Cooke C, Menard M R, Beach G N, Locke S R, Hirsch G H
Functional Evaluation Unit, Worker's Compensation Board of British Columbia, Richmond, Vancouver, Canada.
Spine (Phila Pa 1976). 1992 Jun;17(6):653-62. doi: 10.1097/00007632-199206000-00004.
To determine the significance of changes in motor performance as measured by lumbar dynamometry, serial lumbar dynamometry was performed on a group of 45 male Workers' Compensation patients with chronic "mechanical" low back pain and in a group of 20 healthy male volunteers. The patients were men aged 20-60 years, whose current episode of low back pain had lasted for at least 3 months (mean 19.5 weeks, range 12-47 weeks). Testing was performed at entry into a "back school" program of therapy and again 2 weeks and 4 weeks later. The control group showed a slight improvement in almost all variables of strength and range of motion between the first and second tests but no significant change between the second and third tests. This was consistent with a learning effect. The patient group was analyzed as a whole and also in two groups based on their response to the Waddell maneuvers at entry: Waddell score 0-2 (no excessive illness behavior) and 3-5 (excessive illness behavior). As a whole, the patients showed significant progressive improvement in most variables on successive tests. The group with the low Waddell score had significantly greater strength and range of motion than the group with the high Waddell score but the trend of improvement with time was similar in the two groups. The authors conclude that in this sample of patients with low back pain, serial lumbar dynamometry reveals a progressive improvement in performance, which is greater than the improvement expected from the natural history of physical recovery and greater than the improvement expected from an increase in strength and range of motion attributable to the therapeutic exercises performed and is much larger than any learning effect related to the test procedure.
为了确定通过腰椎测力法测量的运动表现变化的意义，对一组45名患有慢性“机械性”下腰痛的男性工伤赔偿患者和一组20名健康男性志愿者进行了连续腰椎测力法测试。患者为20至60岁的男性，其当前下腰痛发作至少持续了3个月（平均19.5周，范围12 - 47周）。测试在进入“康复学校”治疗计划时进行，2周和4周后再次进行。对照组在第一次和第二次测试之间，几乎所有力量和运动范围变量都有轻微改善，但在第二次和第三次测试之间没有显著变化。这与学习效应一致。患者组作为一个整体进行分析，也根据他们在进入时对瓦德尔手法的反应分为两组：瓦德尔评分0 - 2（无过度疾病行为）和3 - 5（过度疾病行为）。总体而言，患者在连续测试中的大多数变量上显示出显著的渐进性改善。瓦德尔评分低的组比评分高的组具有显著更大的力量和运动范围，但两组随时间的改善趋势相似。作者得出结论，在这个下腰痛患者样本中，连续腰椎测力法显示运动表现有渐进性改善，这种改善大于身体恢复自然病程预期的改善，大于因进行治疗性锻炼导致的力量和运动范围增加所预期的改善，且远大于与测试程序相关的任何学习效应。
