腰痛患者的步态是否不同？系统评价和荟萃分析。

Do people with low back pain walk differently? A systematic review and meta-analysis.

机构信息

Department of Physical Therapy, Chapman University, Irvine, CA 92618, USA.

出版信息

J Sport Health Sci. 2022 Jul;11(4):450-465. doi: 10.1016/j.jshs.2022.02.001. Epub 2022 Feb 10.

DOI:10.1016/j.jshs.2022.02.001

PMID:35151908

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9338341/

Abstract

BACKGROUND

The biomechanics of the trunk and lower limbs during walking and running gait are frequently assessed in individuals with low back pain (LBP). Despite substantial research, it is still unclear whether consistent and generalizable changes in walking or running gait occur in association with LBP. The purpose of this systematic review was to identify whether there are differences in biomechanics during walking and running gait in individuals with acute and persistent LBP compared with back-healthy controls.

METHODS

A search was conducted in PubMed, CINAHL, SPORTDiscus, and PsycINFO in June 2019 and was repeated in December 2020. Studies were included if they reported biomechanical characteristics of individuals with and without LBP during steady-state or perturbed walking and running. Biomechanical data included spatiotemporal, kinematic, kinetic, and electromyography variables. The reporting quality and potential for bias of each study was assessed. Data were pooled where possible to compare the standardized mean differences (SMD) between back pain and back-healthy control groups.

RESULTS

Ninety-seven studies were included and reviewed. Two studies investigated acute pain and the rest investigated persistent pain. Nine studies investigated running gait. Of the studies, 20% had high reporting quality/low risk of bias. In comparison with back-healthy controls, individuals with persistent LBP walked slower (SMD = -0.59, 95% confidence interval (95%CI): -0.77 to -0.42)) and with shorter stride length (SMD = -0.38, 95%CI: -0.60 to -0.16). There were no differences in the amplitude of motion in the thoracic or lumbar spine, pelvis, or hips in individuals with LBP. During walking, coordination of motion between the thorax and the lumbar spine/pelvis was significantly more in-phase in the persistent LBP groups (SMD = -0.60, 95%CI: -0.90 to -0.30), and individuals with persistent LBP exhibited greater amplitude of activation in the paraspinal muscles (SMD = 0.52, 95%CI: 0.23-0.80). There were no consistent differences in running biomechanics between groups.

CONCLUSION

There is moderate-to-strong evidence that individuals with persistent LBP demonstrate differences in walking gait compared to back-healthy controls.

摘要

背景

在患有下腰痛（LBP）的个体中，经常评估其在行走和跑步步态期间的躯干和下肢的生物力学。尽管进行了大量研究，但仍然不清楚与 LBP 相关的行走或跑步步态是否存在一致且可推广的变化。本系统评价的目的是确定与健康对照组相比，急性和持续性 LBP 个体在行走和跑步步态期间的生物力学是否存在差异。

方法

2019 年 6 月在 PubMed、CINAHL、SPORTDiscus 和 PsycINFO 中进行了检索，并于 2020 年 12 月重复了检索。如果研究报告了稳态或受扰行走和跑步期间有无 LBP 的个体的生物力学特征，则将其纳入研究。生物力学数据包括时空、运动学、动力学和肌电图变量。评估了每项研究的报告质量和潜在偏倚。在可能的情况下，对背痛和健康对照组之间的标准化均数差（SMD）进行了汇总比较。

结果

纳入并回顾了 97 项研究。两项研究调查了急性疼痛，其余研究则调查了持续性疼痛。九项研究调查了跑步步态。在这些研究中，有 20%具有较高的报告质量/低偏倚风险。与健康对照组相比，持续性 LBP 患者行走速度较慢（SMD= -0.59，95%置信区间[95%CI]：-0.77 至 -0.42），步长较短（SMD= -0.38，95%CI：-0.60 至 -0.16）。在 LBP 患者中，胸椎或腰椎、骨盆或臀部的运动幅度没有差异。在行走时，持续性 LBP 组中胸腰椎/骨盆之间运动的协调性明显更为同相（SMD= -0.60，95%CI：-0.90 至 -0.30），并且持续性 LBP 患者的竖脊肌激活幅度更大（SMD= 0.52，95%CI：0.23-0.80）。在跑步生物力学方面，各组之间没有一致的差异。