Program in Physical Therapy, Washington University School of Medicine in St Louis, St Louis, Missouri.
Department of Orthopaedic Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri.
JAMA Neurol. 2021 Apr 1;78(4):385-395. doi: 10.1001/jamaneurol.2020.4821.
Chronic low back pain (LBP) is the most prevalent chronic pain in adults, and there is no optimal nonpharmacologic management. Exercise is recommended, but no specific exercise-based treatment has been found to be most effective.
To determine whether an exercise-based treatment of person-specific motor skill training (MST) in performance of functional activities is more effective in improving function than strength and flexibility exercise (SFE) immediately, 6 months, and 12 months following treatment. The effect of booster treatments 6 months following treatment also was examined.
DESIGN, SETTING, AND PARTICIPANTS: In this single-blind, randomized clinical trial of people with chronic, nonspecific LBP with 12-month follow-up, recruitment spanned December 2013 to August 2016 (final follow-up, November 2017), and testing and treatment were performed at an academic medical center. Recruitment was conducted by way of flyers, physician and physical therapy offices, advertisements, and media interviews at Washington University in St Louis, Missouri. Of 1595 adults screened for eligibility, 1301 did not meet the inclusion criteria and 140 could not be scheduled for the first visit. A total of 154 people with at least 12 months of chronic, nonspecific LBP, aged 18 to 60 years, with modified Oswestry Disability Questionnaire (MODQ) score of at least 20% were randomized to either MST or SFE. Data were analyzed between December 1, 2017, and October 6, 2020.
Participants received 6 weekly 1-hour sessions of MST in functional activity performance or SFE of the trunk and lower limbs. Half of the participants in each group received up to 3 booster treatments 6 months following treatment.
The primary outcome was the modified Oswestry Disability Questionnaire (MODQ) score (0%-100%) evaluated immediately, 6 months, and 12 months following treatment.
A total of 149 participants (91 women; mean [SD] age, 42.5 [11.7] years) received some treatment and were included in the intention-to-treat analysis. Following treatment, MODQ scores were lower for MST than SFE by 7.9 (95% CI, 4.7 to 11.0; P < .001). During the follow-up phase, the MST group maintained lower MODQ scores than the SFE group, 5.6 lower at 6 months (95% CI, 2.1 to 9.1) and 5.7 lower at 12 months (95% CI, 2.2 to 9.1). Booster sessions did not change MODQ scores in either treatment.
People with chronic LBP who received MST had greater short-term and long-term improvements in function than those who received SFE. Person-specific MST in functional activities limited owing to LBP should be considered in the treatment of people with chronic LBP.
ClinicalTrials.gov Identifier: NCT02027623.
慢性下背痛（LBP）是成年人最常见的慢性疼痛，目前尚无最佳的非药物治疗方法。建议进行运动治疗，但尚未发现哪种特定的基于运动的治疗方法最有效。
确定基于个人运动技能训练（MST）的治疗方法在改善功能方面是否比力量和柔韧性锻炼（SFE）更有效，即治疗后即刻、6 个月和 12 个月。还检查了治疗后 6 个月时进行增强治疗的效果。
设计、地点和参与者：这是一项在密苏里州圣路易斯华盛顿大学进行的、为期 12 个月、采用单盲、随机临床试验，招募工作于 2013 年 12 月至 2016 年 8 月进行（最后一次随访为 2017 年 11 月），在学术医疗中心进行测试和治疗。通过传单、医生和物理治疗办公室、广告以及密苏里州圣路易斯华盛顿大学的媒体采访进行了招募。在对 1595 名成年人进行了资格筛选后，1301 人不符合纳入标准，140 人无法安排首次就诊。共有 154 名至少患有 12 个月慢性、非特异性 LBP 的成年人符合条件，年龄在 18 至 60 岁之间，改良 Oswestry 残疾问卷（MODQ）评分至少为 20%，他们被随机分配到 MST 或 SFE 组。数据于 2017 年 12 月 1 日至 2020 年 10 月 6 日进行分析。
参与者接受了 6 次每周 1 小时的 MST，内容为功能性活动表现，或 SFE 为躯干和下肢。每组中有一半的参与者在治疗后 6 个月接受了最多 3 次增强治疗。
主要结果是改良 Oswestry 残疾问卷（MODQ）评分（0%-100%），在治疗后即刻、6 个月和 12 个月进行评估。
共有 149 名参与者（91 名女性；平均[标准差]年龄为 42.5[11.7]岁）接受了部分治疗并纳入意向治疗分析。与 SFE 相比，MST 治疗后 MODQ 评分降低了 7.9（95%置信区间，4.7 至 11.0；P<0.001）。在随访阶段，MST 组的 MODQ 评分持续低于 SFE 组，6 个月时低 5.6（95%置信区间，2.1 至 9.1），12 个月时低 5.7（95%置信区间，2.2 至 9.1）。增强治疗并未改变两种治疗方法中的 MODQ 评分。
患有慢性 LBP 的人接受 MST 治疗后，在功能方面的短期和长期改善均优于接受 SFE 治疗的人。应考虑在治疗慢性 LBP 患者时使用基于个人的 MST 进行限制活动的功能治疗。
ClinicalTrials.gov 标识符：NCT02027623。
