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Z Joint Changes in Low Back Pain Following Adjusting

调整后腰痛的 Z 关节变化

基本信息

批准号：
7810838
负责人：
Gregory D Cramer
金额：
$ 46.54万
依托单位：
NATIONAL UNIVERSITY OF HEALTH SCIENCES
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-09-30 至 2011-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7810838
关键词：
Acoustics Acute Address Biology Characteristics Chiropractic manipulation Clinical Clinical Research Clinical Trials Computers Contracts Control Groups Data Data Analyses Equipment Exhibits Exposure to Facet joint structure Faculty Feasibility Studies Goals Hand Hearing Hour Human Resources Image Individual Investigation Joints Lead Left Low Back Pain MRI Scans Magnetic Resonance Imaging Manipulative Therapies Manuals Measurement Measures Mentors Methods Movement National Center for Complementary and Alternative Medicine Occupations Outcome Outcomes Research Pain Patients Positioning Attribute Posture Principal Investigator Printing Progress Reports Radiology Specialty Randomized Reader Reading Recovery Recruitment Activity Research Research Design Research Personnel Role Side Spinal Spinal Manipulation Strategic Planning Students Technology Testing Therapeutic Training Work base clinical practice cost design functional disability graduate student healthy volunteer instrument morphometry parent grant parent project patient population programs public health relevance radiologist skills sound spine bone structure

项目摘要

DESCRIPTION (provided by applicant): The objectives of the parent grant are to quantify the therapeutic opening (gapping) of the L4/L5 and L5/S1 zygapophysial (Z) joint space following side posture positioning and side posture spinal manipulative therapy (SMT; a.k.a., adjusting) in subjects with acute low back pain. In addition, the parent grant is assessing the relationships among pain, functional impairment, and Z joint gapping. This competitive revision uniquely combines technologies from the fields of acoustics and MRI imaging to deepen the research of the parent grant by allowing further investigation of one of the mechanisms of action of SMT, namely the relationship between cavitation (audible release) and Z joint gapping following SMT. In addition, if cavitation is found to correlate with Z joint gapping, cavitation could be used as a simple, inexpensive, and quantified standard for SMT administered in clinical trials and possibly in clinical practice. The specific aims of this study are to correlate cavitation (audible release) that occurs (1) during SMT and (2) during side posture positioning, with gapping of the L3-S1 Z joints in 40 healthy subjects. The collaborating investigators will use established methods, combined with those tested in a feasibility study, to complete the research. Gapping will be calculated from the difference of Z joint space measurements made from MRI scans taken before and after SMT (adjusting group) or before and after lumbar side posture positioning (control group). The vertebral level and side of cavitation will be determined during the adjustment or side posture positioning by using data received from one linear array and two triangular arrays of accelerometers. Data analysis will determine the relationship between cavitation and gapping by comparing Z joints that: cavitate following adjusting, do not cavitate following adjusting, cavitate following side posture positioning, and do not cavitate following side posture positioning. Further work will be conducted to assess the intensity and unique acoustic characteristics of cavitations and other Z joint sounds of healthy subjects. This research is consistent with the NCCAM Strategic Plan to deepen understanding of manual therapies by helping to determine the significance of cavitation to joint movement during spinal adjusting. If a positive relationship is found, cavitation could possibly be used to identify patients who would respond optimally to high velocity low amplitude adjusting. If a negative relationship is found then cavitation would not be used as an indicator of joint movement during spinal adjusting. Consequently, regardless of the outcome, this research will deepen the understanding of SMT and manual therapies. PUBLIC HEALTH RELEVANCE: This project will deepen the research of the parent grant by further investigating one of the mechanisms of action of spinal manipulative therapy (SMT, or spinal adjusting), that is the relationship between cavitation (audible release) and gapping (separation) of the zygapophysial joint (Z joint) spaces following SMT. Although cavitation and gapping are thought to be related, there has been no evidence to support this hypothesis. If a positive relationship is found, cavitation could be used to identify patients who would respond optimally to high velocity low amplitude SMT, whereas no or a negative relationship would provide evidence that cavitation is not a suitable indicator of joint movement during spinal adjusting.

描述（由申请人提供）：家长资助的目的是量化急性腰痛受试者在进行侧位定位和侧位脊柱手法治疗（SMT；又名调整）后 L4/L5 和 L5/S1 关节突 (Z) 关节间隙的治疗开口（间隙）。此外，家长拨款正在评估疼痛、功能障碍和 Z 关节间隙之间的关系。这项竞争性修订独特地结合了声学和 MRI 成像领域的技术，通过进一步研究 SMT 的作用机制之一，即 SMT 后的空化（声音释放）和 Z 关节间隙之间的关系，来深化母基金的研究。此外，如果发现空化与 Z 关节间隙相关，则空化可用作临床试验和临床实践中 SMT 的简单、廉价且量化的标准。本研究的具体目的是将 (1) SMT 期间和 (2) 侧位定位期间发生的空化（声音释放）与 40 名健康受试者的 L3-S1 Z 关节间隙关联起来。合作研究人员将使用既定方法，结合可行性研究中测试的方法来完成研究。间隙将根据 SMT 之前和之后（调整组）或腰椎侧位定位之前和之后（对照组）进行的 MRI 扫描获得的 Z 关节间隙测量值的差异来计算。在调整或侧姿势定位期间，将通过使用从加速度计的一个线性阵列和两个三角形阵列接收的数据来确定椎骨水平和空化侧面。数据分析通过比较Z关节，确定空化与间隙的关系：跟随调节空化、跟随调节不空化、侧位定位空化、侧位定位不空化。将进行进一步的工作来评估健康受试者的空化和其他 Z 关节声音的强度和独特的声学特征。这项研究与 NCCAM 战略计划一致，旨在通过帮助确定脊柱调整过程中空化对关节运动的重要性来加深对手法治疗的理解。如果发现正相关关系，则可以使用空化来识别对高速低振幅调整有最佳反应的患者。如果发现负相关，则在脊柱调整期间，空化将不会被用作关节运动的指标。因此，无论结果如何，这项研究都将加深对 SMT 和手法治疗的理解。公共健康相关性：该项目将通过进一步研究脊柱操纵疗法（SMT，或脊柱调整）的作用机制之一，即 SMT 后的关节突关节（Z 关节）空间的空化（声音释放）和间隙（分离）之间的关系，来深化家长资助的研究。虽然空化和间隙被认为是相关的，但没有证据支持这一假设。如果发现正相关，则空化可用于识别对高速低振幅 SMT 做出最佳反应的患者，而没有或负相关将提供证据表明空化不是脊柱调整期间关节运动的合适指标。