Monticone Marco, Ambrosini Emilia, Cazzaniga Daniele, Rocca Barbara, Motta Lorenzo, Cerri Cesare, Brayda-Bruno Marco, Lovi Alessio
Physical Medicine and Rehabilitation Unit, Scientific Institute of Lissone, Salvatore Maugeri Foundation, Institute of Care and Research (IRCCS), Via Monsignor Bernasconi, 16, 20851, Lissone, Monza Brianza, Italy.
Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy.
Eur Spine J. 2016 Oct;25(10):3120-3129. doi: 10.1007/s00586-016-4528-y. Epub 2016 Mar 25.
To evaluate the effects of motor and cognitive rehabilitation on disability in adults with idiopathic scoliosis at lower risk of progression.
130 adults with idiopathic scoliosis (main curve <35°) were randomly assigned to a 20-week rehabilitation programme consisting of active self-correction, task-oriented exercises and cognitive-behavioural therapy (experimental group, 65 subjects, mean age of 51.6, females 48) or general physiotherapy consisting of active and passive mobilizations, stretching, and strengthening exercises of the spinal muscles (control group, 65 subjects, mean age of 51.7, females 46). Before, at the end, and 12 months after treatment, each participant completed the Oswestry disability index (ODI) (primary outcome), the Tampa scale for kinesiophobia, the pain catastrophizing scale, a pain numerical rating scale, and the Scoliosis Research Society-22 Patient Questionnaire. Radiological (Cobb angle) and clinical deformity (angle of trunk rotation) changes were also investigated. A linear mixed model for repeated measures was used for each outcome.
Significant effects of time, group, and time by group interaction were found for all outcome measures (P < 0.001). After training, the primary outcome showed a clinically significant between-group change (12 % points), which was preserved at follow-up. At follow-up, the radiological deformities showed a significant, although not clinically meaningful, between-group difference of 4° in favour of the experimental group.
The experimental programme was superior to general physiotherapy in reducing disability of adults with idiopathic scoliosis. Motor and cognitive rehabilitation also led to improvements in dysfunctional thoughts, pain, and quality of life. Changes were maintained for at least 1 year.
评估运动和认知康复对进展风险较低的特发性脊柱侧凸成人患者残疾状况的影响。
130例特发性脊柱侧凸成人患者（主弯<35°）被随机分配至一个为期20周的康复计划，该计划包括主动自我矫正、任务导向性锻炼和认知行为疗法（实验组，65名受试者，平均年龄51.6岁，女性48名），或包括主动和被动活动、伸展以及脊柱肌肉强化锻炼的一般物理治疗（对照组，65名受试者，平均年龄51.7岁，女性46名）。在治疗前、治疗结束时以及治疗后12个月，每位参与者完成奥斯威斯利残疾指数（ODI）（主要结局指标）、坦帕运动恐惧量表、疼痛灾难化量表、疼痛数字评定量表以及脊柱侧凸研究学会-22患者问卷。还对放射学（Cobb角）和临床畸形（躯干旋转角度）变化进行了研究。对每个结局指标使用重复测量的线性混合模型。
在所有结局指标中均发现了时间、组间以及时间与组间交互作用的显著影响（P<0.001）。训练后，主要结局指标显示出具有临床意义的组间变化（12个百分点），且在随访时得以维持。随访时，放射学畸形显示出有利于实验组的4°组间显著差异，尽管在临床上无意义。
在降低特发性脊柱侧凸成人患者的残疾程度方面，实验性康复计划优于一般物理治疗。运动和认知康复还改善了功能失调性思维、疼痛和生活质量。这些变化至少维持了1年。
