身体活动是否会在急性腰痛发作期间引发发作？一项纵向病例交叉可行性研究。
Do Physical Activities Trigger Flare-ups During an Acute Low Back Pain Episode?: A Longitudinal Case-Crossover Feasibility Study.
机构信息
Seattle Epidemiologic Research and Information Center (ERIC) and Division of Rehabilitation Care Services, VA Puget Sound Health Care System, Seattle, WA.
Department of Rehabilitation Medicine, University of Washington, Seattle, WA.
出版信息
Spine (Phila Pa 1976). 2018 Mar 15;43(6):427-433. doi: 10.1097/BRS.0000000000002326.
STUDY DESIGN
Prospective, longitudinal case-crossover study.
OBJECTIVE
The aim of this study was to determine whether physical activities trigger flare-ups of pain during the course of acute low back pain (LBP).
SUMMARY OF BACKGROUND DATA
.: There exist no evidence-based estimates for the transient risk of pain flare-ups associated with specific physical activities, during acute LBP.
METHODS
Participants with LBP of duration <3 months completed frequent, Internet-based serial assessments at both 3- and 7-day intervals for 6 weeks. At each assessment, participants reported whether they had engaged in specific physical activity exposures, or experienced stress or depression, during the past 24 hours. Participants also reported whether they were currently experiencing a LBP flare-up, defined as "a period of increased pain lasting at least 2 hours, when your pain intensity is distinctly worse than it has been recently." Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for associations between potential triggers during the past 24 hours, and the risk of LBP flare-ups, using conditional logistic regression.
RESULTS
Of 48 participants followed longitudinally, 30 participants had both case ("flare") and control periods and contributed data to the case-crossover analysis. There were 81 flare periods and 247 control periods, an average of 11 periods per participant. Prolonged sitting (>6 hours) was the only activity that was significantly associated with flare-ups(OR 4.4, 95% CI 2.0-9.7; P < 0.001). Having either stress or depression was also significantly associated with greater risk of flare-ups (OR 2.5, 95% CI 1.0-6.0; P = 0.04). In multivariable analyses, prolonged sitting (OR 4.2, 95% CI 1.9-9.1; P < 0.001), physical therapy (PT) (OR 0.4, 95% CI 0.1-1.0; P = 0.05), and stress/depression (OR 2.8, 95% CI 1.2-6.7; P = 0.02) were independently and significantly associated with LBP flare-up risk.
CONCLUSION
Among participants with acute LBP, prolonged sitting (>6 hours) and stress or depression triggered LBP flare-ups. PT was a deterrent of flare-ups.
LEVEL OF EVIDENCE
研究设计
前瞻性、纵向病例交叉研究。
目的
本研究旨在确定在急性腰痛（LBP）过程中，体力活动是否会引发疼痛发作。
背景资料概述
目前尚无针对急性 LBP 期间与特定体力活动相关的疼痛发作瞬时风险的循证估计。
方法
腰痛持续时间<3 个月的参与者在 3 天和 7 天的间隔内，通过频繁的基于互联网的连续评估，持续 6 周。在每次评估中，参与者报告过去 24 小时内是否进行了特定的体力活动暴露，或经历了压力或抑郁。参与者还报告他们是否正在经历腰痛发作，定义为“疼痛持续至少 2 小时的时期，疼痛强度明显比最近更严重。”使用条件逻辑回归计算过去 24 小时内潜在触发因素与 LBP 发作风险之间的比值比（OR）和 95%置信区间（CI）。
结果
在 48 名进行纵向随访的参与者中，有 30 名参与者既有病例（“发作”）期又有对照期，并为病例交叉分析提供了数据。共有 81 个发作期和 247 个对照期，平均每个参与者有 11 个发作期。长时间坐着（>6 小时）是唯一与发作显著相关的活动（OR 4.4，95%CI 2.0-9.7；P<0.001）。有压力或抑郁也与更大的发作风险显著相关（OR 2.5，95%CI 1.0-6.0；P=0.04）。在多变量分析中，长时间坐着（OR 4.2，95%CI 1.9-9.1；P<0.001）、物理治疗（PT）（OR 0.4，95%CI 0.1-1.0；P=0.05）和压力/抑郁（OR 2.8，95%CI 1.2-6.7；P=0.02）与 LBP 发作风险独立且显著相关。
结论
在急性 LBP 参与者中，长时间坐着（>6 小时）和压力或抑郁会引发 LBP 发作。PT 是发作的抑制因素。
证据水平
2 级。
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