高强度训练可改善慢性非特异性下腰痛患者的中枢敏化症状：一项随机对照试验的二次分析。

High intensity training improves symptoms of central sensitization at six-month follow-up in persons with chronic nonspecific low back pain: Secondary analysis of a randomized controlled trial.

机构信息

REVAL - Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium.

出版信息

Braz J Phys Ther. 2023 Mar-Apr;27(2):100496. doi: 10.1016/j.bjpt.2023.100496. Epub 2023 Mar 17.

DOI:10.1016/j.bjpt.2023.100496

PMID:36963161

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10060179/

Abstract

BACKGROUND

High intensity training (HIT) improves disability and physical fitness in persons with chronic nonspecific low back pain (CNSLBP). However, it remains unclear if HIT affects pain processing and psychosocial factors.

OBJECTIVE

To evaluate 1) the effects of HIT on symptoms of central sensitization and perceived stress and 2) the relationship of symptoms of central sensitization and perceived stress with therapy success, at six-month follow-up, in persons with CNSLBP.

METHODS

This is a secondary analysis of a previously published randomized controlled trial. Persons with CNSLBP (n = 51, age=43.6y) completed the Central Sensitization Inventory (CSI) and Perceived Stress Scale (PSS) at baseline (PRE) and six months after 12-week of HIT consisting of concurrent exercise therapy (FU). Two groups were formed based on CSI scores (low-CSI/high-CSI). First, linear mixed models were fitted for each outcome, with time and groups as covariates. Multiple comparisons were executed to evaluate group (baseline), time (within-group), and interaction (between-group) effects. Second, correlation and regression analyses were performed to evaluate if baseline and changes in CSI/PSS scores were related to therapy success, operationalized as improvements on disability (Modified Oswestry Disability Index), and pain intensity (Numeric Pain Rating Scale).

RESULTS

Total sample analyses showed a decrease in both CSI and PSS. Within-group analyses showed a decrease of CSI only in the high-CSI group and a decrease of PSS only in the low-CSI group. Between-group analyses showed a pronounced decrease favouring high-CSI (mean difference: 7.9; 95%CI: 2.1, 12.7) and no differences in PSS (mean difference: 0.1; 95%CI: -3.0, 3.2). CSI, but not PSS, was weakly related to therapy success.

CONCLUSION

HIT improves symptoms of central sensitization in persons with CNSLBP. This effect is the largest in persons with clinically relevant baseline CSI scores. HIT also decreases perceived stress.

摘要

背景

高强度训练（HIT）可改善慢性非特异性下腰痛（CNSLBP）患者的残疾和身体机能。然而，目前尚不清楚 HIT 是否会影响疼痛处理和心理社会因素。

目的

评估 1）HIT 对中枢敏化症状和感知压力的影响，以及 2）在 CNSLBP 患者 6 个月随访时，中枢敏化症状和感知压力与治疗效果的关系。

方法

这是一项先前发表的随机对照试验的二次分析。CNSLBP 患者（n=51，年龄=43.6y）在基线（PRE）和 12 周的 HIT 后 6 个月（FU）完成了中枢敏化量表（CSI）和感知压力量表（PSS）的评估，HIT 包括同时进行的运动疗法。根据 CSI 评分（低-CSI/高-CSI）将患者分为两组。首先，对每个结果进行线性混合模型拟合，以时间和组为协变量。进行多次比较以评估组（基线）、时间（组内）和交互（组间）效应。其次，进行相关性和回归分析，以评估 CSI/PSS 评分的基线和变化是否与治疗效果相关，即残疾（改良 Oswestry 残疾指数）和疼痛强度（数字疼痛评分量表）的改善相关。

结果

总样本分析显示 CSI 和 PSS 均下降。组内分析显示，仅高-CSI 组的 CSI 下降，仅低-CSI 组的 PSS 下降。组间分析显示，高-CSI 组的下降明显，差异有统计学意义（平均差值：7.9；95%CI：2.1，12.7），而 PSS 组之间无差异（平均差值：0.1；95%CI：-3.0，3.2）。CSI 与治疗效果有弱相关，而 PSS 则无相关。