Biomechanical and Neurophysiological Effects of Spinal Manipulative Therapy

说明(由申请人提供)：本提案是针对编号为Not-OD-09-058的通知(Not-OD-09-058)提交的竞争性修订申请，标题为“NIH宣布恢复法资金可用于竞争性修订申请”。脊柱手法疗法(SMT)是治疗下腰痛(LBP)患者的一种常见疗法，有证据表明，它对某些患者具有治疗益处。尽管SMT有普遍的用法和有益的证据，但其潜在的治疗效果的机制还不是很清楚。目前的理论主要集中在SMT引起的生物力学和神经生理学变化作为可能的机制，但这些变化在LBP患者中还没有得到充分的研究；先前的研究也没有检验这些变化与SMT治疗反应的关系。作为此次竞争更新的基础，最初的R21拨款的总体目标是量化SMT对LBP受试者重要神经生理学和生物力学变量的影响，并将神经生理学和生物力学变量的变化与SMT治疗的临床结果联系起来。自从最初的拨款被提交以来，有更多的证据支持SMT的神经生理效应。更具体地说，SMT传递的高速度、低幅度的脉冲被认为可以刺激脊髓旁组织中的机械敏感传入，改变中枢神经系统的输入，并增强运动神经元的兴奋性。SMT促进的一种肌肉是腰多裂肌。我们最初的R21资助目前正在研究SMT对多裂肌的影响，使用超声波来量化接受SMT前后的肌肉激活。我们的经验似乎与最近的研究一致，研究表明SMT对多裂肌具有兴奋作用，导致SMT后激活增加。随着旨在利用SMT对多裂肌肉的影响作为机会来提高SMT干预的有效性的研究的进展，将需要使用额外的结果测量，其可靠性和有效性在LBP受试者中没有得到充分的描述。这项修订申请的目的是检查这些新的结果衡量标准作为我们最初的R21拨款资助的正在进行的临床研究的辅助目标的实用性。具体地说，我们建议检查使用磁共振成像(MRI)来量化LBP患者多裂肌横截面积和脂肪渗透的可靠性和同时有效性。一旦确定，这些方法可以在随后的临床研究中用作结果测量，以检查SMT对这些重要参数的影响。 公共卫生相关性：下腰痛是一种常见的疾病，会导致高昂的费用和残疾。手法是一种经常用于治疗下腰痛的疗法，尽管一些人从这种疗法中受益，但手法为什么有效目前尚不清楚。一种理论认为，手法改变了多裂肌的招募。我们将检查测量多叉肌变化的能力，并检查变化与背痛症状之间的关系，以帮助确定多叉肌中发现的变化的相关性，并为未来检查手法效果的研究建立程序。

DESCRIPTION (provided by applicant): This proposal is a Competitive Revision request submitted in response to Notice Number (NOT- OD-09-058) entitled "NIH Announces the Availability of Recovery Act Funds for Competitive Revision Applications". Spinal manipulative therapy (SMT) is a common treatment for patients with low back pain (LBP) with evidence that it provides therapeutic benefit for some patients. Despite common usage and evidence of benefit, the mechanisms underlying the therapeutic effects of SMT are not well-understood. Current theories focus on biomechanical and neurophysiologic changes produced by SMT as possible mechanisms, but these changes have not been sufficiently studied in patients with LBP; and prior research has not examined these changes in relation to the therapeutic response to SMT. The overall goal of the original R21 grant on which this competitive renewal is based is to quantify the effects of SMT on important neurophysiologic and biomechanical variables in subjects with LBP, and relate changes occurring in neurophysiologic and biomechanical variables to the clinical outcomes of the SMT treatment. Since the original grant was submitted, further evidence has emerged in support of a neurophysiologic effect of SMT. More specifically, the high-velocity, low-amplitude impulse delivered by SMT is believed to stimulate mechanosensitive afferents in paraspinal tissues, altering input to the central nervous system, and enhancing motor neuron excitability. One muscle that appears to be facilitated by SMT is the lumbar multifidus muscle. Our original R21 grant is currently examining the impact of SMT on the multifidus muscle using ultrasound to quantify muscle activation before and after receiving SMT. Our experience appears to be in line with recent research studies indicating that SMT has an excitatory effect on the multifidus muscle, resulting in increased activation after SMT. Moving forward with research that aims to capitalize on the effect of SMT on the multifidus muscle as an opportunity to enhance the effectiveness of SMT interventions will require the use of additional outcome measures whose reliability and validity has not been adequately described in subjects with LBP. The goal of this revision request is to examine the utility of these novel outcome measures as an ancillary aim to the ongoing clinical research funded by our original R21 grant. Specifically, we propose to examine the reliability and concurrent validity of the use of magnetic resonance imaging (MRI) to quantify cross-sectional area and fat infiltration of the multifidus muscle in individuals with LBP. Once established, these methods can be used as outcome measures in subsequent clinical studies to examine the impact of SMT on these important parameters. PUBLIC HEALTH RELEVANCE: Low back pain is a common condition resulting in high costs and disability. Manipulation is a treatment frequently used to treat low back pain, and although some individuals benefit from the treatment, why manipulation works is presently not known. One theory is that manipulation changes recruitment of the multifidus muscle. We will examine the ability to measure changes in the multifidus muscle and examine the relationship between changes and back pain symptoms to help determine the relevance of changes found in the multifidus muscle and establish procedures for future studies examining the effects of manipulation.