Institut de recherche Robert-Sauvé en santé et en sécurité du travail (IRSST), 505, boul. De Maisonneuve Ouest, Montréal, Québec H3A 3C2, Canada.
Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Institut universitaire sur la réadaptation en déficience physique de Montréal (IURDPM), Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Ile-de-Montréal (CCSMTL), Montréal, Québec, Canada.
PM R. 2019 Jul;11(7):710-721. doi: 10.1002/pmrj.12000. Epub 2019 Feb 22.
Lumbar stabilization exercise programs (LSEPs) act positively on clinical outcome measures in patients with low back pain (LBP), but the underlying mechanisms are not well understood. Among the various neuromuscular mechanisms, a good candidate is better activation of the abdominal wall, as measured with rehabilitative ultrasound imaging (RUSI).
To determine whether RUSI measures are (1) sensitive to LBP status and treatment (LSEP) and (2) correlate with clinical outcomes following the LSEP.
An exploratory one-arm clinical trial with healthy participants as a control group.
LSEP was delivered in a clinical setting; outcomes were measured in a laboratory setting.
Thirty-one patients with nonacute LBP and 30 healthy controls.
Outcome measures were performed before and after an 8-week LSEP in patients with LBP, and with the same time interval for control participants to compare with patients at baseline.
Pain, disability, as well as static (at rest) and dynamic (percent thickness change) RUSI measures for abdominal muscles (transversus abdominis, internal oblique [IO], and external oblique [EO]).
Patients did not produce systematic changes in RUSI measures relative to controls, even if patients had significant improvement in pain and disability. However, the correlational analyses between the absolute change (pre- to post-LSEP) (1) of EO and IO thickness (in mm) at rest (bilaterally), and (2) in pain following the LSEP were significant and consistent (range: .36-.45) in patients.
Although positive clinical improvements were observed following LSEP, there were minimal systematic changes in RUSI measures, likely because patients were not different from controls at baseline. Correlational analyses, however, indicated that greater reductions in pain were associated with reduced thickness of the EO and IO following the LSEP, suggesting the presence of some heterogeneity (or clinical subgroups) among the patients.
II.
腰椎稳定运动计划（LSEPs）对腰痛（LBP）患者的临床结果测量有积极作用，但潜在机制尚不清楚。在各种神经肌肉机制中，一个很好的候选者是更好地激活腹壁，如康复超声成像（RUSI）测量。
确定 RUSI 测量值是否（1）对 LBP 状态和治疗（LSEP）敏感，（2）与 LSEP 后的临床结果相关。
一项具有健康参与者对照组的探索性单臂临床试验。
LSEP 在临床环境中进行；结果在实验室环境中进行测量。
31 名非急性 LBP 患者和 30 名健康对照者。
对 LBP 患者进行 8 周 LSEP 前后进行结果测量，并与对照组参与者进行相同的时间间隔比较，以与基线时的患者进行比较。
疼痛、残疾以及腹壁的静态（休息时）和动态（厚度变化百分比）RUSI 测量值（腹横肌、内斜肌[IO]和外斜肌[EO]）。
患者的 RUSI 测量值相对于对照组没有系统变化，即使患者的疼痛和残疾有明显改善。然而，在患者中，EO 和 IO 厚度（双侧）在休息时的绝对变化（LSEP 前后）（1）和 LSEP 后疼痛的相关性分析（2）是显著且一致的（范围：.36-.45）。
尽管 LSEP 后观察到积极的临床改善，但 RUSI 测量值几乎没有系统变化，这可能是因为患者在基线时与对照组没有差异。然而，相关性分析表明，疼痛减轻越多，LSEP 后 EO 和 IO 的厚度减少越多，这表明患者中存在一些异质性（或临床亚组）。
II。
