Shahvarpour Ali, Henry Sharon M, Preuss Richard, Mecheri Hakim, Larivière Christian
School of Rehabilitation, Faculty of Medicine, Université de Montréal, 2900 Boul. Edouard-Montpetit, Montreal, Quebec H3T 1J4, Canada; Institut de recherche Robert-Sauvé en santé et en sécurité du travail (IRSST), 505 Boul. de Maisonneuve O, Montreal, Quebec H3A 3C2, Canada.
Department of Rehabilitation and Movement Science, The University of Vermont, 305 Rowell Building, Burlington, VT 05405-0068, United States.
Clin Biomech (Bristol). 2017 Oct;48:1-8. doi: 10.1016/j.clinbiomech.2017.06.010. Epub 2017 Jun 23.
BACKGROUND: Lumbar stabilization exercise programs should normalize the aberrant movements patterns often observed in patients with low back pain. This study aimed to determine the effect of an 8-week lumbar stabilization program on EMG/kinematics measures of the aberrant movement patterns in such patients. A secondary goal was to assess the 8-week test-retest reliability of these measures. METHODS: The patients followed an 8-week lumbar stabilization program while no intervention was carried out on the controls. Before and after this period, kinematics of the spine along with the EMG of paraspinal muscles were recorded during trunk maximal flexion-extension. ANOVAs tested the effect of the intervention in the patients, relative to the controls. Within the patients, correlation of the EMG/kinematics measures with the change in disability and pain following the intervention was investigated. FINDINGS: A significant reduction in pain (Hedges's g effect size=2.31) and improvement in function (g=1.74) was reported in the patients. While EMG/kinematics measures disclosed impairments in the patients at baseline compared to the controls, no change was observed over the intervention. Nevertheless, the change of lumbar range of motion was positively correlated (r=0.42; P=0.015) with the change in disability. INTERPRETATION: Although pain and disability decreased following the intervention, the EMG/kinematics measures did not change concomitantly suggesting that the patients learned to stiffen the lumbar spine during the treatment, and this technique was applied even if pain and disability unequivocally decreased after the treatment, which would not necessarily be beneficial to the patient.
背景:腰椎稳定训练计划应使腰痛患者中常见的异常运动模式恢复正常。本研究旨在确定为期8周的腰椎稳定训练计划对此类患者异常运动模式的肌电图/运动学指标的影响。第二个目标是评估这些指标在8周内的重测信度。 方法:患者进行为期8周的腰椎稳定训练计划,而对照组不进行干预。在此期间前后,在躯干最大屈伸过程中记录脊柱的运动学指标以及椎旁肌的肌电图。方差分析测试了干预对患者相对于对照组的影响。在患者组内,研究了肌电图/运动学指标与干预后残疾和疼痛变化的相关性。 结果:患者报告疼痛显著减轻(赫奇斯g效应量=2.31),功能改善(g=1.74)。虽然与对照组相比,患者在基线时的肌电图/运动学指标显示有损伤,但在干预过程中未观察到变化。然而,腰椎活动范围的变化与残疾变化呈正相关(r=0.42;P=0.015)。 解读:尽管干预后疼痛和残疾程度有所降低,但肌电图/运动学指标并未随之改变,这表明患者在治疗过程中学会了使腰椎僵硬,并且即使治疗后疼痛和残疾明显减轻,这种技巧仍在应用,而这不一定对患者有益。
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