Curtin University, Perth, Western Australia, Australia.
Eur J Pain. 2019 Apr;23(4):823-834. doi: 10.1002/ejp.1351. Epub 2019 Jan 11.
Investigation of movement and sensory profiles across STarT Back risk subgroups.
A chronic low back pain cohort (n = 290) were classified as low, medium or high risk using the STarT Back Tool, and completed a repeated spinal bending task and quantitative sensory testing. Pain summation, time taken and the number of protective behaviours with repeated bending were measured. Sensory tests included two-point discrimination, temporal summation, pressure/thermal pain thresholds and conditioned pain modulation. Subgroups were profiled against movement and sensory variables.
The high-risk subgroup demonstrated greater pain summation following repeated forward bending (p < 0.001). The medium-risk subgroup demonstrated greater pain summation following repeated backward bending (p = 0.032). Medium- and high-risk subgroups demonstrated greater forward/backward bend time compared to the low-risk subgroup (p = 0.001, p = 0.005, respectively). Medium- and high-risk subgroups demonstrated a higher number of protective behaviours per forward bend compared to the low-risk subgroup (p = 0.008). For sensory variables, only two-point discrimination differed between subgroups, with medium- and high-risk subgroups demonstrating higher thresholds (p = 0.016).
This study showed altered movement characteristics and sensory discrimination across SBT risk subgroups in people with CLBP. Membership of the high SBT risk subgroup was associated with greater pain and disability levels, greater pain summation following repeated bending, slower bending times, a greater number of protective behaviours during forward bending, and a higher TPD threshold. Treatment outcomes for higher risk SBT subgroups may be enhanced by interventions specifically targeting movement and sensory alterations.
In 290 people with chronic low back pain movement profile and two-point discrimination threshold differed across risk subgroups defined by the STarT Back Tool. Conversely, pain sensitivity did not differ across these subgroups. These findings may add further guidance for targeted care in these subgroups.
研究 STAR*D 后背风险亚组的运动和感觉特征。
使用 STAR*D 后背工具对 290 例慢性下背痛患者进行分类，分为低、中、高风险，并完成反复脊柱弯曲试验和定量感觉测试。测量反复弯曲时的疼痛总和、时间和保护行为的数量。感觉测试包括两点辨别觉、时间总和、压力/热痛阈值和条件性疼痛调制。根据运动和感觉变量对亚组进行分析。
高风险亚组在反复向前弯曲后表现出更大的疼痛总和（p<0.001）。中风险亚组在反复向后弯曲后表现出更大的疼痛总和（p=0.032）。中、高风险亚组与低风险亚组相比，向前/向后弯曲时间更长（p=0.001，p=0.005）。中、高风险亚组在每次向前弯曲时的保护行为数量多于低风险亚组（p=0.008）。对于感觉变量，只有两点辨别觉在亚组之间存在差异，中、高风险亚组的阈值较高（p=0.016）。
本研究显示，慢性下背痛患者的 SBT 风险亚组在运动特征和感觉辨别力方面存在差异。高 SBT 风险亚组的成员与更高的疼痛和残疾水平、反复弯曲后更大的疼痛总和、更慢的弯曲时间、向前弯曲时更多的保护行为以及更高的 TPD 阈值有关。针对 SBT 风险较高的亚组的干预措施可能会通过专门针对运动和感觉改变来增强治疗效果。
在 290 例慢性下背痛患者中，基于 STAR*D 后背工具定义的风险亚组之间，运动模式和两点辨别觉阈值存在差异，而这些亚组之间的疼痛敏感性没有差异。这些发现可能为这些亚组的针对性护理提供进一步的指导。
