Bousema Eric J, Verbunt Jeanine A, Seelen Henk A M, Vlaeyen Johan W S, Knottnerus André J
Health Promotion at Work, Mozartstraat 21, 6127 RJ Sittard, The Netherlands Rehabilitation Foundation Limburg, PO Box 88, 6430 AB Hoensbroek, The Netherlands Pain Management and Research Center, University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands Department of Medical, Clinical, and Experimental Psychology, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands Department of General Practice, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands.
Pain. 2007 Aug;130(3):279-286. doi: 10.1016/j.pain.2007.03.024. Epub 2007 Apr 30.
For years, physical deconditioning has been thought to be both a cause and a result of back pain. As a consequence physical reconditioning has been proposed as treatment-goal in patients with chronic low back pain (LBP). However, it is still unclear whether a patient's physical fitness level really decreases after pain-onset. The objectives of the present study were, firstly, to test the assumption that long-term non-specific LBP leads to a decrease of the level of physical activity (disuse), secondly, to evaluate any development of physical deconditioning as a result of disuse in CLBP, and thirdly, to evaluate predictors for disuse in CLBP. A longitudinal cohort study over one year including 124 patients with sub-acute LBP (i.e., 4-7 weeks after pain onset) was performed. Main outcome measures were change in physical activity level (PAL) and physical fitness (measured by changes in body weight, body fat and muscle strength) over one year. Hypothesized predictors for disuse were: pain catastrophizing; fear of movement; depression; physical activity decline; the perceived level of disability and PAL prior to pain. Results showed that only in a subgroup of patients a PAL-decrease had occurred after the onset of pain, whereas no signs of physical deconditioning were found. Negative affect and the patients' perceived physical activity decline in the subacute phase predicted a decreased level of PAL over one year. Based on these results, we conclude that as to the assumption that patients with CLBP suffer from disuse and physical deconditioning empirical evidence is still lacking.
多年来，身体机能下降一直被认为既是背痛的原因，也是背痛的结果。因此，身体机能恢复已被提议作为慢性下腰痛（LBP）患者的治疗目标。然而，疼痛发作后患者的体能水平是否真的会下降仍不清楚。本研究的目的，首先是检验长期非特异性下腰痛会导致身体活动水平下降（废用）这一假设，其次是评估慢性下腰痛患者因废用而导致的身体机能下降的任何发展情况，第三是评估慢性下腰痛患者废用的预测因素。进行了一项为期一年的纵向队列研究，纳入了124例亚急性下腰痛患者（即疼痛发作后4至7周）。主要结局指标是一年中身体活动水平（PAL）和体能（通过体重、体脂和肌肉力量的变化来衡量）的变化。废用的假设预测因素为：疼痛灾难化；运动恐惧；抑郁；身体活动下降；疼痛前的残疾感知水平和PAL。结果显示，只有一小部分患者在疼痛发作后出现了PAL下降，而未发现身体机能下降的迹象。消极情绪和患者在亚急性期感知到的身体活动下降预测了一年中PAL水平的下降。基于这些结果，我们得出结论，关于慢性下腰痛患者存在废用和身体机能下降这一假设，仍然缺乏实证证据。
