Liddle Sarah Dianne, Baxter G David, Gracey Jacqueline H
Rehabilitation Sciences Research Group, University of Ulster at Jordanstown, Shore Road, Newtownabbey, Co. Antrim BT37 OQB, Northern Ireland, UK.
Pain. 2004 Jan;107(1-2):176-90. doi: 10.1016/j.pain.2003.10.017.
The aim of this review was to investigate current evidence for the type and quality of exercise being offered to chronic low back pain (CLBP) patients, within randomised controlled trials (RCTs), and to assess how treatment outcomes are being measured. A two-fold methodological approach was adopted: a methodological assessment identified RCTs of 'medium' or 'high' methodological quality. Exercise quality was subsequently assessed according to the predominant exercise used. Outcome measures were analysed based on current recommendations. Fifty-four relevant RCTs were identified, of which 51 were scored for methodological quality. Sixteen RCTs involving 1730 patients qualified for inclusion in this review based upon their methodological quality, and chronicity of symptoms; exercise had a positive effect in all 16 trials. Twelve out of 16 programmes incorporated strengthening exercise, of which 10 maintained their positive results at follow-up. Supervision and adequate compliance were common aspects of trials. A wide variety of outcome measures were used. Outcome measures did not adequately represent the guidelines for impairment, activity and participation, and impairment measures were over-represented at the expense of others. Despite the variety offered, exercise has a positive effect on CLBP patients, and results are largely maintained at follow-up. Strengthening is a common component of exercise programmes, however, the role of exercise co-interventions must not be overlooked. More high quality trials are needed to accurately assess the role of supervision and follow-up, together with the use of more appropriate outcome measures.
本综述的目的是调查随机对照试验（RCT）中为慢性下腰痛（CLBP）患者提供的运动类型和质量的现有证据，并评估治疗结果的测量方式。采用了双重方法：方法学评估确定了“中等”或“高质量”方法学的RCT。随后根据主要使用的运动来评估运动质量。根据当前建议对结果指标进行分析。共识别出54项相关RCT，其中51项进行了方法学质量评分。16项涉及1730名患者的RCT根据其方法学质量和症状的慢性程度符合纳入本综述的标准；在所有16项试验中运动均产生了积极效果。16个项目中有12个纳入了强化运动，其中10个在随访时保持了积极结果。监督和充分的依从性是试验的常见方面。使用了各种各样的结果指标。结果指标没有充分体现损伤、活动和参与方面的指南，且损伤指标占比过高，牺牲了其他指标。尽管提供了多种运动方式，但运动对CLBP患者有积极作用，且结果在随访时大多得以维持。强化是运动方案的常见组成部分，然而，运动联合干预的作用也不容忽视。需要更多高质量试验来准确评估监督和随访的作用，以及使用更合适的结果指标。
