Department of Physical Therapy, Tokyo University of Technology, Ota-ku, Tokyo, Japan.
Department of Physical Therapy, Secomedic Hospital, Funabashi, Chiba, Japan.
PLoS One. 2021 May 24;16(5):e0252141. doi: 10.1371/journal.pone.0252141. eCollection 2021.
To identify suggestions for future research on spinal movement variability (SMV) in individuals with low back pain (LBP) by investigating (1) the methodologies and statistical tools used to assess SMV; (2) characteristics that influence the direction of change in SMV; (3) the methodological quality and potential biases in the published studies; and (4) strategies for optimizing SMV in LBP patients.
We searched literature databases (CENTRAL, Medline, PubMed, Embase, and CINAHL) and comprehensively reviewed the relevant papers up to 5 May 2020. Eligibility criteria included studies investigating SMV in LBP subjects by measuring trunk angle using motion capture devices during voluntary repeated trunk movements in any plane. The Newcastle-Ottawa risk of bias tool was used for data quality assessment. Results were reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews.
Eighteen studies were included: 14 cross-sectional and 4 prospective studies. Seven linear and non-linear statistical tools were used. Common movement tasks included trunk forward bending and backward return, and object lifting. Study results on SMV changes associated with LBP were inconsistent. Two of the three interventional studies reported changes in SMV, one of which was a randomized controlled trial (RCT) involving neuromuscular exercise interventions. Many studies did not account for the potential risk of selection bias in the LBP population.
Designers of future studies should recognize that each of the two types of statistical tools assesses functionally different aspects of SMV. Future studies should also consider dividing participants into subgroups according to LBP characteristics, as three potential subgroups with different SMV characteristics were proposed in our study. Different task demands also produced different effects. We found preliminary evidence in a RCT that neuromuscular exercises could modify SMV, suggesting a rationale for well-designed RCTs involving neuromuscular exercise interventions in future studies.
通过调查（1）评估脊柱运动可变性（SMV）的方法学和统计工具；（2）影响 SMV 变化方向的特征；（3）已发表研究中的方法学质量和潜在偏倚；以及（4）优化 LBP 患者 SMV 的策略，确定有关 LBP 患者 SMV 的未来研究建议。
我们搜索了文献数据库（CENTRAL、Medline、PubMed、Embase 和 CINAHL），并全面回顾了截至 2020 年 5 月 5 日的相关论文。纳入标准包括使用运动捕捉设备测量脊柱角度，在任何平面上通过自愿重复脊柱运动来研究 LBP 受试者 SMV 的研究。使用纽卡斯尔-渥太华偏倚风险工具进行数据质量评估。结果按照系统评价和荟萃分析扩展的首选报告项目进行报告。
纳入了 18 项研究：14 项横断面研究和 4 项前瞻性研究。使用了 7 种线性和非线性统计工具。常见的运动任务包括脊柱前屈和后伸，以及抬举物体。与 LBP 相关的 SMV 变化的研究结果不一致。三项干预性研究中有两项报告了 SMV 的变化，其中一项是涉及神经肌肉锻炼干预的随机对照试验（RCT）。许多研究没有考虑到 LBP 人群中潜在的选择偏倚风险。
未来研究的设计者应认识到，这两种统计工具中的每一种都评估了 SMV 的两个不同方面。未来的研究还应考虑根据 LBP 特征将参与者分为亚组，因为我们的研究提出了三个具有不同 SMV 特征的潜在亚组。不同的任务需求也产生了不同的效果。我们在一项 RCT 中发现了神经肌肉锻炼可以改变 SMV 的初步证据，这为未来研究中涉及神经肌肉锻炼干预的精心设计的 RCT 提供了依据。
