Department of Anesthesiology, Keio University School of Medicine, Tokyo 160-8582, Japan.
Interdisciplinary Pain Center, Keio University Hospital, Tokyo 160-8582, Japan.
Pain Res Manag. 2022 Aug 29;2022:4203138. doi: 10.1155/2022/4203138. eCollection 2022.
The biopsychosocial mechanism by which exercise leads to improvement in chronic low back pain (CLBP) remains unstudied. This prospective cohort study was performed to examine the effectiveness of exercise on pain, disability, and psychological status for CLBP. We also tested path analytic models in which changes in these variables were included.
CLBP patients who visited the Interdisciplinary Pain Center of Keio University Hospital from July 2018 to April 2020 were included. The propensity score matching was performed between patients who underwent exercise (the exercise group) and those who did not (the control group). At the first visit and at the 3-month follow-up, pain (Numerical Rating Scale (NRS)), disability (Pain Disability Assessment Scale (PDAS)), and psychological status (Pain Self-Efficacy Questionnaire (PSEQ), and Pain Catastrophizing Scale (PCS)) were assessed. Changes in pain and disability at the follow-up were compared between the groups. The relationships between changes in pain, disability, and psychological variables were examined using Pearson's correlation and mediation analysis.
A significantly larger decrease in the PDAS was observed in the exercise group ( = 49) than in the control ( = 49) ( < 0.05). Increased PSEQ scores were significantly correlated with decreased NRS scores in both groups. In the exercise group, decreased PDAS fully mediated the relationship between increased PSEQ and decreased NRS ( < 0.05).
Exercise improved disability, and the improved disability by exercise mediated the effect of increased self-efficacy on pain relief in CLBP patients.
运动导致慢性下腰痛（CLBP）改善的生物心理社会机制尚未研究。本前瞻性队列研究旨在检验运动对 CLBP 患者疼痛、残疾和心理状况的疗效。我们还测试了包含这些变量变化的路径分析模型。
纳入 2018 年 7 月至 2020 年 4 月期间到庆应义塾大学医院综合疼痛中心就诊的 CLBP 患者。对接受运动（运动组）和未接受运动（对照组）的患者进行倾向评分匹配。在首次就诊和 3 个月随访时，评估疼痛（数字评分量表（NRS））、残疾（疼痛残疾评估量表（PDAS））和心理状况（疼痛自我效能问卷（PSEQ）和疼痛灾难化量表（PCS））。比较两组随访时疼痛和残疾的变化。使用 Pearson 相关分析和中介分析检验疼痛、残疾和心理变量变化之间的关系。
运动组（n=49）的 PDAS 下降幅度明显大于对照组（n=49）（<0.05）。两组 PSEQ 评分的增加均与 NRS 评分的降低显著相关。在运动组中，PDAS 的降低完全介导了 PSEQ 增加与 NRS 降低之间的关系（<0.05）。
运动改善了残疾，运动引起的残疾改善介导了自我效能感增加对 CLBP 患者疼痛缓解的作用。
