慢性腰痛患者认知功能治疗与运动系统损伤治疗的比较：一项随机对照试验。

Comparison of cognitive functional therapy and movement system impairment treatment in chronic low back pain patients: a randomized controlled trial.

机构信息

Faculty of Physical Education and Sport Sciences, Department of Biomechanics and Sport Injuries, Kharazmi University, Tehran, Iran.

Department of Psychology, Springfield College, Springfield, USA.

出版信息

BMC Musculoskelet Disord. 2023 Aug 29;24(1):684. doi: 10.1186/s12891-023-06815-x.

DOI:10.1186/s12891-023-06815-x

PMID:37644472

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10463585/

Abstract

BACKGROUND

This study aimed to compare the effects of cognitive functional therapy (CFT) and movement system impairment (MSI)-based treatment on pain intensity, disability, Kinesiophobia, and gait kinetics in patients with chronic non-specific low back pain (CNSLBP).

METHODS

In a single-blind randomized clinical trial, we randomly assigned 91 patients with CNSLBP into CFT (n = 45) and MSI-based treatment (n = 46) groups. An 8-week training intervention was given to both groups. The researchers measured the primary outcome, which was pain intensity (Numeric rating scale), and the secondary outcomes, including disability (Oswestry disability index), Kinesiophobia (Tampa Kinesiophobia Scale), and vertical ground reaction force (VGRF) parameters at self-selected and faster speed (Force distributor treadmill). We evaluated patients at baseline, at the end of the 8-week intervention (post-treatment), and six months after the first treatment. We used mixed-model ANOVA to evaluate the effects of the interaction between time (baseline vs. post-treatment vs. six-month follow-up) and group (CFT vs. MSI-based treatment) on each measure.

RESULTS

CFT showed superiority over MSI-based treatment in reducing pain intensity (P < 0.001, Effect size (ES) = 2.41), ODI (P < 0.001, ES = 2.15), and Kinesiophobia (P < 0.001, ES = 2.47) at eight weeks. The CFT also produced greater improvement in VGRF parameters, at both self-selected (FPF[P < 0.001, ES = 3], SPF[P < 0.001, ES = 0.5], MSF[P < 0.001, ES = 0.67], WAR[P < 0.001, ES = 1.53], POR[P < 0.001, ES = 0.8]), and faster speed, FPF(P < 0.001, ES = 1.33, MSF(P < 0.001, ES = 0.57), WAR(P < 0.001, ES = 0.67), POR(P < 0.001, ES = 2.91)] than the MSI, except SPF(P < 0.001, ES = 0.0) at eight weeks.

CONCLUSION

This study suggests that the CFT is associated with better results in clinical and cognitive characteristics than the MSI-based treatment for CNSLBP, and the researchers maintained the treatment effects at six-month follow-up. Also, This study achieved better improvements in gait kinetics in CFT. CTF seems to be an appropriate and applicable treatment in clinical setting.

TRIAL REGISTRATION

The researchers retrospectively registered the trial 10/11/2022, at https://www.umin.ac.jp/ with identifier number (UMIN000047455).

摘要

背景

本研究旨在比较认知功能疗法（CFT）和基于运动系统障碍（MSI）的治疗对慢性非特异性下腰痛（CNSLBP）患者疼痛强度、残疾、运动恐惧和步态动力学的影响。

方法

在一项单盲随机临床试验中，我们将 91 名 CNSLBP 患者随机分为 CFT（n=45）和基于 MSI 的治疗组（n=46）。两组均接受 8 周的训练干预。研究人员测量了主要结局，即疼痛强度（数字评分量表），以及次要结局，包括残疾（Oswestry 残疾指数）、运动恐惧（坦帕运动恐惧量表）和垂直地面反力（VGRF）参数在自我选择和更快速度（Force distributor treadmill）下。我们在基线、8 周干预结束时（治疗后）和首次治疗后 6 个月评估患者。我们使用混合模型方差分析评估时间（基线与治疗后与 6 个月随访）和组（CFT 与基于 MSI 的治疗）之间的交互作用对每个测量值的影响。

结果

CFT 在 8 周时在降低疼痛强度（P<0.001，效应量（ES）=2.41）、ODI（P<0.001，ES=2.15）和运动恐惧（P<0.001，ES=2.47）方面优于基于 MSI 的治疗。CFT 还在自我选择速度下（FPF[P<0.001，ES=3]、SPF[P<0.001，ES=0.5]、MSF[P<0.001，ES=0.67]、WAR[P<0.001，ES=1.53]、POR[P<0.001，ES=0.8]）和更快速度下（FPF[P<0.001，ES=1.33]、MSF[P<0.001，ES=0.57]、WAR[P<0.001，ES=0.67]、POR[P<0.001，ES=2.91]）产生了更大的 VGRF 参数改善，而基于 MSI 的治疗在 8 周时只在 SPF（P<0.001，ES=0.0）方面有改善。