Long Audrey, Donelson Ron, Fung Tak
Bonavista Physical Therapy, Calgary, Alberta, Canada.
Spine (Phila Pa 1976). 2004 Dec 1;29(23):2593-602. doi: 10.1097/01.brs.0000146464.23007.2a.
Multicentered randomized controlled trial.
To determine if previously validated low back pain (LBP) subgroups respond differently to contrasting exercise prescriptions.
The role of "patient-specific" exercises in managing LBP is controversial.
A total of 312 acute, subacute, and chronic patients, including LBP-only and sciatica, underwent a standardized mechanical assessment classifying them by their pain response, specifically eliciting either a "directional preference" (DP) (i.e., an immediate, lasting improvement in pain from performing either repeated lumbar flexion, extension, or sideglide/rotation tests), or no DP. Only DP subjects were randomized to: 1) directional exercises "matching" their preferred direction (DP), 2) exercises directionally "opposite" their DP, or 3) "nondirectional" exercises. Outcome measures included pain intensity, location, disability, medication use, degree of recovery, depression, and work interference.
A DP was elicited in 74% (230) of subjects. One third of both the opposite and non-directionally treated subjects withdrew within 2 weeks because of no improvement or worsening (no matched subject withdrew). Significantly greater improvements occurred in matched subjects compared with both other treatment groups in every outcome (P values <0.001), including a threefold decrease in medication use.
Consistent with prior evidence, a standardized mechanical assessment identified a large subgroup of LBP patients with a DP. Regardless of subjects' direction of preference, the response to contrasting exercise prescriptions was significantly different: exercises matching subjects' DP significantly and rapidly decreased pain and medication use and improved in all other outcomes. If repeatable, such subgroup validation has important implications for LBP management.
多中心随机对照试验。
确定先前已验证的腰痛（LBP）亚组对不同运动处方的反应是否不同。
“针对患者个体的”运动在腰痛管理中的作用存在争议。
总共312例急性、亚急性和慢性患者，包括单纯腰痛患者和坐骨神经痛患者，接受了标准化的力学评估，根据他们的疼痛反应进行分类，具体表现为“方向偏好”（DP）（即通过重复进行腰椎前屈、后伸或侧方滑动/旋转试验，疼痛立即、持续改善）或无DP。只有DP受试者被随机分为：1）与他们偏好方向“匹配”的定向运动（DP），2）与他们的DP方向“相反”的运动，或3）“非定向”运动。结果指标包括疼痛强度、疼痛部位、功能障碍、药物使用、恢复程度、抑郁和工作干扰。
74%（230例）受试者出现DP。在接受相反方向和非定向治疗的受试者中，三分之一在2周内因无改善或病情恶化而退出（无匹配组受试者退出）。与其他两个治疗组相比，匹配组受试者在各项结果上均有显著更大的改善（P值<0.001），包括药物使用减少了三倍。
与先前的证据一致，标准化的力学评估确定了一大组有DP的LBP患者亚组。无论受试者的偏好方向如何，对不同运动处方的反应都有显著差异：与受试者DP匹配的运动显著且迅速地减轻了疼痛和药物使用，并在所有其他结果上有所改善。如果可重复，这种亚组验证对LBP管理具有重要意义。
