运动性心理意象产生对慢性下腰痛患者物理治疗的影响。

Influence of the Generation of Motor Mental Images on Physiotherapy Treatment in Patients with Chronic Low Back Pain.

机构信息

Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain; Motion in Brains Research Group, Centro Superior de Estudios Universitarios La Salle; Universidad Autónoma de Madrid, Aravaca, Madrid, Spain.

Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain; Motion in Brains Research Group, Instituto de Neurosciencias y Ciencias del Movimiento (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain.

出版信息

Pain Physician. 2020 Jul;23(4):E399-E408.

PMID:32709186

Abstract

BACKGROUND

Patients with nonspecific chronic low back pain (NCLBP) have greater difficulty generating kinesthetic and visual motor imagery.

OBJECTIVES

The main aim of this study was to determine whether the ability to generate mental motor imagery (MIab) influences psychological, motor, and disability variables in patients with NCLBP. The secondary aim was to determine whether an approach based on therapeutic exercise (TE) and therapeutic education (TEd) could improve the MIab in those patients with less ability to perform it.

STUDY DESIGN

Cross-sectional and quasiexperimental study.

SETTING

Physical Therapy Unit of primary health care center in Madrid, Spain.

METHODS

A total of 68 patients were divided into 2 groups according to a greater (n = 34) or lesser (n = 34) MIab. Treatment was based on TEd and TE for the group with less ability to generate kinesthetic and visual motor imagery. The outcome measures were imagery requested time, self-efficacy, disability, pain intensity, lumbar strength, psychological variables, and MIab.

RESULTS

The group with lesser MIab showed lower levels of self-efficacy (P = 0.04; d, -0.47) and lower levels of lumbar strength and extension strength (P = 0.04; d, -0.46 and P = 0.02; d, -0.52, respectively). After the intervention with TE and TEd, MIab (both kinesthetic and visual) improved significantly, with a moderate to large effect size (P <= 0.01; d, -0.80 and P <= 0.01; d, -0.76, respectively), as did pain intensity, lumbar strength, disability, and psychological variables (P < 0.05), but not levels of self-efficacy (P > 0.05). Based on the results, the patients with NCLBP with lesser MIab achieved lower levels of self-efficacy and lower strength levels.

LIMITATIONS

The results of this study should be interpreted with caution because of its quasiexperimental design and a bias selection.

CONCLUSIONS

A clinical TE approach, coupled with a TEd program, resulted in significant improvement in MIab (both kinesthetic and visual), reduced pain intensity, increased lumbar strength, reduced disability, and improved psychological variables, but it did not significantly improve self-efficacy levels in the patients with NCLBP.

KEY WORDS

Chronic low back pain, motor imagery, disability, lumbar strength.

摘要

背景

非特异性慢性下腰痛（NCLBP）患者在产生运动知觉意象和视觉运动意象方面存在更大的困难。

目的

本研究的主要目的是确定生成心理运动意象（MIab）的能力是否会影响 NCLBP 患者的心理、运动和残疾变量。次要目的是确定基于治疗性运动（TE）和治疗性教育（TEd）的方法是否可以改善那些运动能力较差的患者的 MIab。

研究设计

横断面和准实验研究。

设置

西班牙马德里初级保健中心的物理治疗科。

方法

根据更大（n = 34）或更小（n = 34）的 MIab 将 68 名患者分为两组。对于运动能力较差的组，治疗基于 TEd 和 TE。结果测量指标包括想象请求时间、自我效能、残疾、疼痛强度、腰椎力量、心理变量和 MIab。

结果

MIab 较差的组自我效能水平较低（P = 0.04；d，-0.47），腰椎力量和伸展力量水平较低（P = 0.04；d，-0.46 和 P = 0.02；d，-0.52，分别）。经过 TE 和 TEd 的干预，MIab（包括运动知觉和视觉运动知觉）均显著改善，具有中等至较大的效应量（P <= 0.01；d，-0.80 和 P <= 0.01；d，-0.76，分别），疼痛强度、腰椎力量、残疾和心理变量也得到改善（P < 0.05），但自我效能水平无明显改善（P > 0.05）。基于这些结果，MIab 较差的 NCLBP 患者自我效能水平较低，力量水平较低。