Nuffield Department of Population Health, The George Institute for Global Health, University of Oxford, Oxford, United Kingdom.
Musculoskeletal Division, The George Institute for Global Health, The University of Sydney, Sydney, NSW, Australia(1); EMGO+ Institute, VU University Medical Center, Amsterdam, The Netherlands.
Complement Ther Med. 2016 Apr;25:61-6. doi: 10.1016/j.ctim.2015.12.013. Epub 2016 Jan 2.
There is evidence to support the effectiveness of tai chi for reducing pain-related symptoms across multiple musculoskeletal conditions, however, the mechanism(s) are unclear. This study explores the role of pain-catastrophising as a possible mediator in the relationship between practising tai chi and back pain symptoms.
Exploratory mediation analyses using a Baron and Kenny approach and bootstrapping methods were employed as a secondary analysis of data from a previously published randomised controlled trial.
Adults with persistent low back pain were recruited via community advertisement in Sydney, NSW, Australia.
A 10-week tai chi intervention and a wait-list control.
Patients completed self-assessments of pain intensity and bothersomeness using 0-10 numerical rating scales, disability using the Roland Morris Disability Questionnaire and pain catastrophising using the Pain Coping Strategies Questionnaire pre and post intervention.
The results suggest partial mediation, by which a reduction in catastrophising explained approximately 1/3 of the effect on pain intensity and bothersomeness and 2/3 of the effect on disability.
As the first known mediation analysis of tai chi for reducing low back pain-symptoms, it provides initial evidence that it may do so by having an effect on cognitive appraisal outcomes such as pain-catastrophising and information for choosing appropriate process measures for future studies. As tai chi is growing in popularity as an alternative treatment for patients with chronic musculoskeletal conditions, it is important to gain a better understanding of how it might work using confirmatory mediation analysis alongside future RCTs.
有证据表明，太极拳在多种肌肉骨骼疾病中都能有效减轻与疼痛相关的症状，但其机制尚不清楚。本研究探讨了疼痛灾难化作为太极拳练习与背痛症状之间关系的中介因素的作用。
采用巴伦和肯尼方法以及自举法对先前发表的随机对照试验数据进行探索性中介分析。
澳大利亚新南威尔士州悉尼的社区广告招募了患有持续性腰痛的成年人。
10 周的太极拳干预和等待名单对照。
患者在干预前后使用 0-10 数字评定量表自我评估疼痛强度和困扰程度、使用 Roland Morris 残疾问卷评估残疾程度、使用疼痛应对策略问卷评估疼痛灾难化程度。
结果表明存在部分中介效应，即疼痛灾难化的减少解释了疼痛强度和困扰程度约 1/3的变化，以及残疾程度 2/3的变化。
作为太极拳减轻腰痛症状的首个中介分析，它提供了初步证据表明，它可能通过对认知评估结果（如疼痛灾难化）产生影响，从而起到作用，这为未来的研究选择适当的过程措施提供了信息。随着太极拳作为慢性肌肉骨骼疾病患者的替代治疗方法越来越受欢迎，了解它如何通过确认性中介分析和未来的 RCT 发挥作用非常重要。
