Department of Orthopedic Surgery, Southwestern Medical Center, University of Texas, Dallas, TX 75235, USA.
Spine (Phila Pa 1976). 2009 Oct 15;34(22):2458-65. doi: 10.1097/BRS.0b013e3181b20070.
A prospective cohort study evaluating the quantitative lumbar flexion-relaxation phenomenon (QLFRP), measured with surface electromyographic (SEMG) signals from the erector spinae during trunk flexion pre- and postrehabilitation, in patients with chronic disabling occupational lumbar disorders (CDOLD).
To assess the responsiveness of the QLFRP in documenting change in functional performance during a functional restoration program for CDOLD patients.
A recent theoretical construct suggests that QLFRP is responsive to change in lumbar range of motion (ROM) during rehabilitation, with high sensitivity and specificity for abnormal QLFRP predicting ROM.
A cohort of normal subjects was tested for QLFRP correlated to inclinometric lumbar ROM measures. The cutoff score was applied to a group of CDOLD patients entering a functional restoration program (N = 135), and to program completers (N = 104). Pain and functional self-report scores were compared with SEMG and ROM measures.
The CDOLD group averaged 23.7 months off work. Surgical treatment was provided prerehabilitation to 51% of patients, with 29% receiving lumbar fusions. From pre- to post-treatment, achievement of QLFRP rose from 31% to 74% of patients, while normal ROM rose from 8% to 63% of patients. Compared to the 16% of patients still demonstrating both abnormal QLFRP and ROM, the other groups showed significantly greater improvement in self-reported pain and function, with the best improvements occurring in patients showing normal ROM and QLFRP. The QLFRP showed high sensitivity, but only modest predictive validity and specificity for predicting ROM postrehabilitation. Improvement in sensitivity and predictive validity occur when surgical cases were excluded from the analysis.
A majority of patients in an interdisciplinary functional restoration program failed to demonstrate either the QLFRP or normal ROM on admission to the program. A majority of program completers, however, achieved both normal ROM and QLFRP and another 30% demonstrated either normal QLFRP or normal ROM. Both QLFRP and ROM measures were responsive to relevant self-report scales.
一项前瞻性队列研究，评估慢性致残性职业性腰椎疾病（CDOLD）患者在康复前和康复后通过脊柱伸肌表面肌电图（SEMG）信号测量的腰椎屈伸定量松弛现象（QLFRP），以评估其在功能性康复计划中对功能表现变化的反应能力。
评估 QLFRP 在记录 CDOLD 患者康复过程中腰椎活动范围（ROM）变化的反应能力。
最近的理论结构表明，QLFRP 对康复过程中腰椎 ROM 的变化敏感，具有高灵敏度和特异性，异常 QLFRP 预测 ROM。
对一组正常受试者进行 QLFRP 与倾斜计腰椎 ROM 测量的相关性测试。将截距评分应用于一组接受功能性康复计划的 CDOLD 患者（N=135）和计划完成者（N=104）。将疼痛和功能自我报告评分与 SEMG 和 ROM 测量进行比较。
CDOLD 组平均离职 23.7 个月。51%的患者在康复前接受手术治疗，29%的患者接受腰椎融合术。从治疗前到治疗后，QLFRP 的获得率从 31%上升到 74%的患者，而正常 ROM 的获得率从 8%上升到 63%的患者。与仍表现出异常 QLFRP 和 ROM 的 16%的患者相比，其他组的自我报告疼痛和功能改善明显更大，表现出正常 ROM 和 QLFRP 的患者改善最大。QLFRP 对预测康复后 ROM 具有较高的灵敏度，但预测效度和特异性仅适度。排除手术病例后，灵敏度和预测效度均有所提高。
大多数接受跨学科功能性康复计划的患者在进入该计划时都没有表现出 QLFRP 或正常 ROM。然而，大多数计划完成者都实现了正常的 ROM 和 QLFRP，另有 30%的患者表现出正常的 QLFRP 或正常 ROM。QLFRP 和 ROM 测量均对相关自我报告量表有反应。
