腰背伸肌强化和神经肌肉控制再训练对慢性腰痛患者残疾的影响:一项随机对照试验方案。

Effects of lumbar extensor muscle strengthening and neuromuscular control retraining on disability in patients with chronic low back pain: a protocol for a randomised controlled trial.

机构信息

Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia

Health Professions, Swinburne University of Technology, Hawthorn, Victoria, Australia.

出版信息

BMJ Open. 2019 Aug 19;9(8):e028259. doi: 10.1136/bmjopen-2018-028259.

Abstract

INTRODUCTION

Chronic low back pain (CLBP) is the leading cause of disability worldwide. However, there is no consensus in the literature regarding optimal management. Exercise intervention is the most widely used treatment as it likely influences contributing factors such as physical and psychological. Literature evaluating the effects of exercise on CLBP is often generalised, non-specific and employs inconsistent outcome measures. Moreover, the mechanisms behind exercise-related improvements are poorly understood. Recently, research has emerged identifying associations between neuromuscular-biomechanical impairments and CLBP-related disability. This information can be used as the basis for more specific and, potentially more efficacious exercise interventions for CLBP patients.

METHODS AND ANALYSIS

Ninety-four participants (including both males and females) with CLBP aged 18-65 who present for treatment to a Melbourne-based private physiotherapy practice will be recruited and randomised into one of two treatment groups. Following baseline assessment, participants will be randomly allocated to receive either: (i) strengthening exercises in combination with lumbar force accuracy training exercises or (ii) strengthening exercises alone. Participants will attend exercise sessions twice a week for 12 weeks, with assessments conducted at baseline, midway (ie, 6 weeks into the trial) and at trial completion. All exercise interventions will be supervised by a qualified physiotherapist trained in the intervention protocol. The primary outcome will be functional disability measured using the Oswestry Disability Index. Other psychosocial and mechanistic parameters will also be measured.

ETHICS AND DISSEMINATION

This study was given approval by the University of Melbourne Behavioural and Social Sciences Human Ethics Sub-Committee on 8 August 2017, reference number 1 749 845. Results of the randomised controlled trial will be published in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

ACTRN12618000894291.

摘要

简介

慢性下腰痛(CLBP)是全球导致残疾的主要原因。然而,文献中对于最佳治疗方法尚未达成共识。运动干预是最广泛使用的治疗方法,因为它可能影响到身体和心理等致病因素。评估运动对 CLBP 影响的文献通常是一般性的、非特异性的,并且使用不一致的结果测量方法。此外,运动相关改善的机制还了解甚少。最近,有研究发现了神经肌肉生物力学损伤与 CLBP 相关残疾之间的关联。这些信息可作为 CLBP 患者更具体且可能更有效的运动干预的基础。

方法和分析

将招募并随机分配 94 名患有 CLBP 的参与者(包括男性和女性)至墨尔本一家私人物理治疗诊所就诊,他们的年龄在 18-65 岁之间。在基线评估后,参与者将随机分配接受以下两种治疗之一:(i)强化锻炼结合腰椎力准确性训练,或(ii)强化锻炼。参与者将每周参加两次运动课程,为期 12 周,在基线、中途(即试验进行 6 周时)和试验结束时进行评估。所有运动干预都将由经过强化锻炼和腰椎力准确性训练方案培训的合格物理治疗师进行监督。主要结局指标将使用 Oswestry 残疾指数测量功能障碍。还将测量其他心理社会和机械参数。

伦理和传播

该研究于 2017 年 8 月 8 日获得墨尔本大学行为和社会科学人类伦理小组委员会的批准,注册号为 1 749 845。随机对照试验的结果将发表在同行评议的期刊上。

试验注册号

ACTRN12618000894291。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d85a/6707707/6681cd8d6c73/bmjopen-2018-028259f01.jpg

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