Browder David A, Childs John D, Cleland Joshua A, Fritz Julie M
Outpatient Physical Therapy, Physical Therapy Department, Wilford Hall Medical Center, San Antonio, TX, USA.
Phys Ther. 2007 Dec;87(12):1608-18; discussion 1577-9. doi: 10.2522/ptj.20060297. Epub 2007 Sep 25.
The purpose of this multicenter randomized clinical trial was to examine the effectiveness of an extension-oriented treatment approach (EOTA) in a subgroup of subjects with low back pain (LBP) who were hypothesized to benefit from the treatment compared with similar subjects who received a lumbar spine strengthening exercise program.
Subjects with LBP and symptoms distal to the buttocks that centralized with extension movements were included. Forty-eight subjects were randomly assigned to groups that received an EOTA (n=26) or a strengthening exercise program (n=22). Subjects attended 8 physical therapy sessions and completed a home exercise program. Follow-up data were obtained at 1 week, 4 weeks, and 6 months after randomization. Primary outcome measures were disability (modified Oswestry Low Back Pain Disability Questionnaire) and pain (Numeric Pain Rating Scale).
Subjects in the EOTA group experienced greater improvements in disability compared with subjects who received trunk strengthening exercises at 1 week (mean difference between groups from baseline=8.9, 95% confidence interval [CI]=2.0, 15.9), 4 weeks, (mean difference=14.4, 95% CI=4.8, 23.9), and 6 months (mean difference=14.6, 95% CI=4.6, 24.6). The EOTA group demonstrated greater change in pain at the 1-week follow-up only.
An EOTA was more effective than trunk strengthening exercise in a subgroup of subjects hypothesized to benefit from this treatment approach. Additional research is needed to explore whether an EOTA may benefit other subgroups of patients.
这项多中心随机临床试验的目的是，在一组被认为可能从该治疗中获益的下腰痛（LBP）患者亚组中，检验一种以伸展为导向的治疗方法（EOTA）的有效性，并与接受腰椎强化锻炼计划的类似患者进行比较。
纳入有LBP且臀部远端症状在伸展动作时集中的患者。48名患者被随机分配至接受EOTA的组（n = 26）或强化锻炼计划的组（n = 22）。患者参加8次物理治疗课程并完成家庭锻炼计划。在随机分组后1周、4周和6个月获取随访数据。主要结局指标为残疾程度（改良奥斯维斯特下腰痛残疾问卷）和疼痛（数字疼痛评分量表）。
与接受躯干强化锻炼的患者相比，EOTA组患者在1周（组间与基线的平均差异 = 8.9，95%置信区间[CI] = 2.0，15.9）、4周（平均差异 = 14.4，95%CI = 4.8，23.9）和6个月（平均差异 = 14.6，95%CI = 4.6，24.6）时残疾程度改善更大。EOTA组仅在1周随访时疼痛变化更大。
在被认为可能从这种治疗方法中获益的患者亚组中，EOTA比躯干强化锻炼更有效。需要进一步研究以探索EOTA是否可能使其他患者亚组获益。
