Hekmatfard Maryam, Sanjari Mohammad Ali, Maroufi Nader, Saeedi Hassan, Ebrahimi Esmail, Behtash Hamid
Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.
Department of Rehabilitation Basic Sciences, School of Rehabilitation Sciences, and Biomechanics Lab., Rehabilitation Research Center, Iran University of Medical Sciences, Tehran, Iran.
Asian Spine J. 2017 Oct;11(5):748-755. doi: 10.4184/asj.2017.11.5.748. Epub 2017 Oct 11.
Clinical pilot study.
To objectively evaluate the compliance rate of lumbar-support use in patients with chronic nonspecific low back pain, as well as to assess low back pain intensity, disability, and fear-avoidance beliefs.
Wearing time is an important factor in the assessment of the efficacy of lumbar-support use in patients with chronic nonspecific low back pain. Previous studies have measured lumbar-support wearing time based on subjective assessment, and these evaluations are not easily verifiable and are usually overestimated by subjects.
Twelve subjects with chronic nonspecific low back pain who had been wearing semirigid lumbar supports for 6 weeks were evaluated. Compliance was objectively monitored using temperature sensors integrated into the semirigid lumbar supports. Subjects wore their lumbar supports for 8 hour/day on workdays and 3 hour/day on holidays during the first 3 weeks. During the next 3 weeks, subjects were gradually weaned off the lumbar supports. Pain intensity was measured using a numerical rating scale. The Oswestry disability index was used to assess the subjects' disability. Fear-avoidance behavior was evaluated using a fear-avoidance beliefs questionnaire.
The mean compliance rate of the subjects was 78.16%±13.9%. Pain intensity was significantly lower in patients with a higher compliance rate (=0.001). Disability index and fear-avoidance beliefs (functional outcomes) significantly improved during the second 3-weeks period of the treatment (<0.001, =0.02, respectively).
The compliance rate of patients wearing lumbar supports is a determining factor in chronic low back pain management. Wearing semirigid lumbar supports, as advised, was associated with decreased pain intensity, improved disability index scores, and improved fear-avoidance beliefs in patients with chronic nonspecific low back pain.
临床试点研究。
客观评估慢性非特异性下腰痛患者使用腰部支撑器具的依从率，并评估下腰痛强度、功能障碍及恐惧回避信念。
佩戴时间是评估慢性非特异性下腰痛患者使用腰部支撑器具疗效的重要因素。既往研究基于主观评估来测量腰部支撑器具的佩戴时间，而这些评估不易核实，且通常被受试者高估。
对12例佩戴半硬性腰部支撑器具6周的慢性非特异性下腰痛患者进行评估。使用集成在半硬性腰部支撑器具中的温度传感器客观监测依从情况。在最初3周内，受试者工作日每天佩戴腰部支撑器具8小时，节假日每天佩戴3小时。在接下来的3周内，受试者逐渐减少腰部支撑器具的使用。使用数字评分量表测量疼痛强度。采用Oswestry功能障碍指数评估受试者的功能障碍情况。使用恐惧回避信念问卷评估恐惧回避行为。
受试者的平均依从率为78.16%±13.9%。依从率较高的患者疼痛强度显著更低（P=0.001）。在治疗的第二个3周期间，功能障碍指数和恐惧回避信念（功能结局）显著改善（分别为P<0.001，P=0.02）。
慢性下腰痛管理中，患者佩戴腰部支撑器具的依从率是一个决定性因素。按照建议佩戴半硬性腰部支撑器具与慢性非特异性下腰痛患者疼痛强度降低、功能障碍指数评分改善及恐惧回避信念改善相关。
