Clinical Locomotion Science, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, Odense M, Denmark.
BMC Musculoskelet Disord. 2010 Feb 10;11:30. doi: 10.1186/1471-2474-11-30.
Active approaches including both specific and unspecific exercise are probably the most widely recommended treatment for patients with chronic low back pain but it is not known exactly which types of exercise provide the most benefit. Nordic Walking - power walking using ski poles - is a popular and fast growing type of exercise in Northern Europe that has been shown to improve cardiovascular metabolism. Until now, no studies have been performed to investigate whether Nordic Walking has beneficial effects in relation to back pain.
A total of 151 patients with low back and/or leg pain of greater than eight weeks duration were recruited from a hospital based outpatient back pain clinic. Patients continuing to have pain greater than three on the 11-point numeric rating scale after a multidisciplinary intervention were included. Fifteen patients were unable to complete the baseline evaluation and 136 patients were randomized to receive A) Nordic walking supervised by a specially trained instructor twice a week for eight weeks B) One-hour instruction in Nordic walking by a specially trained instructor followed by advice to perform Nordic walking at home as much as they liked for eight weeks or C) Individual oral information consisting of advice to remain active and about maintaining the daily function level that they had achieved during their stay at the backcenter. Primary outcome measures were pain and disability using the Low Back Pain Rating Scale, and functional limitation further assessed using the Patient Specific Function Scale. Furthermore, information on time off work, use of medication, and concurrent treatment for their low back pain was collected. Objective measurements of physical activity levels for the supervised and unsupervised Nordic walking groups were performed using accelerometers. Data were analyzed on an intention-to-treat basis.
No mean differences were found between the three groups in relation to any of the outcomes at baseline. For pain, disability, and patient specific function the supervised Nordic walking group generally faired best however no statistically significant differences were found. Regarding the secondary outcome measures, patients in the supervised group tended to use less pain medication, to seek less concurrent care for their back pain, at the eight-week follow-up. There was no difference between physical activity levels for the supervised and unsupervised Nordic walking groups. No negative side effects were reported.
We did not find statistically significant differences between eight weeks of supervised or unsupervised Nordic walking and advice to remain active in a group of chronic low back pain patients. Nevertheless, the greatest average improvement tended to favor the supervised Nordic walking group and - taking into account other health related benefits of Nordic walking - this form of exercise may potentially be of benefit to selected groups of chronic back pain patients.
http://www.ClinicalTrials.gov # NCT00209820.
主动疗法包括特定和非特定运动，可能是治疗慢性下腰痛患者最广泛推荐的治疗方法，但尚不清楚哪种运动提供最大的益处。北欧式健走——使用滑雪杖的强力行走——是北欧流行且快速发展的一种运动方式，已被证明可以改善心血管代谢。到目前为止，还没有研究调查北欧式健走对腰痛是否有有益的影响。
共招募了 151 名下背部和/或腿部疼痛持续时间超过 8 周的患者，这些患者来自一家基于医院的门诊腰痛诊所。在接受多学科干预后，仍有疼痛大于 3（11 点数字评定量表）的患者被纳入。15 名患者无法完成基线评估，136 名患者被随机分为 A）接受由专门培训的指导员每周两次监督的北欧式健走，为期 8 周；B）接受由专门培训的指导员进行 1 小时的北欧式健走指导，然后建议他们尽可能多地在家中进行北欧式健走，为期 8 周；C）接受个人口头信息，包括保持活动和保持在背部中心期间达到的日常功能水平的建议。主要结局指标是使用腰痛评分量表评估疼痛和残疾，以及使用特定于患者的功能量表进一步评估功能受限。此外，还收集了关于他们的下背部疼痛的停工时间、药物使用和同时治疗的信息。使用加速度计对监督和非监督的北欧式健走组的身体活动水平进行了客观测量。数据进行意向治疗分析。
在基线时，三组之间在任何结局上均无显著差异。对于疼痛、残疾和特定于患者的功能，监督的北欧式健走组通常表现最好，但未发现统计学上的显著差异。关于次要结局指标，监督组的患者在 8 周随访时倾向于使用较少的止痛药，并且对他们的腰痛寻求较少的同时治疗。监督和非监督的北欧式健走组的身体活动水平没有差异。没有报告负面的副作用。
我们没有发现 8 周的监督或非监督的北欧式健走与保持活动的建议在慢性下腰痛患者组之间存在统计学上的显著差异。然而，最大的平均改善倾向于有利于监督的北欧式健走组，并且考虑到北欧式健走对其他健康相关益处，这种运动形式可能对慢性背痛患者的某些群体有益。
http://www.ClinicalTrials.gov # NCT00209820。
