Nzamba J, Van Damme S, Favre J, Christe G
Division of Physiotherapy, School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland.
Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium.
Eur J Pain. 2024 Jan;28(1):37-53. doi: 10.1002/ejp.2162. Epub 2023 Jul 21.
The role of spinal movement alterations in low back pain (LBP) remains unclear. This systematic review and meta-analyses examined the relationships between spinal amplitude of movement, disability and pain intensity in patients with LBP.
We searched PubMed, CINAHL, Embase, Pedro and Web of Science for relevant articles until 14th March 2023. Risk of bias was assessed with the Quality in Prognostic Studies Tool. We analysed the relationships between amplitude of movement, disability and pain intensity with standard correlational meta-analyses and meta-analytic structural equation modelling (MASEM) in cross-sectional and longitudinal data.
A total of 106 studies (9001 participants) were included. In cross-sectional data, larger amplitude of movement was associated with lower disability (pooled coefficient: -0.25, 95% confidence interval: [-0.29 to -0.21]; 69/5899 studies/participants) and pain intensity (-0.13, [-0.17 to -0.09]; 74/5806). An increase in amplitude of movement was associated with a decrease in disability (-0.23, [-0.31 to -0.15]; 33/2437) and pain intensity (-0.25, [-0.33 to -0.17]; 38/2172) in longitudinal data. MASEM revealed similar results and, in addition, showed that amplitude of movement had a very small influence on the pain intensity-disability relationship.
These results showed a significant but small association between amplitude of movement and disability or pain intensity. Moreover, they demonstrated a direct association between an increase in amplitude of movement and a decrease in pain intensity or disability, supporting interventions aiming to reduce protective spinal movements in patients with LBP.
The large meta-analyses performed in this work revealed an association between reductions in spinal amplitude of movement and increased levels of disability and pain intensity in people with LBP. Moreover, it highlighted that LBP recovery is associated with a reduction in protective motor behaviour (increased amplitude of movement), supporting the inclusion of spinal movement in the biopsychosocial understanding and management of LBP.
脊柱运动改变在腰痛（LBP）中的作用尚不清楚。本系统评价和荟萃分析研究了LBP患者脊柱运动幅度、残疾和疼痛强度之间的关系。
我们检索了PubMed、CINAHL、Embase、Pedro和Web of Science等数据库，以查找截至2023年3月14日的相关文章。使用预后研究质量工具评估偏倚风险。我们在横断面和纵向数据中，通过标准相关荟萃分析和荟萃分析结构方程模型（MASEM）分析了运动幅度、残疾和疼痛强度之间的关系。
共纳入106项研究（9001名参与者）。在横断面数据中，较大的运动幅度与较低的残疾程度（合并系数：-0.25，95%置信区间：[-0.29至-0.21]；69/5899项研究/参与者）和疼痛强度（-0.13，[-0.17至-0.09]；74/5806）相关。在纵向数据中，运动幅度的增加与残疾程度的降低（-0.23，[-0.31至-0.15]；33/2437）和疼痛强度的降低（-0.25，[-0.33至-0.17]；38/2172）相关。MASEM显示了类似的结果，此外，还表明运动幅度对疼痛强度-残疾关系的影响非常小。
这些结果表明运动幅度与残疾或疼痛强度之间存在显著但较小的关联。此外，它们还表明运动幅度的增加与疼痛强度或残疾程度的降低之间存在直接关联，支持旨在减少LBP患者脊柱保护性运动的干预措施。
本研究进行的大型荟萃分析揭示了LBP患者脊柱运动幅度降低与残疾程度和疼痛强度增加之间的关联。此外，它强调LBP的恢复与保护性运动行为的减少（运动幅度增加）相关，支持将脊柱运动纳入LBP的生物心理社会理解和管理中。
