Mannion Anne F, Pulkovski Natascha, Gubler Deborah, Gorelick Mark, O'Riordan David, Loupas Thanasis, Schenk Peter, Gerber Hans, Sprott Haiko
Spine Center Division, Department of Research and Development, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland.
Eur Spine J. 2008 Apr;17(4):494-501. doi: 10.1007/s00586-008-0589-x. Epub 2008 Jan 15.
Spine stabilization exercises, in which patients are taught to perform isolated contractions of the transverses abdominus (TrA) during "abdominal hollowing", are a popular physiotherapeutic treatment for low back pain (LBP). Successful performance is typically judged by the relative increase in TrA thickness compared with that of the internal (OI) and external (OE) oblique muscles, measured using ultrasound. The day-to-day measurement error (imprecision) associated with these indices of preferential activation has not been assessed but is important to know since it influences the interpretation of changes after treatment. On 2 separate days, 14 controls and 14 patients with chronic LBP (cLBP) performed abdominal hollowing exercises in hook-lying, while M-mode ultrasound images superimposed with tissue Doppler imaging (TDI) data were recorded from the abdominal muscles (N = 5 on each side). The fascial lines bordering the TrA, OI and OE were digitized, and muscle thicknesses were calculated. The between-day error (intra-observer) was expressed as the standard error of measurement, SEM; SEM as a percentage of the mean gave the coefficient of variation (CV). There were no significant between-day differences for the mean values of resting or maximal thickness for any muscle, in either group (P > 0.05). The median SEM and CV of all thickness variables was 0.71 mm and 10.9%, respectively for the controls and 0.80 mm or 11.3%, respectively for the cLBP patients. For the contraction ratios (muscle thickness contracted/thickness at rest), the CVs were 3-11% (controls) and 5-12% (patients). The CVs were unacceptably high (30-50%, both groups) for the TrA preferential activation ratio (TrA proportion of the total lateral abdominal muscle thickness when contracted minus at rest). In both the controls and patients, the precision of measurement of absolute muscle thickness and relative change in thickness during abdominal hollowing was acceptable, and commensurate with that typical of biological measurements. The TrA preferential activation ratio is too imprecise to be of clinical use. Knowledge of the SEM for these indices is essential for interpreting the clinical relevance of any changes observed following physiotherapy.
脊柱稳定训练是一种治疗下背痛（LBP）的常用物理治疗方法，在训练中患者被教导在“收腹”时进行腹横肌（TrA）的孤立收缩。通常通过超声测量比较TrA厚度与腹内斜肌（OI）和腹外斜肌（OE）厚度的相对增加来判断训练是否成功。与这些优先激活指标相关的日常测量误差（不精确性）尚未得到评估，但了解这一点很重要，因为它会影响对治疗后变化的解释。在两个不同的日子里，14名对照组和14名慢性下背痛（cLBP）患者以钩状卧位进行收腹练习，同时从腹部肌肉记录叠加组织多普勒成像（TDI）数据的M型超声图像（每侧N = 5）。勾勒TrA、OI和OE边界的筋膜线被数字化，并计算肌肉厚度。日间误差（观察者内）用测量标准误（SEM）表示；SEM占平均值的百分比即为变异系数（CV）。两组中任何肌肉的静息或最大厚度平均值在日间均无显著差异（P > 0.05）。对照组所有厚度变量的SEM中位数和CV分别为0.71 mm和10.9%，cLBP患者分别为0.80 mm和11.3%。对于收缩率（收缩时肌肉厚度/静息时厚度），CV分别为3 - 11%（对照组）和5 - 12%（患者组）。腹横肌优先激活率（收缩时腹横肌占腹部外侧肌肉总厚度的比例减去静息时比例）的CV过高（两组均为30 - 50%）。在对照组和患者组中，腹部中空时绝对肌肉厚度和厚度相对变化的测量精度是可接受的，与典型的生物学测量精度相当。腹横肌优先激活率过于不精确，无法用于临床。了解这些指标的SEM对于解释物理治疗后观察到的任何变化的临床相关性至关重要。
