Rosner Anthony L, Conable Katharine M, Edelmann Tracy
Research Director, International College of Applied Kinesiology, Shawnee Mission, KS.
Associate Professor, Chiropractic Division, Logan University/College of Chiropractic, Chesterfield, MO.
J Manipulative Physiol Ther. 2014 Feb;37(2):124-40. doi: 10.1016/j.jmpt.2013.11.003. Epub 2014 Jan 10.
The purpose of this study was to investigate the effects of 4 weeks of custom foot orthotics on pain, disability, recurrence of spinal fixation, and muscle dysfunction in adult low back pain patients receiving limited chiropractic care.
Adult volunteers with low back pain of greater than or equal to 1 month's duration were randomized to receive custom orthotics (group A) or a flat insole sham (group B) with limited chiropractic care in 5 visits over 4 weeks. Primary outcome measures are as follows: Quadruple Numerical Pain Rating Scale (for back), the Roland-Morris Disability Questionnaire, the number of muscles grade 4 or lower on manual muscle testing, and the number of spinal fixations detected by motion palpation and vertebral challenge at intake (B1), 2 weeks later before treatment began and orthotic use was initiated (B2) and before each subsequent treatment at approximately days 3, 10, 17, and 24 after B2. Secondary outcome measures are correlations of all primary outcomes.
Both groups improved on all Numerical Pain Rating Scale, Roland-Morris Disability Questionnaire, and the number of muscles from intake (B1) to final visit. Only group B yielded significant improvements in the number of spinal fixations. No outcome measures showed statistical difference between groups at any time point; however, those who wore custom orthotics longer each day showed trends toward greater improvements in some outcome measures.
Both groups improved with chiropractic care including spinal manipulation; however, there were no statistical differences shown between sham and custom orthotic groups. Future studies should formally measure the time that orthotics or shams are worn in a weight-bearing capacity each day.
本研究旨在调查定制足部矫形器对接受有限整脊治疗的成年腰痛患者的疼痛、功能障碍、脊柱固定复发及肌肉功能障碍的影响。
将持续腰痛大于或等于1个月的成年志愿者随机分为两组，一组接受定制矫形器（A组），另一组接受平底鞋垫假干预（B组），在4周内进行5次有限的整脊治疗。主要结局指标如下：四重数字疼痛评分量表（用于背部）、罗兰-莫里斯功能障碍问卷、徒手肌力测试中4级及以下肌力的肌肉数量，以及在入组时（B1）、2周后治疗开始前且开始使用矫形器前（B2）以及B2后大约第3、10、17和24天每次后续治疗前通过动态触诊和椎体激发检测到的脊柱固定数量。次要结局指标为所有主要结局指标的相关性。
从入组（B1）到最后一次随访，两组在所有数字疼痛评分量表、罗兰-莫里斯功能障碍问卷以及肌肉数量方面均有改善。只有B组在脊柱固定数量上有显著改善。在任何时间点，两组的结局指标均无统计学差异；然而，每天佩戴定制矫形器时间更长的患者在某些结局指标上有更大改善的趋势。
两组在包括脊柱推拿的整脊治疗后均有改善；然而，假干预组和定制矫形器组之间未显示出统计学差异。未来的研究应正式测量矫形器或假干预装置每天在负重状态下的佩戴时间。
