Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom.
Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia.
PLoS One. 2023 Jun 14;18(6):e0287029. doi: 10.1371/journal.pone.0287029. eCollection 2023.
BACKGROUND: Variability in spine kinematics is a common motor adaptation to pain, which has been measured in various ways. However, it remains unclear whether low back pain (LBP) is typically characterised by increased, decreased or unchanged kinematic variability. Therefore, the aim of this review was to synthesise the evidence on whether the amount and structure of spine kinematic variability is altered in people with chronic non-specific LBP (CNSLBP). METHODS: Electronic databases, grey literature, and key journals were searched from inception up to August 2022, following a published and registered protocol. Eligible studies must investigated kinematic variability in CNSLBP people (adults ≥18 years) while preforming repetitive functional tasks. Two reviewers conducted screening, data extraction, and quality assessment independently. Data synthesis was conducted per task type and individual results were presented quantitatively to provide a narrative synthesis. The overall strength of evidence was rated using the Grading of Recommendations, Assessment, Development and Evaluation guidelines. FINDINGS: Fourteen observational studies were included in this review. To facilitate the interpretation of the results, the included studies were grouped into four categories according to the task preformed (i.e., repeated flexion and extension, lifting, gait, and sit to stand to sit task). The overall quality of evidence was rated as a very low, primarily due to the inclusion criteria that limited the review to observational studies. In addition, the use of heterogeneous metrics for analysis and varying effect sizes contributed to the downgrade of evidence to a very low level. INTERPRETATION: Individuals with chronic non-specific LBP exhibited altered motor adaptability, as evidenced by differences in kinematic movement variability during the performance of various repetitive functional tasks. However, the direction of the changes in movement variability was not consistent across studies.
背景:脊柱运动学的可变性是对疼痛的一种常见运动适应性,已经有多种方式进行了测量。然而,目前尚不清楚慢性非特异性下腰痛(CNSLBP)患者的运动可变性通常是增加、减少还是不变。因此,本综述的目的是综合评估慢性非特异性下腰痛患者脊柱运动学可变性的程度和结构是否发生改变。
方法:根据已发表并注册的方案,从建立之初到 2022 年 8 月,对电子数据库、灰色文献和主要期刊进行了搜索。合格的研究必须调查 CNSLBP 人群(18 岁及以上成年人)在执行重复功能任务时的运动学可变性。两名评审员独立进行筛选、数据提取和质量评估。根据任务类型进行数据综合,并以定量方式呈现个体结果,提供叙述性综合。使用推荐评估、制定与发展分级(Grading of Recommendations, Assessment, Development and Evaluation)指南对证据的总体强度进行评级。
发现:本综述共纳入了 14 项观察性研究。为了便于解释结果,根据所执行的任务(即重复屈伸、举重、步态和坐站坐任务)将纳入的研究分为四类。由于纳入标准将综述仅限于观察性研究,因此证据的总体质量被评为非常低。此外,分析中使用了不同的指标和不同的效应量也导致证据质量降级为非常低。
解释:慢性非特异性下腰痛患者的运动适应性发生改变,表现在执行各种重复功能任务时运动学运动可变性的差异。然而,运动可变性变化的方向在不同的研究中并不一致。
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