保持活动建议对身体活动及急性重度腰痛病程的影响。
The effect of the stay active advice on physical activity and on the course of acute severe low back pain.
作者信息
Olaya-Contreras Patricia, Styf Jorma, Arvidsson Daniel, Frennered Karin, Hansson Tommy
机构信息
Department of Orthopedics, Institute of Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden ; Department of Postgraduate Studies, Faculty of Nursing, University of Antioquia, Calle 70 No 52-21, Apartado Aereo, 1226 Medellín, Antioquia Colombia ; Unit for Health Promotion Research, University of Southern Denmark, Esbjerg, Denmark.
Department of Orthopedics, Institute of Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
出版信息
BMC Sports Sci Med Rehabil. 2015 Aug 27;7:19. doi: 10.1186/s13102-015-0013-x. eCollection 2015.
BACKGROUND
Disability due to acute low back pain (ALBP) runs parallel with distress and physical inactivity. If low back pain persists, this may lead to long-term sick leave and chronic back pain. This prospective randomized study evaluated the effect on physical activity and on the course of ALBP of two different treatment advices provided in routine care.
METHODS
Ninety-nine patients with acute severe LBP examined within 48 h after pain onset were randomized to the treatment advices "Stay active in spite of pain" (stay active group) or "Adjust activity to the pain" (adjust activity group). Pedometer step count and pain intensity (Numeric Rating Scale, NRS, 0-10) were followed daily during seven days. Linear mixed modeling were employed for statistical analyses.
RESULTS
The step count change trajectory showed a curvilinear shape with a steep initial increase reaching a plateau after day 3 in both groups, followed by an additional increase to day 7 in the stay active group only. At day 1, the step count was 4560 in the stay active group compared to 4317 in adjust activity group (p = 0.76). Although there were no statistical differences between the two groups in the parameters describing the change trajectory for step count, the increase in step count was larger in the stay active group. At day 7 the step count was 9865 in the stay active group compared to 6609 in the adjust activity group (p = 0.008). The pain intensity (NRS) trajectory was similar in the two groups. Between day 1 and day 7 it decreased linearly from 5.0 to 2.8 in the stay active group (p < 0.001), and from 4.8 to 2.3 in the adjust activity group (p < 0.001).
CONCLUSIONS
Patients with acute severe LBP advised to stay active in spite of the pain exhibited a considerable more active behavior compared to patients adjusting their activity to pain. This result confirms compliance to the treatment advice as well as the utility of the stay active advice to promote additional physical activity for more health benefits in patients with ALBP. There was minimal effect of the treatment advice on the course of ALBP.
TRIAL REGISTRATION
ClinicalTrials.gov (NCT02517762).
背景
急性下背痛（ALBP）导致的残疾与痛苦和身体活动不足同时存在。如果下背痛持续存在，可能会导致长期病假和慢性背痛。这项前瞻性随机研究评估了常规护理中提供的两种不同治疗建议对身体活动和急性下背痛病程的影响。
方法
99例在疼痛发作后48小时内接受检查的急性重度下背痛患者被随机分为“尽管疼痛仍保持活动”（保持活动组）或“根据疼痛调整活动”（调整活动组）的治疗建议组。在七天内每天记录计步器步数和疼痛强度（数字评分量表，NRS，0-10）。采用线性混合模型进行统计分析。
结果
步数变化轨迹呈曲线形，两组在第3天后均有一个陡峭的初始增加并达到平台期，随后仅保持活动组在第7天有进一步增加。在第1天，保持活动组的步数为4560步，而调整活动组为4317步（p = 0.76）。虽然两组在描述步数变化轨迹的参数上没有统计学差异，但保持活动组的步数增加幅度更大。在第7天，保持活动组的步数为9865步，而调整活动组为6609步（p = 0.008）。两组的疼痛强度（NRS）轨迹相似。在第1天至第7天之间，保持活动组从5.0线性下降至2.8（p < 0.001），调整活动组从4.8下降至2.3（p < 0.001）。
结论
与根据疼痛调整活动的患者相比，被建议尽管疼痛仍保持活动的急性重度下背痛患者表现出明显更积极的行为。这一结果证实了对治疗建议的依从性以及保持活动建议在促进急性下背痛患者进行更多身体活动以获得更多健康益处方面的效用。治疗建议对急性下背痛病程的影响极小。
试验注册
ClinicalTrials.gov（NCT02517762）。
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