 10-weeks of SSE training. Clinical outcomes (pain and function) and biomechanical measurements (local and global indices of motor control) will be evaluated at weeks 5 and 11. Statistical analyses will compare the change over time with SSE training and will compare the subjects with LBP to 51 subjects without LBP. The goal of this study is to identify local and global neuromuscular control factors that contribute to a state of potential instability in individuals with recurrent LBP. We will determine if and when SSE training improves these factors in persons with recurrent LBP. We will investigate the relationships between improvements in local and global factors of neuromuscular control and clinically important improvements in pain and functional status, The proposed study will initiate this research program and develop pilot statistics to facilitate the design of a large scale, prospective, randomized controlled trial.

描述(申请人提供)：腰部疾病是活动受限的主要原因，影响高达47%的受伤工人。虽然大多数(80%至90%)急性下腰痛(LBP)患者在受伤后四周内恢复，但其中60%至86%的患者在急性发作后的一年内将经历反复的背痛。腰椎稳定训练通常用于LBP的康复计划，其理论基础是肌肉损伤、虚弱、肌肉协同激活模式改变和反应延迟导致的脊椎神经肌肉控制不足是疼痛和反复损伤的来源。因此，有必要确定是否可以通过治疗性运动来提高稳定性，并确定治疗靶向的神经肌肉控制因素是否有助于稳定性。特殊稳定运动(SSE)包括一系列的训练，最初强调的是与脊柱(多裂肌和腹横肌)相连的深层肌肉的招募和协同激活，以实现局部和腰椎节段控制。随后，练习重点是在中立姿势下招募较大的躯干肌肉，以实现躯干平衡控制。在一小部分患者队列中出现的证据表明，SSE训练可以减轻疼痛，改善功能，并降低治疗后长达3年的下腰痛复发的风险。在拟议的调查中，51名符合稳定运动疗法适应症的急性复发性LBP患者将接受为期10周的SSE训练。临床结果(疼痛和功能)和生物力学测量(局部和全局运动控制指数)将在第5周和第11周进行评估。统计分析将比较SSE训练随时间的变化，并将有LBP的受试者与51名未接受LBP的受试者进行比较。这项研究的目的是确定导致复发性LBP患者潜在不稳定状态的局部和全局神经肌肉控制因素。我们将确定SSE培训是否以及何时改善复发的LBP患者的这些因素。我们将调查局部和整体神经肌肉控制因素的改善与临床上重要的疼痛和功能状态改善之间的关系，拟议的研究将启动这一研究计划并开发试点统计数据，以促进大规模、前瞻性、随机对照试验的设计。