Hu Yong, Kwok Jerry Weilun, Tse Jessica Yuk-Hang, Luk Keith Dip-Kei
Department of Orthopaedics and Traumatology, The University of Hong Kong, 12 Sandy Bay Rd, Pokfulam, Hong Kong.
Department of Orthopaedics and Traumatology, The University of Hong Kong, 12 Sandy Bay Rd, Pokfulam, Hong Kong.
Spine J. 2014 Jun 1;14(6):1049-56. doi: 10.1016/j.spinee.2013.11.060. Epub 2014 Feb 12.
Nonsurgical rehabilitation therapy is a commonly used strategy to treat chronic low back pain (LBP). The selection of the most appropriate therapeutic options is still a big challenge in clinical practices. Surface electromyography (sEMG) topography has been proposed to be an objective assessment of LBP rehabilitation. The quantitative analysis of dynamic sEMG would provide an objective tool of prognosis for LBP rehabilitation.
To evaluate the prognostic value of quantitative sEMG topographic analysis and to verify the accuracy of the performance of proposed time-varying topographic parameters for identifying the patients who have better response toward the rehabilitation program.
A retrospective study of consecutive patients.
Thirty-eight patients with chronic nonspecific LBP and 43 healthy subjects.
The accuracy of the time-varying quantitative sEMG topographic analysis for monitoring LBP rehabilitation progress was determined by calculating the corresponding receiver-operating characteristic (ROC) curves. Physiologic measure was the sEMG during lumbar flexion and extension.
Patients who suffered from chronic nonspecific LBP without the history of back surgery and any medical conditions causing acute exacerbation of LBP during the clinical test were enlisted to perform the clinical test during the 12-week physiotherapy (PT) treatment. Low back pain patients were classified into two groups: "responding" and "nonresponding" based on the clinical assessment. The responding group referred to the LBP patients who began to recover after the PT treatment, whereas the nonresponding group referred to some LBP patients who did not recover or got worse after the treatment. The results of the time-varying analysis in the responding group were compared with those in the nonresponding group. In addition, the accuracy of the analysis was analyzed through ROC curves.
The time-varying analysis showed discrepancies in the root-mean-square difference (RMSD) parameters between the responding and nonresponding groups. The relative area (RA) and relative width (RW) of RMSD at flexion and extension in the responding group were significantly lower than those in the nonresponding group (p<.05). The areas under the ROC curve of RA and RW of RMSD at flexion and extension were greater than 0.7 and were statistically significant.
The quantitative time-varying analysis of sEMG topography showed significant difference between the healthy and LBP groups. The discrepancies in quantitative dynamic sEMG topography of LBP group from normal group, in terms of RA and RW of RMSD at flexion and extension, were able to identify those LBP subjects who would respond to a conservative rehabilitation program focused on functional restoration of lumbar muscle.
非手术康复治疗是治疗慢性下腰痛（LBP）的常用策略。在临床实践中，选择最合适的治疗方案仍然是一项重大挑战。表面肌电图（sEMG）地形图已被提议作为LBP康复的客观评估方法。动态sEMG的定量分析将为LBP康复提供一个客观的预后工具。
评估定量sEMG地形图分析的预后价值，并验证所提出的时变地形参数在识别对康复计划有更好反应的患者方面的性能准确性。
对连续患者的回顾性研究。
38例慢性非特异性LBP患者和43名健康受试者。
通过计算相应的受试者操作特征（ROC）曲线来确定时变定量sEMG地形图分析监测LBP康复进展的准确性。生理测量指标为腰椎屈伸过程中的sEMG。
招募在临床测试期间患有慢性非特异性LBP且无背部手术史以及任何导致LBP急性加重的疾病的患者，在为期12周的物理治疗（PT）期间进行临床测试。根据临床评估，下腰痛患者分为两组：“有反应”组和“无反应”组。“有反应”组指在PT治疗后开始康复的LBP患者，而“无反应”组指一些在治疗后未康复或病情恶化的LBP患者。将“有反应”组的时变分析结果与“无反应”组进行比较。此外，通过ROC曲线分析该分析的准确性。
时变分析显示“有反应”组和“无反应”组之间在均方根差（RMSD）参数上存在差异。“有反应”组屈伸时RMSD的相对面积（RA）和相对宽度（RW）显著低于“无反应”组（p<0.05）。屈伸时RMSD的RA和RW的ROC曲线下面积大于0.7，且具有统计学意义。
sEMG地形图的定量时变分析显示健康组和LBP组之间存在显著差异。LBP组与正常组在屈伸时RMSD的RA和RW方面的定量动态sEMG地形图差异能够识别出那些对侧重于腰背部肌肉功能恢复的保守康复计划有反应的LBP受试者。
