运动过程中及之后肩部疼痛加剧：一项前瞻性队列研究。
Increased shoulder pain across an exercise session and subsequent shoulder exercise: a prospective cohort study.
机构信息
Elective Surgery Centre, Silkeborg Regional Hospital, 8600, Silkeborg, Denmark.
Department of Clinical Medicine, Aarhus University, 8200, Aarhus N, Denmark.
出版信息
BMC Musculoskelet Disord. 2022 Jul 29;23(1):726. doi: 10.1186/s12891-022-05674-2.
BACKGROUND
Shoulder complaints are common and the recommended first-line treatment is exercise therapy. However, it remains unknown if increased shoulder pain after an exercise session is a barrier for subsequent exercise dose, particularly in people with high fear-avoidance beliefs. Such knowledge could indicate ways to optimise shoulder rehabilitation. The aim was to examine whether increased shoulder pain across an exercise session was associated with a lower subsequent exercise dose, and if high fear-avoidance beliefs exaggerated this association.
METHODS
We conducted a prospective cohort study using data from a randomised controlled trial in Central Denmark Region 2017-2019. Participants were employees (n = 79) with shoulder complaints and high occupational shoulder exposures. The intervention was a home-based or partly supervised exercise programme lasting 2-3 months. Linear mixed models were used to examine the associations between change in shoulder pain and exercise dose (number of repetitions, progression level (1-3), resistance level (1-3), and time until next exercise session [days]).
RESULTS
At baseline, the participants had a median pain intensity at rest of 2 on a numerical rating scale (0-10). For a 1-cm increase in pain on a visual analogue scale (0-10 cm) during an exercise session, the subsequent number of repetitions, progression level and resistance level were - 1.3 (95% confidence interval [CI] - 3.4 to 0.9), 0.0 (95% CI - 0.1 to 0.0) and - 0.0 (95% CI - 0.1 to 0.0), respectively. Likewise, the time until next exercise session was - 0.6 (95% CI - 2.4 to 1.3) days for a 1-cm increase. There were no interactions with fear-avoidance beliefs.
CONCLUSION
Increased pain across an exercise session was not associated with subsequent exercise dose, regardless of fear-avoidance beliefs, among employees with shoulder complaints and high occupational shoulder exposures.
TRIAL REGISTRATION
The trial was registered at Clinicaltrials.gov 19/05/2017 (ID: NCT03159910).
背景
肩部疼痛较为常见，推荐的一线治疗方法是运动疗法。然而，运动后肩部疼痛增加是否会成为后续运动剂量的障碍，特别是对于那些高恐惧回避信念的人，目前仍不清楚。这些知识可以指出优化肩部康复的方法。本研究旨在探讨运动过程中肩部疼痛增加是否与随后的运动剂量较低有关，以及高恐惧回避信念是否会夸大这种关联。
方法
我们进行了一项前瞻性队列研究，使用了 2017-2019 年丹麦中部地区的一项随机对照试验的数据。参与者为（n=79）患有肩部疼痛和高职业性肩部暴露的员工。干预措施为家庭或部分监督的运动方案，持续 2-3 个月。线性混合模型用于检查疼痛变化与运动剂量（重复次数、进展水平（1-3）、阻力水平（1-3）和下次运动间隔时间（天））之间的关系。
结果
基线时，参与者的静息状态下的疼痛强度中位数为 2（数字评分量表 0-10）。对于运动过程中疼痛增加 1cm（0-10cm 视觉模拟量表），随后的重复次数、进展水平和阻力水平分别为-1.3（95%置信区间 [CI] -3.4 至 0.9）、0.0（95% CI -0.1 至 0.0）和-0.0（95% CI -0.1 至 0.0）。同样，对于疼痛增加 1cm，下次运动的间隔时间为-0.6（95% CI -2.4 至 1.3）天。没有与恐惧回避信念的交互作用。
结论
在有肩部疼痛和高职业性肩部暴露的员工中，运动过程中疼痛增加与随后的运动剂量无关，无论恐惧回避信念如何。
试验注册
该试验于 2017 年 5 月 19 日在 Clinicaltrials.gov 注册（ID：NCT03159910）。
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