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运动参与对社区慢性腰痛人群 12 个月时腰痛残疾的影响可通过疼痛和灾难化来介导。

The effect of exercise engagement on low back disability at 12-months is mediated by pain and catastrophizing in a community sample of people with chronic low back pain.

机构信息

School of Health Sciences, Western Sydney University, Australia; Department of Exercise Sciences, University of Auckland, New Zealand.

School of Medicine, Western Sydney University, Australia; Translational Health Research Institute, Western Sydney University, Australia.

出版信息

Behav Res Ther. 2022 Dec;159:104205. doi: 10.1016/j.brat.2022.104205. Epub 2022 Oct 4.

Abstract

Despite being a first-line treatment recommendation, there is uncertainly for how exercise helps people with chronic low back pain. We designed this study to examine how exercise might help people with chronic low back pain by following a large community sample for 1-year. Qualitative questionnaires and self-report measures were collected every 3-months for 1-year in 400 people with chronic low back pain. People were not provided any specific treatment advice as part of this study but were allowed to engage with any normal physical activity, treatment, or medication as part of their normal life. Exercise engagement was defined from inspection of participant qualitative responses, according to minimum acceptable levels of exercise that elicit symptom reduction. Multiple mediation analysis was performed to examine the effect of exercise engagement on disability through the proposed mediators (pain, fear, catastrophizing, depression, anxiety, self-efficacy). The significant effect of exercise engagement on reductions in disability at 6- and 12-months was explained through pain and catastrophizing. People with chronic low back pain who reported worsening of symptoms over the year had similar reporting of exercise throughout the 12-months to people who had improvements in disability. Exercise can reduce disability through the effect on pain and catastrophizing, but how this effect occurs (i.e., an active or passive component of exercise) is unclear.

摘要

尽管运动是慢性下背痛的一线治疗推荐,但对于运动如何帮助慢性下背痛患者仍存在不确定性。我们设计了这项研究,通过对 400 名慢性下背痛患者进行为期 1 年的随访,来探讨运动如何帮助慢性下背痛患者。在 1 年的时间里,每 3 个月收集一次定性问卷和自我报告的测量数据。作为本研究的一部分,没有为参与者提供任何特定的治疗建议,但允许他们在日常生活中参与任何正常的身体活动、治疗或药物治疗。根据能够减轻症状的最低可接受的运动水平,从参与者定性反应的检查中定义运动参与度。采用多重中介分析,通过提出的中介变量(疼痛、恐惧、灾难化、抑郁、焦虑、自我效能),检验运动参与度对残疾的影响。运动参与度对 6 个月和 12 个月时残疾减轻的显著影响,是通过疼痛和灾难化来解释的。在这一年中,报告症状恶化的慢性下背痛患者在 12 个月内的运动报告与残疾改善的患者相似。运动可以通过对疼痛和灾难化的影响来减轻残疾,但这种影响是如何产生的(即运动的主动或被动成分)尚不清楚。

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