Department of Health Sciences and Technology, Institute for Human Movement Sciences, ETH Zurich, Zurich, Switzerland.
Research Department, Reha Rheinfelden, Rheinfelden, Switzerland.
PLoS One. 2018 Mar 9;13(3):e0193358. doi: 10.1371/journal.pone.0193358. eCollection 2018.
Sensorimotor training (SMT) is popularly applied as exercise in rehabilitation settings, particularly for musculoskeletal pain. With insufficient evidence on its effect on pain and function, this exploratory randomised controlled trial investigated the potential effects of SMT in rehabilitation of chronic non-specific low back pain. Two arms received 9x30 minutes physiotherapy with added interventions: The experimental arm received 15 minutes of postural SMT while the comparator arm performed 15 minutes of added sub-effective low-intensity training. A treatment blinded tester assessed outcomes at baseline 2-4 days prior to intervention, pre- and post-intervention, and at 4-week follow-up. Main outcomes were pain and functional status assessed with a 0-100mm visual analogue scale and the Oswestry Disability Questionnaire. Additionally, postural control was analysed using a video-based tracking system and a pressure plate during perturbed stance. Robust, nonparametric multivariate hypothesis testing was performed. 22 patients (11 females, aged 32 to 75 years) with mild to moderate chronic pain and functional limitations were included for analysis (11 per arm). At post-intervention, average values of primary outcomes improved slightly, but not to a clinically relevant or statistically significant extent. At 4-week follow-up, there was a significant improvement by 12 percentage points (pp) on the functional status questionnaire in the SMT-group (95% confidence intervall (CI) = 5.3pp to 17.7pp, p < 0.001) but not in the control group (4 pp improvement, CI = 11.8pp to 19.2pp). However, group-by-time interaction effects for functional status (Q = 3.3, 19 p = 0.07) and pain (Q = 0.84, p = 0.51) were non-significant. Secondary kinematic outcomes did not change over time in either of the groups. Despite significant improvement of functional status after SMT, overall findings of this exploratory study suggest that SMT provides no added benefit for pain reduction or functional improvement in patients with moderate chronic non-specific low back pain.
ClinicalTrials.gov NCT02304120 and related study protocol, DOI: 10.1186/1471-2474-15-382.
背景：感觉运动训练（SMT）作为康复治疗的一种运动方式在临床上很受欢迎，尤其是在治疗肌肉骨骼疼痛方面。由于缺乏其对疼痛和功能影响的证据，本探索性随机对照试验研究了 SMT 在慢性非特异性下腰痛康复中的潜在效果。两组均接受 9 次 30 分钟的物理治疗，并附加干预措施：实验组接受 15 分钟的姿势 SMT，对照组则进行 15 分钟的附加低强度训练。一位经过治疗盲测培训的测试员在干预前 2-4 天、干预前和干预后以及 4 周随访时评估结果。主要结局是使用 0-100mm 视觉模拟量表和 Oswestry 残疾问卷评估疼痛和功能状态。此外，使用基于视频的跟踪系统和压力板在受扰站立时分析姿势控制。进行了稳健的、非参数的多变量假设检验。
方法：纳入了 22 名（11 名女性，年龄 32-75 岁）有轻度至中度慢性疼痛和功能限制的患者进行分析（每组 11 名）。干预后，主要结局的平均数值略有改善，但没有达到临床相关或统计学显著程度。在 4 周随访时，SMT 组在功能状态问卷上的改善显著，提高了 12 个百分点（95%置信区间（CI）=5.3 点至 17.7 点，p<0.001），而对照组则没有改善（改善 4 个百分点，CI=11.8 点至 19.2 点）。然而，功能状态的组间时间交互效应（Q=3.3，p=0.07）和疼痛（Q=0.84，p=0.51）均无统计学意义。两组的运动学结果在随访期间均无变化。
结论：尽管 SMT 后功能状态有显著改善，但本探索性研究的总体结果表明，对于中度慢性非特异性下腰痛患者，SMT 对减轻疼痛或改善功能没有额外益处。
临床试验注册：ClinicalTrials.gov NCT02304120 及相关研究方案，DOI：10.1186/1471-2474-15-382。
