School of Science and Health, University of Western Sydney, Penrith South, NSW 2751, Australia.
Spine (Phila Pa 1976). 2013 Jul 1;38(15):E952-9. doi: 10.1097/BRS.0b013e318297c1e5.
Randomized controlled trial.
This is the companion study to a previous publication that presented 8-week pain, disability, and trunk muscle motor control results. The objective of this study was to compare the effect of 8 weeks of specific trunk exercises and stationary cycling on outcomes measures of catastrophizing and fear-avoidance beliefs (FAB) in patients with chronic nonspecific low back pain, and provide 6-month outcome data for all self-report measures.
It is thought that any form of moderate-to-vigorous physical activity is sufficient to address catastrophizing and FAB, and concomitant levels of pain and disability.
Sixty-four patients with low back pain were randomly assigned to 8 weeks of specific trunk exercise group (SEG), or stationary cycling group (CEG). Self-rated pain, disability, catastrophizing and FAB scores were collected before, immediately after (8 wk), and 6 months after the training program. Clinically meaningful improvements were defined as greater than a 30% reduction from baseline in pain and disability scores. "Intention-to-treat" principles were used for missing data. Per-protocol analysis was performed on participants who attended at least two-thirds of the exercise sessions.
At 8 weeks, disability was significantly lower in the SEG compared with the CEG (d = 0.62, P = 0.018). Pain was reduced from baseline in both the groups after training (P < 0.05), but was lower for the SEG (P < 0.05). FAB scores were reduced in the SEG at 8 weeks, and in the CEG at 6 months. No between-group differences in FAB scores were observed. Similar reductions in catastrophizing in each group were observed at each time point. At 6 months, the overall data pattern suggested no long-term difference between groups. Per-protocol analysis of clinically meaningful improvements suggests no between-group differences for how many patients are likely to report improvement.
Inferential statistics suggest greater improvements at 8 weeks, but not 6 months, for the SEG. Inspection of clinically meaningful changes based on a minimum level of adherence suggests no between-group differences. If a patient with low back pain adheres to either specific trunk exercises or stationary cycling, it is reasonable to think that similar improvements will be achieved.
随机对照试验。
这是之前发表的一项研究的配套研究，该研究报告了 8 周的疼痛、残疾和躯干肌肉运动控制结果。本研究的目的是比较 8 周的特定躯干运动和固定自行车运动对慢性非特异性下腰痛患者的灾难性和回避恐惧信念（FAB）的影响，并提供所有自我报告测量的 6 个月结果数据。
人们认为，任何形式的中等到剧烈的体育活动都足以解决灾难性和 FAB，以及同时存在的疼痛和残疾水平。
64 名腰痛患者被随机分配到 8 周的特定躯干运动组（SEG）或固定自行车运动组（CEG）。在训练前、训练后立即（8 周）和训练后 6 个月收集自我评定的疼痛、残疾、灾难性和 FAB 评分。临床意义上的改善定义为疼痛和残疾评分比基线降低 30%以上。对于缺失数据，采用“意向治疗”原则。对至少参加三分之二运动课程的参与者进行了符合方案分析。
8 周时，SEG 的残疾程度明显低于 CEG（d = 0.62，P = 0.018）。两组训练后疼痛均较基线下降（P < 0.05），但 SEG 组下降更明显（P < 0.05）。SEG 在 8 周时 FAB 评分降低，CEG 在 6 个月时 FAB 评分降低。两组间 FAB 评分无差异。每个组在每个时间点都观察到灾难性事件的减少。6 个月时，总体数据模式表明两组之间没有长期差异。基于最低依从水平的临床意义上的改善的符合方案分析表明，两组之间报告改善的患者数量没有差异。
推断统计学表明，SEG 在 8 周时的改善更大，但在 6 个月时没有改善。基于最低依从水平的临床意义上的变化的检查表明，两组之间没有差异。如果腰痛患者坚持特定的躯干运动或固定自行车运动，那么可以认为类似的改善将是可以实现的。
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