一种简化的核心稳定训练方案（TRICCS-特里凡得琅社区核心稳定训练）用于慢性非特异性下腰痛社区干预的效果

The effectiveness of a simplified core stabilization program (TRICCS-Trivandrum Community-based Core Stabilisation) for community-based intervention in chronic non-specific low back pain.

作者信息

Majeed A Shiju, Ts Anish, Sugunan Asha, Ms Arun

机构信息

Department of Orthopedics, Government Medical College, Trivandrum, India.

Department of Community Medicine, Government Medical College, Trivandrum, India.

出版信息

J Orthop Surg Res. 2019 Mar 22;14(1):86. doi: 10.1186/s13018-019-1131-z.

DOI:10.1186/s13018-019-1131-z

PMID:30902095

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6431028/

Abstract

BACKGROUND

Chronic low back pain is a common public health problem all over the world. Conservative therapy is prescribed as the initial treatment strategy in chronic low back pain. The cornerstone of conservatism in back care is core muscle strengthening. However, exercises prescribed for the purpose are manifold and some are not easily done by patients in Asian countries. We developed an easy to adhere exercise protocol for core stabilization and tested its effectiveness in south Indian population.

METHODS

Prospective study of 73 patients with chronic low back pain (CLBP) who were subjected to Trivandrum Community-based Core Stabilisation protocol of treatment. The enrolled patients underwent initial Oswestry Disability Index (ODI) evaluation and Keele Start Back (KSB) questionnaire before starting the protocol. Back education was given, and the patient started on stratified exercise protocol. ODI assessment was done weekly. The trend in ODI changes and the factors determining them were assessed using ANOVA. The correlation of quantitative variables like age, initial ODI score, and KSB score with the rate of reduction of ODI was assessed using Pearson's correlation. Cross-tabulations were done using the chi-square test. Parametric tests were used throughout the analysis as the quantitative study variables found to be linear. Multiple linear regression (for the quantitative outcome) and binary logistic regression (for the dichotomous outcome) were performed.

RESULTS

Mean (SD) of ODI score has reduced significantly from 43.4 (16.6) to 24.6 (17.1) over the period of 6 weeks (p value < 0.001). The trend in reduction of ODI scores was significantly more in KSB score less than or equal to 3 compared to KSB more than 3 even after adjusting for the general trend of decreasing ODI score over time. The reduction in ODI scores appeared to be low for advancing age (p = 0.468) and higher KSB scores (p = 0.001).

CONCLUSION

The TRICCS protocol is effective in a community-based approach in achieving satisfactory outcomes in CLBP in a period of 6 weeks. Patients with high KSB scores may require cognitive intervention also.

摘要

背景

慢性下腰痛是全球常见的公共卫生问题。保守治疗是慢性下腰痛的初始治疗策略。背部护理保守治疗的基石是核心肌群强化。然而，为此目的规定的锻炼方法多种多样，在亚洲国家，有些锻炼患者不易做到。我们制定了一种易于坚持的核心稳定锻炼方案，并在印度南部人群中测试了其有效性。

方法

对73例慢性下腰痛（CLBP）患者进行前瞻性研究，这些患者接受了基于特里凡得琅社区的核心稳定治疗方案。入选患者在开始该方案前进行了初始奥斯维斯特残疾指数（ODI）评估和基尔启动背部（KSB）问卷。进行了背部教育，患者开始采用分层锻炼方案。每周进行ODI评估。使用方差分析评估ODI变化趋势及其决定因素。使用Pearson相关性评估年龄、初始ODI评分和KSB评分等定量变量与ODI降低率的相关性。使用卡方检验进行交叉表分析。在整个分析过程中使用参数检验，因为定量研究变量呈线性。进行了多元线性回归（用于定量结果）和二元逻辑回归（用于二分结果）。

结果

在6周期间，ODI评分的平均值（标准差）从43.4（16.6）显著降低至24.6（17.1）（p值<0.001）。即使在调整了ODI评分随时间下降的总体趋势后，与KSB评分大于3的患者相比，KSB评分小于或等于3的患者ODI评分降低趋势明显更大。随着年龄增长（p = 0.468）和KSB评分升高（p = 0.001），ODI评分的降低似乎较少。