Lee Pei-Yun, Lin Sang-I, Liao Yu-Ting, Lin Ruey-Mo, Hsu Che-Chia, Huang Kuo-Yuan, Chen Yi-Ting, Tsai Yi-Ju
Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Department of Orthopedic, Tainan Municipal An-Nan Hospital-China Medical University, Tainan, Taiwan.
PLoS One. 2016 Sep 13;11(9):e0162187. doi: 10.1371/journal.pone.0162187. eCollection 2016.
Chronic low back pain (CLBP), one of the most common musculoskeletal conditions in older adults, might affect balance and functional independence. The purpose of this study was to investigate the postural responses to a suddenly released pulling force in older adults with and without CLBP. Thirty community-dwelling older adults with CLBP and 26 voluntary controls without CLBP were enrolled. Participants were required to stand on a force platform while, with one hand, they pulled a string that was fastened at the other end to a 2-kg or to a 4-kg force in the opposite direction at a random order. The number of times the participants lost their balance and motions of center of pressure (COP) when the string was suddenly released were recorded. The results demonstrated that although the loss of balance rates for each pulling force condition did not differ between groups, older adults with CLBP had poorer postural responses: delayed reaction, larger displacement, higher velocity, longer path length, and greater COP sway area compared to the older controls. Furthermore, both groups showed larger postural responses in the 4-kg pulling force condition. Although aging is generally believed to be associated with declining balance and postural control, these findings highlight the effect of CLBP on reactive balance when responding to an externally generated force in an older population. This study also suggests that, for older adults with CLBP, in addition to treating them for pain and disability, reactive balance evaluation and training, such as reaction and movement strategy training should be included in their interventions. Clinicians and older patients with CLBP need to be made aware of the significance of impaired reactive balance and the increased risk of falls when encountering unexpected perturbations.
慢性下腰痛（CLBP）是老年人中最常见的肌肉骨骼疾病之一，可能会影响平衡和功能独立性。本研究的目的是调查有和没有CLBP的老年人对突然释放的拉力的姿势反应。招募了30名社区居住的患有CLBP的老年人和26名无CLBP的自愿对照者。参与者被要求站在一个测力平台上，用一只手拉一根绳子，绳子的另一端随机固定一个2千克或4千克的力，方向相反。记录绳子突然松开时参与者失去平衡的次数和压力中心（COP）的运动情况。结果表明，尽管在每种拉力条件下两组之间的失衡率没有差异，但与老年对照组相比，患有CLBP的老年人姿势反应较差：反应延迟、位移更大、速度更高、路径长度更长以及COP摆动面积更大。此外，两组在4千克拉力条件下均表现出更大的姿势反应。虽然一般认为衰老与平衡和姿势控制能力下降有关，但这些发现突出了CLBP在老年人群体中对外界产生的力做出反应时对反应性平衡的影响。本研究还表明，对于患有CLBP的老年人，除了治疗疼痛和残疾外，反应性平衡评估和训练，如反应和运动策略训练应纳入其干预措施中。需要让临床医生和患有CLBP的老年患者意识到反应性平衡受损的重要性以及遇到意外干扰时跌倒风险增加的情况。
