Institute of Environmental Medicine, Unit of Intervention and Implementation Research for Worker Health, Karolinska Institutet, Stockholm, Sweden.
Department of Health Promotion Sciences, Musculoskeletal & Sports Injury Epidemiology Center, Sophiahemmet Högskola, Box 5605, 114 86, Stockholm, Sweden.
BMC Musculoskelet Disord. 2021 Oct 8;22(1):857. doi: 10.1186/s12891-021-04727-2.
Neck and back pain are musculoskeletal conditions with serious individual and societal consequences. Current evidence about the prognostic value for neck and back pain is limited and conflicting. This prospective cohort study aimed to assess the association between leisure-time physical activity (LPA) and improvement of neck and/or back pain in a working population receiving manual therapy or general care in one of two randomized controlled trials (RCTs).
Analyses of data from two RCTs evaluating the effect of manual therapies for neck and/or back pain was conducted. Participants (n = 1 464) answered questionnaires about frequency and effort level of LPA at baseline. LPA on moderate or vigorous levels was compared to no or low/irregular moderate and vigorous levels. Pain intensity was assessed with numerical scales at baseline and 3-, 6-, and 12-month follow-up. The outcome was minimal clinically important improvement in pain intensity, defined as ≥2 points improvement in mean pain intensity at follow-up. Crude- and adjusted risk ratios (RR) with 95% confidence intervals (CI) were calculated with Poisson regression analysis and stratified by pain location.
Participants with neck and/or back pain performing vigorous LPA showed a minimal clinically important improvement after 12 months compared to the control group; RR 1.35 (95% CI; 1.06-1.73). No effect was observed at 3 or 6 months. Moderate LPA did not improve pain intensity in any follow-up. Stratified analyses revealed that the effect of vigorous LPA at 12 months in back pain was RR 1.83 (95% CI; 1.26-2.66) and neck pain RR 1.06 (95% CI; 0.75-1.49).
Persons with neck and/or back pain receiving manual therapy or general evidence-based care have greater chance of improvement after 12 months if they prior to treatment frequently practice vigorous LPA. When analyzed separately, the effect was only present for back pain.
Registration in Current Controlled Trials (ISRCTN), Stockholm Manual Intervention Trial (MINT), ISRCTN92249294 BJORN-trial, ISRCTN56954776.
颈部和背部疼痛是一种肌肉骨骼疾病，会给个人和社会带来严重后果。目前关于颈部和背部疼痛预后价值的证据有限且相互矛盾。本前瞻性队列研究旨在评估在接受手动治疗或一般护理的工作人群中，休闲时间体力活动（LPA）与颈部和/或背部疼痛改善之间的关联，这是在两项随机对照试验（RCT）中进行的。
对两项评估手动疗法治疗颈部和/或背部疼痛效果的 RCT 数据进行分析。参与者（n=1464）在基线时回答了关于 LPA 频率和努力程度的问卷。与无 LPA、低/不规则中高强度 LPA 相比，中高强度 LPA 与疼痛强度进行了比较。在基线和 3、6 和 12 个月随访时使用数字量表评估疼痛强度。结局是疼痛强度的最小临床重要改善，定义为随访时平均疼痛强度改善≥2 分。使用泊松回归分析和按疼痛部位分层，计算了最小临床重要改善的粗风险比（RR）和 95%置信区间（CI）。
与对照组相比，进行剧烈 LPA 的颈部和/或背部疼痛患者在 12 个月时表现出最小临床重要改善；RR 1.35（95%CI；1.06-1.73）。在 3 或 6 个月时未观察到效果。中等强度 LPA 在任何随访中均未改善疼痛强度。分层分析显示，12 个月时背部疼痛剧烈 LPA 的效果 RR 为 1.83（95%CI；1.26-2.66），颈部疼痛 RR 为 1.06（95%CI；0.75-1.49）。
接受手动治疗或基于证据的一般护理的颈部和/或背部疼痛患者，如果在治疗前经常进行剧烈的 LPA，在 12 个月后更有可能改善。当分别分析时，这种效果仅存在于背部疼痛中。
当前对照试验注册（ISRCTN）、斯德哥尔摩干预试验（MINT）、ISRCTN92249294 BJORN 试验、ISRCTN56954776。
