Smeets Rob J E M, Wade Derick, Hidding Alita, Van Leeuwen Peter J C M, Vlaeyen Johan W S, Knottnerus J Andre
Rehabilitation Centre Blixembosch, P.O. Box 1355, 5602 BJ, Eindhoven, The Netherlands.
Disabil Rehabil. 2006 Jun 15;28(11):673-93. doi: 10.1080/09638280500264782.
Does physical deconditioning (loss of cardiovascular capacity and strength/endurance of paraspinal muscles) exist in patients with chronic low back pain (CLBP) and are treatments specifically aimed to reduce these signs effective?
Systematic literature search in PUBMED, MEDLINE, EMBASE and PsycINFO until December 2004 to identify observational studies regarding deconditioning signs and high quality RCTs regarding the effectiveness of cardiovascular and/or muscle strengthening exercises. Internal validity of the RCTs was assessed by using a checklist of nine methodology criteria in accordance with the Cochrane Collaboration.
There is conflicting evidence that cardiovascular deconditioning is present in CLBP and limited evidence for wasting of the multifidus muscle. No study examined the effectiveness of cardiovascular training specifically. General and lumbar muscle strengthening are equally effective as other active treatments. Only moderate evidence is available for the effectiveness of intensive low back extensor muscle strengthening compared to less intensive strengthening.
Probably reactivation caused by active treatment and not the reconditioning itself is the important factor in the reduction of disability. Further prospective and evaluative research into the role of physical deconditioning is necessary. It seems more promising to further explore the interplay between biological, social and psychological factors.
慢性下腰痛（CLBP）患者是否存在身体机能下降（心血管功能以及椎旁肌肉力量/耐力丧失），专门针对减轻这些体征的治疗是否有效？
截至2004年12月，在PUBMED、MEDLINE、EMBASE和PsycINFO数据库中进行系统文献检索，以确定关于机能下降体征的观察性研究以及关于心血管和/或肌肉强化锻炼有效性的高质量随机对照试验（RCT）。按照Cochrane协作组的方法，使用包含九条方法学标准的清单评估RCT的内部效度。
关于CLBP患者存在心血管机能下降的证据相互矛盾，关于多裂肌萎缩的证据有限。没有研究专门考察心血管训练的有效性。一般肌肉强化和腰部肌肉强化与其他主动治疗同样有效。与强度较低的强化相比，高强度的下背部伸肌强化的有效性仅有中等证据。
可能是主动治疗引起的机能恢复而非机能恢复本身是减少残疾的重要因素。有必要对身体机能下降的作用进行进一步的前瞻性和评估性研究。进一步探索生物、社会和心理因素之间的相互作用似乎更有前景。
