Department of Physical Education and Recreation, Mount Royal University, Calgary, Alberta, Canada.
Arch Phys Med Rehabil. 2012 Nov;93(11):2008-14. doi: 10.1016/j.apmr.2012.05.014. Epub 2012 May 31.
To examine changes in objectively measured physical activity (performance) at 1 week following epidural steroid injection for lumbar spinal stenosis.
Prospective cohort.
University spine program.
Individuals (N=17) who were undergoing fluoroscopically guided epidural steroid injection for symptomatic lumbar spinal stenosis (mean age ± SD, 70.1±6.7; 47% women).
Fluoroscopically guided epidural injection.
MAIN OUTCOME MEASURE(S): The 2 primary outcomes, measured with accelerometers, were total activity (performance) measured over 7 days and maximum continuous activity (capacity). Walking capacity was also assessed with the Self-Paced Walking Test, and subjects completed the Oswestry Disability Index, Swiss Spinal Stenosis Questionnaire, Medical Outcomes Study 36-Item Short-Form Health Survey, visual analog pain scales, and body diagrams.
At 1 week postinjection, 58.8% of the subjects demonstrated increased total activity and 53% had increased maximum continuous activity, although neither change was statistically significant. Significant improvements were observed in a number of the self-report instruments, including the Physical Function Scale of the Swiss Spinal Stenosis Questionnaire, general health (Medical Outcomes Study 36-Item Short-Form Health Survey), role-limitation emotional (Medical Outcomes Study 36-Item Short-Form Health Survey), leg pain intensity (visual analog pain scales), and presence of leg weakness.
While patients perceived improvements in pain and function following injection, these improvements were not reflected in significant changes in performance or capacity. Future studies will continue to find value in subjective measures of pain and quality of life. However, with modern technology, performance is no longer a subjective variable. Use of activity monitors to objectively measure performance can result in more rigorous validation of treatment effects, while simultaneously highlighting the potential need for additional postinjection rehabilitation aimed at improving performance.
观察腰椎管狭窄症患者行硬膜外类固醇注射后 1 周时客观测量的体力活动（表现）的变化。
前瞻性队列研究。
大学脊柱计划。
接受透视引导硬膜外类固醇注射治疗症状性腰椎管狭窄症的个体（N=17；平均年龄±标准差，70.1±6.7；47%为女性）。
透视引导硬膜外注射。
使用加速度计测量的 2 个主要结局指标，即 7 天内的总活动（表现）和最大连续活动（能力）。还使用自我调节步行测试评估步行能力，受试者完成 Oswestry 残疾指数、瑞士脊柱狭窄问卷、医疗结果研究 36 项简明健康调查问卷、视觉模拟疼痛量表和身体图表。
在注射后 1 周时，58.8%的受试者表现出总活动增加，53%的受试者最大连续活动增加，但均无统计学意义。多项自我报告工具的评分显著改善，包括瑞士脊柱狭窄问卷的身体功能量表、一般健康（医疗结果研究 36 项简明健康调查问卷）、角色限制情绪（医疗结果研究 36 项简明健康调查问卷）、腿部疼痛强度（视觉模拟疼痛量表）和腿部无力。
尽管患者在注射后对疼痛和功能的改善有感知，但这些改善并未反映在表现或能力的显著变化中。未来的研究将继续发现疼痛和生活质量的主观测量有价值。然而，随着现代技术的发展，表现不再是一个主观变量。使用活动监测器客观测量表现可以更严格地验证治疗效果，同时突出可能需要额外的注射后康复治疗来提高表现。
