Department of Physical Education and Sports Sciences, Karaj Branch, Islamic Azad University, Karaj, Iran.
Sports Injury and Corrective Exercises, Faculty of Physical Education and Sports Sciences, Kharazmi University, Tehran, Iran.
Pain Pract. 2021 Mar;21(3):333-342. doi: 10.1111/papr.12963. Epub 2020 Nov 21.
Different individualized interventions have been used to improve chronic low back pain (CLBP). However, their superiority over group-based interventions has yet to be elucidated. We compared an individualized treatment involving pain neuroscience education (PNE) plus motor control exercise (MCE) with group-based exercise (GE) in patients with CLBP.
Seventy-three patients with CLBP were randomly assigned into the PNE plus MCE group (n = 37) and GE group (n = 36). Both PNE plus MCE and GE were administered twice weekly for 8 weeks. Pain intensity (as measured using the VAS), disability (as measured using the Roland-Morris Disability Questionnaire), fear-avoidance beliefs (as measured using the Fear-Avoidance Beliefs Questionnaire), and self-efficacy (as measured using the Pain Self-Efficacy Questionnaire) were assessed at baseline and 8 weeks post-intervention. A 2 × 2 variance analysis (treatment group × time) with a mixed-model design was applied to statistically analyze the data.
Both groups showed significant improvements in all the outcome measures, with a large effect size (P < 0.001, partial eta squared [ηp ] = 0.66 to 0.81) after the intervention. The PNE plus MCE group showed greater improvements, with a moderate effect size in pain intensity (P = 0.041, ηp = 0.06) and disability (P = 0.021, ηp = 0.07) compared to the GE group. No significant difference was found in fear-avoidance beliefs during physical activity and work, and self-efficacy (P > 0.05) between the 2 groups.
PNE and MCE seem to be better at reducing pain intensity and disability compared to GE, while no significant differences were observed for fear-avoidance beliefs and self-efficacy between the 2 groups in patients with CLBP. With regard to the superiority of individualized interventions over group-based ones, more studies are warranted.
为了改善慢性下腰痛（CLBP），已经使用了不同的个体化干预措施。然而，它们相对于基于群组的干预措施的优越性尚未阐明。我们比较了一种涉及疼痛神经科学教育（PNE）加运动控制练习（MCE）的个体化治疗与基于群组的锻炼（GE）在 CLBP 患者中的效果。
73 名 CLBP 患者被随机分配到 PNE 加 MCE 组（n=37）和 GE 组（n=36）。PNE 加 MCE 和 GE 每周各进行两次，共 8 周。在基线和干预 8 周后，分别采用视觉模拟评分（VAS）评估疼痛强度，采用罗伦兹-莫里斯残疾问卷（Roland-Morris Disability Questionnaire）评估残疾程度，采用恐惧回避信念问卷（Fear-Avoidance Beliefs Questionnaire）评估恐惧回避信念，采用疼痛自我效能问卷（Pain Self-Efficacy Questionnaire）评估自我效能。采用混合模型设计的 2×2 方差分析（治疗组×时间）对数据进行统计学分析。
两组患者在所有结局指标上均有显著改善，干预后效应量较大（P<0.001，部分 eta 平方[ηp]为 0.66 至 0.81）。PNE 加 MCE 组在疼痛强度（P=0.041，ηp=0.06）和残疾程度（P=0.021，ηp=0.07）方面的改善程度大于 GE 组，具有中等效应量。两组患者在身体活动和工作中的恐惧回避信念和自我效能方面无显著差异（P>0.05）。
PNE 和 MCE 似乎比 GE 更能降低疼痛强度和残疾程度，而在 CLBP 患者中，两组在恐惧回避信念和自我效能方面无显著差异。关于个体化干预优于基于群组的干预的优越性，还需要更多的研究。
