Gouteron Anaïs, Tabard-Fougère Anne, Bourredjem Abderrahmane, Casillas Jean-Marie, Armand Stéphane, Genevay Stéphane
Inserm UMR 1093, Cognition, Action, Plasticité sensori-motrice, Dijon, France.
University Hospital Dijon-Burgundy Franche-Comté, France, Pôle Rééducation-Réadaptation, CHU de Dijon, 23, Rue Gaffarel, 21078, Dijon, France.
Eur Spine J. 2022 Jan;31(1):136-151. doi: 10.1007/s00586-021-06992-0. Epub 2021 Sep 22.
The flexion relaxation phenomenon (FRP) is characterized by the reduction of paraspinal muscle activity at maximum trunk flexion. The FRP is reported to be altered (persistence of spinal muscle activity) in nonspecific chronic low back pain (NSCLBP) and is considered a promising biomarker. The aim of this systematic review was to synthetize current knowledge on FRP in the NSCLBP population regarding prevalence, the reliability of FRP measurement using surface electromyography (sEMG), the average value, and variation of the relaxation ratios (RR).
Five databases were searched (PubMed, EMBASE, Web of Sciences, Cochrane Library, Pedro). A qualitative analysis was done for all included studies and meta-analysis studying prevalence, mean value of flexion relaxation ratio (FRR) and extension relaxation ratio (ERR), and difference between asymptomatic and NSCLBP FRR.
Twenty-seven studies were included for qualitative analysis and 21 studies for meta-analysis. The prevalence of the altered FRP was 55% (95%CI [32-79%]) in the NSCLBP population. The studies on reliability reported good within-session and between-session reproducibility. In the NSLBP population, the mean FRR was 2.96 (95%CI [2.02; 3.90]) and the mean ERR was 4.07 (95%CI [2.08; 6.07]). The difference between asymptomatic and NSCLBP FRR was - 1.19 (95%CI [- 1.92, - 0.45]). In all meta-analysis, the I index was > 80%.
An altered FRP is frequently found in NSCLBP population using sEMG and the test has a good reproducibility. The difference between asymptomatic and NSCLBP FRR was significant. Nevertheless, considering the high heterogeneity observed, additional research is required to confirm the value of RR.
屈曲放松现象（FRP）的特征是在躯干最大程度屈曲时椎旁肌活动减少。据报道，非特异性慢性下腰痛（NSCLBP）患者的FRP会发生改变（脊柱肌肉活动持续存在），并被认为是一种很有前景的生物标志物。本系统评价的目的是综合目前关于NSCLBP人群中FRP的患病率、使用表面肌电图（sEMG）测量FRP的可靠性、平均值以及放松率（RR）变化的知识。
检索了五个数据库（PubMed、EMBASE、科学网、考克兰图书馆、佩德罗）。对所有纳入研究进行了定性分析，并对研究患病率、屈曲放松率（FRR）和伸展放松率（ERR）的平均值以及无症状者与NSCLBP患者FRR差异的研究进行了荟萃分析。
纳入27项研究进行定性分析，21项研究进行荟萃分析。NSCLBP人群中FRP改变的患病率为55%（95%CI[32 - 79%]）。关于可靠性的研究报告了良好的组内和组间重复性。在NSLBP人群中，平均FRR为2.96（95%CI[2.02；3.90]），平均ERR为4.07（95%CI[2.08；6.07]）。无症状者与NSCLBP患者FRR的差异为 - 1.19（95%CI[-1.92，-0.45]）。在所有荟萃分析中，I指数均>80%。
使用sEMG在NSCLBP人群中经常发现FRP改变，且该测试具有良好的重复性。无症状者与NSCLBP患者FRR的差异具有显著性。然而，考虑到观察到的高度异质性，需要进一步研究以确认RR的价值。
