Fehrmann Elisabeth, Tuechler Kerstin, Kienbacher Thomas, Mair Patrick, Spreitzer Juliane, Fischer Linda, Kollmitzer Josef, Ebenbichler Gerold
*Karl-Landsteiner-Institute of Outpatient Rehabilitation Research †Karl Landsteiner University of Health Sciences, Department of Psychology §Technical School of Engineering ∥University of Applied Sciences, Department of Biomedical Engineering ¶Department of Physical Medicine and Rehabilitation, Medical University Vienna, Austria ‡Department of Psychology, Harvard University, Cambridge, MA.
Clin J Pain. 2017 Oct;33(10):912-920. doi: 10.1097/AJP.0000000000000479.
Evidence suggests that chronic low back pain patients with fear-avoidance (FAR) or endurance behavior are at risk of treatment failure and pain maintenance, with bodily overuse or underuse being assumed as mediating mechanisms for pain chronification. This study sought to examine whether or not the avoidance-endurance model subgroups, FAR, distress-endurers (DER), eustress-endurers (EER), and adaptive responders (AR), differed in physical measures and outcomes after training therapy.
A total of 137 chronic low back pain patients were assessed before, at the end of, and 6 months after a 6-month rehabilitation training. Patients performed maximum back extension strength and trunk range-of-motion measures, flexion-relaxation tests, and completed the following questionnaires: Avoidance-Endurance Questionnaire, Roland-Morris Disability Questionnaire, Pain Disability Index, 36-Item Short-Form Health Survey, International Physical Activity Questionnaire, and visual analog scale. Statistical analysis included cluster analysis, analysis of covariances, and mixed-effects models.
At baseline, avoidance-endurance model subgroups did not differ in physical measures and activity levels. At the end of training, patients' back-related health was significantly improved in all subgroups. However, the DER and the FAR were found to be more impaired before and after the intervention compared with EER and AR, as indicated by a higher pain intensity, higher disability levels, lower quality of life, and inferior working capacity.
Although FAR and DER did not differ in physical measures or activity levels from EER and AR, they demonstrated poor lower back-related health at baseline and after intervention. Thus, future research should elucidate as to which additional interventions could optimize their health.
有证据表明，患有恐惧回避（FAR）或耐力行为的慢性腰痛患者存在治疗失败和疼痛持续的风险，身体过度使用或使用不足被认为是疼痛慢性化的中介机制。本研究旨在探讨回避 - 耐力模型亚组，即FAR、痛苦耐力者（DER）、良性应激耐力者（EER）和适应性反应者（AR）在训练治疗后的身体测量指标和结果方面是否存在差异。
共有137名慢性腰痛患者在为期6个月的康复训练前、训练结束时和训练后6个月接受评估。患者进行了最大背部伸展力量和躯干活动范围测量、屈伸放松测试，并完成了以下问卷：回避 - 耐力问卷、罗兰 - 莫里斯残疾问卷、疼痛残疾指数、36项简短健康调查、国际体力活动问卷和视觉模拟量表。统计分析包括聚类分析、协方差分析和混合效应模型。
在基线时，回避 - 耐力模型亚组在身体测量指标和活动水平上没有差异。在训练结束时，所有亚组患者与背部相关的健康状况均有显著改善。然而，与EER和AR相比，DER和FAR在干预前后被发现受损更严重，表现为更高的疼痛强度、更高的残疾水平、更低的生活质量和更差的工作能力。
尽管FAR和DER在身体测量指标或活动水平上与EER和AR没有差异，但它们在基线和干预后显示出较差的下背部相关健康状况。因此，未来的研究应阐明哪些额外的干预措施可以优化他们的健康状况。
