Edmond Susan L, Werneke Mark W, Young Michelle, Grigsby David, McGill Troy, McClenahan Brian
Doctoral Programs in Physical Therapy, Rutgers The State University of New Jersey, Newark, New Jersey, USA.
Focus On Therapeutic Outcomes Inc., Knoxville, Tennessee, Dip MDT, Waipahu, Hawaii, USA.
Physiother Res Int. 2019 Jul;24(3):e1773. doi: 10.1002/pri.1773. Epub 2019 Apr 4.
Graded activity and graded exposure are recommended cognitive behavioural approaches to improve function and pain outcomes for patients receiving physiotherapy for chronic nonspecific low back pain. Directional preference identified following the McKenzie method is also associated with favourable patient outcomes. Study objectives were to examine associations between graded activity and/or graded exposure, and directional preference or no directional preference combined with or without graded activity/graded exposure subgroups, and function and pain outcomes among patients with chronic nonspecific low back pain managed by clinicians credentialed in the McKenzie approach.
Cohort study: Subjects (n = 801) with chronic nonspecific low back pain completed intake surveys, that is, the Lumbar Computer Adaptive Test measuring function and the Numeric Pain Rating Scale measuring pain, and questions addressing their demographic, lifestyle, and health status. Directional preference was determined at intake. Treatment with graded activity/graded exposure during the episode of care was recorded. Function and pain measures were repeated at discharge. Two models were developed controlling for potential confounding effects. The first model examined associations between patients receiving versus not receiving graded activity/graded exposure. The second model examined interaction effects between four combinations of directional preference and graded activity/graded exposure. Outcome measures were changes in function and pain during rehabilitation.
Regarding the first objective, there were no clinically relevant differences between treatment versus no treatment with graded activity/graded exposure, and functional outcomes. Regarding the second objective, patients in the no-directional preference group were more likely to see benefits from the addition of graded activity/graded exposure to their treatment groups than those with a directional preference.
Clinicians using McKenzie methods might attain improved patient functional outcomes when augmenting treatment with graded activity and/or graded exposure among patients who do not demonstrate directional preference.
对于接受物理治疗的慢性非特异性下腰痛患者，分级活动和分级暴露是推荐的认知行为疗法，旨在改善其功能和疼痛状况。采用麦肯齐方法确定的方向偏好也与良好的患者预后相关。本研究的目的是探讨分级活动和/或分级暴露与方向偏好或无方向偏好（结合或不结合分级活动/分级暴露亚组）之间的关联，以及由具备麦肯齐方法资质的临床医生管理的慢性非特异性下腰痛患者的功能和疼痛状况。
队列研究：801名慢性非特异性下腰痛患者完成了入组调查，即测量功能的腰椎计算机自适应测试和测量疼痛的数字疼痛评分量表，以及有关其人口统计学、生活方式和健康状况的问题。在入组时确定方向偏好。记录在护理期间采用分级活动/分级暴露的治疗情况。在出院时重复进行功能和疼痛测量。建立了两个模型以控制潜在的混杂效应。第一个模型研究接受与未接受分级活动/分级暴露的患者之间的关联。第二个模型研究方向偏好与分级活动/分级暴露的四种组合之间的交互作用。结局指标为康复期间功能和疼痛的变化。
关于第一个目标，采用分级活动/分级暴露治疗与未治疗之间在功能结局方面没有临床相关差异。关于第二个目标，无方向偏好组的患者比有方向偏好的患者更有可能从在其治疗组中增加分级活动/分级暴露中获益。
对于未表现出方向偏好的患者，使用麦肯齐方法的临床医生在采用分级活动和/或分级暴露增强治疗时，可能会改善患者的功能结局。
