Sheeran Liba, van Deursen Robert, Caterson Bruce, Sparkes Valerie
*Research Centre for Clinical Kinaesiology, School of Healthcare Studies, Cardiff University, Cardiff, Wales, United Kingdom †School of Biosciences, Cardiff University, Cardiff, Wales, United Kingdom; and ‡Research Centre for Clinical Kinaesiology School of Healthcare Studies, Cardiff Institute of Tissue Engineering and Repair, Cardiff University, Cardiff, Wales, United Kingdom.
Spine (Phila Pa 1976). 2013 Sep 1;38(19):1613-25. doi: 10.1097/BRS.0b013e31829e049b.
Pragmatic randomized controlled single-blinded study.
To compare the effects of the classification system guided postural intervention (CSPI) with generalized postural intervention (GPI) in subgroups of nonspecific chronic low back pain (NSCLBP).
Spinal motor control impairments and the associated alterations in spinal postures adopted by patients with NSCLBP are highly variable. Research evaluating the effect of interventions that target the specific movement/posture impairments in NSCLBP subgroups is therefore warranted.
A total of 49 patients with NSCLBP with a classification of flexion pattern (n = 29) and active extension pattern (n = 20) control impairment were recruited from a large cohort study and randomly assigned into CSPI and GPI. The primary outcome was change in Roland-Morris Disability Questionnaire, secondary outcomes were change in pain visual analogue scale, spinal repositioning sense including thoracic and lumbar absolute error, variable error, constant error, and trunk muscle activity during sitting and standing. The intervention was evaluated at baseline, immediately post one-to-one intervention and post 4-week home-based training.
The CSPI produced statistically and clinically significant reduction in disability (4.2 [95% CI, 2.9-5.3]) and pain (2, [95% CI, 1.3-2.6]) compared with minimal change in the GPI disability (0.4, [95% CI, -0.8 to 1.6]) and pain (-0.2, [95% CI, -0.5 to 0.9]). Repeated measures analysis of variance revealed that CSPI significantly reduced absolute error in thoracic (sitting) and lumbar spine (standing) and constant error in lumbar spine (standing) post one-to-one phase, although this was no longer significant at 4 weeks. Neither intervention had an effect on trunk muscle activity.
Compared with minimal change in the GPI group, the CSPI produced statistically and clinically significant improvements in disability and pain outcomes and short-term improvements in some parameters of spinal repositioning sense in NSCLBP subgroups.
实用随机对照单盲研究。
比较分类系统指导下的姿势干预（CSPI）与一般姿势干预（GPI）对非特异性慢性下腰痛（NSCLBP）亚组的影响。
NSCLBP患者的脊柱运动控制障碍以及相关的脊柱姿势改变差异很大。因此，有必要开展研究评估针对NSCLBP亚组特定运动/姿势障碍的干预措施的效果。
从一项大型队列研究中招募了49例NSCLBP患者，根据控制障碍分为屈曲型（n = 29）和主动伸展型（n = 20），并随机分为CSPI组和GPI组。主要结局指标为罗兰·莫里斯功能障碍问卷的变化，次要结局指标为疼痛视觉模拟量表的变化、脊柱重新定位觉，包括胸段和腰段的绝对误差、可变误差、恒定误差，以及坐立位时的躯干肌肉活动。在基线、一对一干预后即刻以及4周家庭训练后对干预效果进行评估。
与GPI组功能障碍（0.4，[95%CI，-0.8至1.6]）和疼痛（-0.2，[95%CI，-0.5至0.9]）的微小变化相比，CSPI组在功能障碍（4.2 [95%CI，2.9 - 5.3]）和疼痛（2，[95%CI，1.3 - 2.6]）方面产生了具有统计学意义和临床意义的降低。重复测量方差分析显示，CSPI组在一对一干预阶段后显著降低了胸段（坐位）和腰段（站立位）的绝对误差以及腰段（站立位）的恒定误差，尽管在4周时这不再具有统计学意义。两种干预措施对躯干肌肉活动均无影响。
与GPI组的微小变化相比，CSPI在NSCLBP亚组的功能障碍和疼痛结局方面产生了具有统计学意义和临床意义的改善，以及脊柱重新定位觉某些参数的短期改善。
