Classification-Guided Versus Generalized Postural Intervention in Subgroups of Nonspecific Chronic Low Back Pain A Pragmatic Randomized Controlled Study
Classification-Guided Versus Generalized Postural Intervention in Subgroups of Nonspecific Chronic Low Back Pain A Pragmatic Randomized Controlled Study
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DOI：
10.1097/brs.0b013e31829e049b
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发表时间：
2013-09-01
期刊：
影响因子：
3
通讯作者：
Sparkes, Valerie
中科院分区：
文献类型：
--
作者：
Sheeran, Liba;van Deursen, Robert;Sparkes, Valerie
研究设计.实用随机对照单盲研究。比较分类系统指导的姿势干预（CSPI）与全身姿势干预（GPI）在非特异性慢性下腰痛（NSCLBP）亚组中的效果。脊髓运动控制障碍和相关的改变，在脊柱姿势采用的非小细胞肺癌患者是高度可变的。因此，研究评估的干预措施，针对具体的运动/姿势障碍的非典型LBP亚组的效果。从一项大型队列研究中招募了共49例具有屈曲模式（n = 29）和主动伸展模式（n = 20）控制损害分类的NSCLBP患者，并将其随机分配至CSPI和GPI。主要结局是Roland-Morris功能障碍问卷的变化，次要结局是疼痛视觉模拟量表、脊柱复位感觉（包括胸腰椎绝对误差、可变误差、恒定误差）和坐位和站立时躯干肌肉活动的变化。在基线、一对一干预后即刻和4周家庭培训后对干预进行评估。与GPI残疾（0.4，[95% CI，-0.8至1.6]）和疼痛（-0.2，[95% CI，-0.5至0.9]）的最小变化相比，CSPI使残疾（4.2 [95% CI，2.9-5.3]）和疼痛（2，[95% CI，1.3-2.6]）发生统计学和临床显著性降低。重复测量方差分析显示，CSPI显著降低了一对一阶段后胸椎（坐位）和腰椎（站立）的绝对误差以及腰椎（站立）的恒定误差，尽管在4周时不再显著。这两种干预措施对躯干肌肉活动都没有影响。与GPI组的最小变化相比，CSPI在残疾和疼痛结局方面产生了统计学和临床显著改善，并且在NSCLBP亚组中脊柱重新定位感觉的一些参数方面产生了短期改善。
Study Design. Pragmatic randomized controlled single-blinded study.Objective. To compare the effects of the classification system guided postural intervention (CSPI) with generalized postural intervention (GPI) in subgroups of nonspecific chronic low back pain (NSCLBP).Summary of Background Data. Spinal motor control impairments and the associated alterations in spinal postures adopted by patients with NSCLBP are highly variable. Research evaluating the effect of interventions that target the specific movement/posture impairments in NSCLBP subgroups is therefore warranted.Methods. A total of 49 patients with NSCLBP with a classification of flexion pattern (n = 29) and active extension pattern (n = 20) control impairment were recruited from a large cohort study and randomly assigned into CSPI and GPI. The primary outcome was change in Roland-Morris Disability Questionnaire, secondary outcomes were change in pain visual analogue scale, spinal repositioning sense including thoracic and lumbar absolute error, variable error, constant error, and trunk muscle activity during sitting and standing. The intervention was evaluated at baseline, immediately post one-to-one intervention and post 4-week home-based training.Results. The CSPI produced statistically and clinically significant reduction in disability (4.2 [95% CI, 2.9-5.3]) and pain (2, [95% CI, 1.3-2.6]) compared with minimal change in the GPI disability (0.4, [95% CI, -0.8 to 1.6]) and pain (-0.2, [95% CI, -0.5 to 0.9]). Repeated measures analysis of variance revealed that CSPI significantly reduced absolute error in thoracic (sitting) and lumbar spine (standing) and constant error in lumbar spine (standing) post one-to-one phase, although this was no longer significant at 4 weeks. Neither intervention had an effect on trunk muscle activity.Conclusion. Compared with minimal change in the GPI group, the CSPI produced statistically and clinically significant improvements in disability and pain outcomes and short-term improvements in some parameters of spinal repositioning sense in NSCLBP subgroups.