Houle Mariève, O'Shaughnessy Julie, Tétreau Charles, Châtillon Claude-Édouard, Marchand Andrée-Anne, Descarreaux Martin
Département des Sciences de l'activité physique, Université du Québec à Trois-Rivières, 3351, boul. des Forges, C.P. 500, Trois-Rivières, QC, G8Z 4M3, Canada.
Département de Chiropratique, Université du Québec à Trois-Rivières, 3351, boul. des Forges, C.P. 500, Trois-Rivières, QC, G8Z 4M3, Canada.
Chiropr Man Therap. 2021 Jul 15;29(1):24. doi: 10.1186/s12998-021-00382-5.
Lumbar spinal stenosis (LSS) and peripheral arterial disease (PAD) are two distinct conditions characterized by similar symptoms including leg pain and walking limitations due to claudication. Differentiation between both origins can be difficult and characteristics such as symptom manifestations, time to relief in rest position and pain localization should be considered when determining diagnosis and the treatment plan. The objectives of this study were to compare changes in walking time to symptom change during treadmill tests and self-reported outcomes measures related to claudication, kinesophobia and global health between individuals with LSS, PAD and non-specific low back pain (nLBP).
Fifty-five patients (23 with LSS, 14 with PAD and 18 with nLBP) were recruited from May 2018 to March 2020 to complete a treadmill walking test involving two 5-min walking tasks (Upright and Forward Leaning Trunk (FLT) Walking tasks). The speed was set at 1.9 km/h (1.2 mph), and each task was followed by a 5-min rest period. Walking time to symptom change and Total walking time were recorded during each walking task. Patients were asked to complete four questionnaires related to the impact of claudication, walking impairment, kinesiophobia and global health. One-way ANOVAs were performed to compare walking time difference from the Upright to the FLT walking tasks and to compare questionnaires results between groups.
One-way ANOVAs showed a significant difference between groups regarding difference in Walking time to symptom change between both tasks (F = 4.12, p = 0.022). The LSS group improved its Walking time to symptom change from the Upright to the FLT walking tasks more than the PAD (p = 0.34) and the nLBP group (p = 0.12). The nLBP group was less impacted by claudication and less impaired during walking compared to the LSS and PAD groups (ps < 0.001). The nLBP group also had less kinesiophobia than the LSS one (p < 0.001), but was similar to the PAD group. The global health rating was not statistically different between groups (p = 0.118).
The test was able to distinguish neurogenic from vascular or nLBP related claudication. However, further studies are needed to validate this new treadmill walking test.
clinicaltrials.gov ( NCT04058171 ), Registered August 15, 2019 -Registered during recruitment.
腰椎管狭窄症（LSS）和外周动脉疾病（PAD）是两种不同的病症，其特征是症状相似，包括腿痛和因间歇性跛行导致的行走受限。区分这两种病因可能很困难，在确定诊断和治疗方案时，应考虑症状表现、休息时症状缓解时间和疼痛部位等特征。本研究的目的是比较LSS、PAD和非特异性下腰痛（nLBP）患者在跑步机测试期间步行至症状改变的时间变化，以及与间歇性跛行、运动恐惧和整体健康相关的自我报告结果指标。
2018年5月至2020年3月招募了55名患者（23例LSS患者、14例PAD患者和18例nLBP患者），以完成一项跑步机步行测试，该测试包括两项5分钟的步行任务（直立和前倾躯干（FLT）步行任务）。速度设定为1.9公里/小时（1.2英里/小时），每项任务后有5分钟的休息时间。在每个步行任务期间记录步行至症状改变的时间和总步行时间。要求患者完成四份与间歇性跛行的影响、步行障碍、运动恐惧和整体健康相关的问卷。进行单因素方差分析以比较从直立步行任务到FLT步行任务的步行时间差异，并比较各组之间的问卷结果。
单因素方差分析显示，两组之间在两项任务的步行至症状改变时间差异方面存在显著差异（F = 4.12，p = 0.022）。LSS组从直立步行任务到FLT步行任务的步行至症状改变时间的改善幅度大于PAD组（p = 0.34）和nLBP组（p = 0.12）。与LSS组和PAD组相比，nLBP组受间歇性跛行的影响较小，步行时受损程度较轻（p < 0.001）。nLBP组的运动恐惧也比LSS组少（p < 0.001），但与PAD组相似。各组之间的整体健康评分无统计学差异（p = 0.118）。
该测试能够区分神经源性与血管性或nLBP相关的间歇性跛行。然而，需要进一步研究来验证这项新的跑步机步行测试。
clinicaltrials.gov（NCT04058171），2019年8月15日注册 - 在招募期间注册。
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