有背痛和无背痛人群的脊柱前凸、活动范围及腰骨盆节律的一致性如何？

How consistent are lordosis, range of movement and lumbo-pelvic rhythm in people with and without back pain?

作者信息

Laird Robert A, Kent Peter, Keating Jennifer L

机构信息

Department of Physiotherapy, Monash University, PO Box 527, Frankston, VIC, 3199, Australia.

, 380 Springvale Rd, Forest Hill, 3131, Melbourne, VIC, Australia.

出版信息

BMC Musculoskelet Disord. 2016 Sep 22;17(1):403. doi: 10.1186/s12891-016-1250-1.

DOI:10.1186/s12891-016-1250-1

PMID:27658946

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5034504/

Abstract

BACKGROUND

Comparing movements/postures in people with and without lower back pain (LBP) may assist identifying LBP-specific dysfunction and its relationship to pain or activity limitation. This study compared the consistency in lumbo-pelvic posture and movement (range and pattern) in people with and without chronic LBP (>12 week's duration).

METHODS

Wireless, wearable, inertial measurement units measured lumbar lordosis angle, range of movement (ROM) and lumbo-pelvic rhythm in adults (n = 63). Measurements were taken on three separate occasions: two tests on the same day with different raters and a third (intra-rater) test one to two weeks later. Participants performed five repetitions of tested postures or movements. Test data were captured automatically. Minimal detectable change scores (MDC) provided estimates of between-test consistency.

RESULTS

There was no significant difference between participants with and without LBP for lordosis angle. There were significant differences for pelvic flexion ROM (LBP 60.8°, NoLBP 54.8°, F(1,63) = 4.31, p = 0.04), lumbar right lateral flexion ROM (LBP 22.2°, NoLBP 24.6° F(1,63) = 4.48, p = .04), trunk right lateral flexion ROM (LBP 28.4°, NoLBP 31.7°, F(1,63) = 5.9, p = .02) and lumbar contribution to lumbo-pelvic rhythm in the LBP group (LBP 45.8 %, F(1,63) = 4.20, NoLBP 51.3 % p = .044). MDC estimates for intra and inter-rater comparisons were 10°-15° for lumbar lordosis, and 5°-15° for most ROM. For lumbo-pelvic rhythm, we found 8-15 % variation in lumbar contribution to flexion and lateral flexion and 36-56 % variation in extension. Good to excellent agreement (reliability) was seen between raters (mean r = .88, ICC (2,2)).

CONCLUSION

Comparisons of ROM between people with and without LBP showed few differences between groups, with reduced relative lumbar contribution to trunk flexion. There was no difference between groups for lordosis. Wide, within-group differences were seen for both groups for ROM and lordosis. Due to variability between test occasions, changes would need to exceed 10°-15° for lumbar lordosis, 5°-15° for ROM components, and 8-15 % of lumbar contribution to lumbo-pelvic rhythm, to have 90 % confidence that movements had actually changed. Lordosis, range of movement and lumbo-pelvic rhythm typically demonstrate variability between same-day and different-day tests. This variability needs to be considered when interpreting posture and movement changes.

摘要

背景

比较有和没有下背痛（LBP）的人群的运动/姿势，可能有助于识别LBP特有的功能障碍及其与疼痛或活动受限的关系。本研究比较了患有和未患有慢性LBP（病程>12周）的人群在腰骨盆姿势和运动（范围和模式）方面的一致性。

方法

使用无线、可穿戴的惯性测量单元测量成年人（n = 63）的腰椎前凸角度、运动范围（ROM）和腰骨盆节律。在三个不同的时间进行测量：同一天由不同评估者进行两次测试，一到两周后进行第三次（评估者内部）测试。参与者对测试的姿势或运动进行五次重复。测试数据自动采集。最小可检测变化分数（MDC）提供了测试间一致性的估计。

结果

有LBP和无LBP的参与者在腰椎前凸角度上没有显著差异。在骨盆前屈ROM（LBP为60.8°，无LBP为54.8°，F(1,63)=4.31，p = 0.04）、腰椎右侧侧屈ROM（LBP为22.2°，无LBP为24.6°，F(1,63)=4.48，p = 0.04）、躯干右侧侧屈ROM（LBP为28.4°，无LBP为31.7°，F(1,63)=5.9，p = 0.02）以及LBP组中腰椎对腰骨盆节律的贡献（LBP为45.8%，F(1,63)=4.20，无LBP为51.3%，p = 0.044）方面存在显著差异。评估者内部和评估者间比较的MDC估计值，腰椎前凸为10° - 15°，大多数ROM为5° - 15°。对于腰骨盆节律，我们发现腰椎在屈曲和侧屈中的贡献变化为8 - 15%，伸展时变化为36 - 56%。评估者之间观察到良好至优秀的一致性（可靠性）（平均r = 0.88，ICC(2,2)）。

结论

有LBP和无LBP的人群之间ROM的比较显示，组间差异很少，腰椎对躯干屈曲的相对贡献减少。两组在腰椎前凸方面没有差异。两组在ROM和腰椎前凸方面在组内均存在较大差异。由于测试时机之间存在变异性，对于腰椎前凸，变化需要超过10° - 15°，对于ROM分量需要超过5° - 15°，对于腰椎对腰骨盆节律的贡献需要超过8 - 15%，才有90%的信心认为运动实际上发生了变化。腰椎前凸、运动范围和腰骨盆节律通常在同一天和不同天的测试之间表现出变异性。在解释姿势和运动变化时需要考虑这种变异性。