髋关节活动范围与非特异性下腰痛之间是否存在关联？系统评价。

Is there an association between hip range of motion and nonspecific low back pain? A systematic review.

机构信息

School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, Australia.

出版信息

Musculoskelet Sci Pract. 2019 Jul;42:38-51. doi: 10.1016/j.msksp.2019.03.002. Epub 2019 Mar 30.

DOI:10.1016/j.msksp.2019.03.002

Abstract

OBJECTIVE: To systematically review whether there is an association between hip range of motion (ROM) and nonspecific low back pain (NSLBP). DATA SOURCES: MEDLINE, EMBASE, Cochrane library, PsychINFO, CINAHL and AMED databases were searched from year of inception until October 31st, 2018, using a combination of LBP and hip joint search terms. Commonly cited journals were also hand searched within the previous two years. STUDY SELECTION: Two reviewers independently screened identified articles, by title and abstract and then by full-text. After first round screening of 2908 identified records, 248 progressed to full-text screening. Due to the heterogeneity of studies identified, post hoc inclusion criteria of English language, studies comparing subjects with NSLBP and healthy controls, cross-sectional design, and clinical measures of hip ROM were applied. Twenty-four records were finally included. DATA EXTRACTION: Extracted data included population characteristics, duration and severity of NSLBP, hip movement direction, testing position, measurement tool and between-group difference. The Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to assess for study bias. DATA SYNTHESIS: Hip flexion ROM was measured in seven studies, extension in 13, internal rotation (IR) in 14, external rotation (ER) in 13, abduction in six, and adduction in only two studies. Among all directions tested, IR ROM was reported in more studies as significantly reduced in NSLBP subjects compared to healthy individuals. Overall the quality of evidence was very low. Common sources of study bias included lack of sample size justification, blinding of outcome assessors, adjusting for key confounders, and poor reporting. CONCLUSION: There is very low-quality evidence to support an association between limited hip ROM and NSLBP. Limited hip IR ROM was the only movement impairment found to be significantly associated with NSLBP, however this should be viewed with caution due to the low-quality supportive evidence. Further studies are needed.

摘要

目的：系统评价髋关节活动范围（ROM）与非特异性下腰痛（NSLBP）之间是否存在关联。

资料来源：从建库起至 2018 年 10 月 31 日，通过 LBP 和髋关节检索词的组合，检索 MEDLINE、EMBASE、Cochrane 图书馆、PsychINFO、CINAHL 和 AMED 数据库。还在手检了过去两年中引用率较高的期刊。

研究选择：两名评审员分别通过标题和摘要，然后通过全文对已识别的文章进行筛选。在首轮筛选出的 2908 条记录中，有 248 条进入了全文筛选。由于所识别研究的异质性，应用了事后纳入标准，即英语语言、比较 NSLBP 患者和健康对照组的研究、横断面设计和髋关节 ROM 的临床测量。最终有 24 条记录被纳入。

数据提取：提取的数据包括人口统计学特征、NSLBP 的持续时间和严重程度、髋关节运动方向、测试体位、测量工具以及组间差异。使用观察性队列和横断面研究的质量评估工具来评估研究偏倚。

数据综合：7 项研究测量了髋关节屈曲 ROM，13 项研究测量了伸展 ROM，14 项研究测量了内旋（IR）ROM，13 项研究测量了外旋（ER）ROM，6 项研究测量了外展 ROM，仅有 2 项研究测量了内收 ROM。在所有测试的方向中，IR ROM 在更多的研究中被报道为 NSLBP 患者与健康个体相比明显减少。总体而言，证据质量非常低。研究偏倚的常见来源包括缺乏样本量理由、结果评估者的盲法、对关键混杂因素的调整以及不良报告。

结论：有非常低质量的证据支持髋关节 ROM 受限与 NSLBP 之间存在关联。有限的髋关节 IR ROM 是唯一与 NSLBP 显著相关的运动障碍，但由于支持证据质量低，应谨慎看待这一结果。需要进一步的研究。