Department of Physiotherapy, HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland.
Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Eur J Pain. 2024 Aug;28(7):1116-1126. doi: 10.1002/ejp.2245. Epub 2024 Feb 1.
The need to improve spinal motor behaviour in chronic low back pain (CLBP) rehabilitation remains unclear. The objective of this study was to test if changes in spinal motor behaviour were associated with changes in disability after an interdisciplinary rehabilitation program (IRP) in patients with CLBP.
Seventy-one patients with CLBP participating in an IRP were included. Spinal motor behaviour was assessed with biomechanical (lumbar angular amplitude and velocity, erector spinae muscle activity and duration of the task), cognitive-emotional (task-specific fear [PRF]) and pain-related (movement-evoked pain [MEP]) measures during a lifting task before and after the IRP. Disability was measured before and after the IRP, and at 3-month and 1-year follow-ups.
After adjusting for confounders, changes in disability were significantly associated with MEP changes (β adj. = 0.49, p < 0.001) and PRF changes (β adj. = 0.36, p = 0.008), but not with changes in any of the biomechanical measures. MEP at the end of IRP was also associated with disability at 3 months (β adj. = 0.37, p = 0.001) and 1 year (β adj. = 0.42, p = 0.01). Biomechanical measures at the end of the IRP were not associated with disability, except for the duration of the task that was significantly associated with reduction of disability at 3 months (β non-adj = 0.5, p < 0.001).
Pain-related and cognitive-emotional measures of spinal motor behaviour were associated with reduction in disability following an IRP. Future research is needed to further investigate causal relationships between spinal motor behaviour and disability.
This study supports a multidimensional understanding and analysis of spinal motor behaviour, integrating the cognitive-emotional, pain-related and biomechanical domains. It also supports the consideration of spinal motor behaviour as a potentially important treatment target in chronic low back pain management. Moreover, it suggests that reducing movement-evoked pain and task-specific fear may have more influence on disability than changing lumbar amplitude, lumbar angular velocity or erector muscle activity, which may have important implications for rehabilitation.
改善慢性下腰痛（CLBP）康复中脊柱运动行为的需求仍不清楚。本研究的目的是测试在 CLBP 患者接受跨学科康复计划（IRP）后，脊柱运动行为的变化是否与残疾的变化相关。
纳入 71 例接受 IRP 的 CLBP 患者。在 IRP 前后，通过生物力学（腰椎角幅度和速度、竖脊肌肌肉活动和任务持续时间）、认知-情绪（特定任务恐惧[PRF]）和疼痛相关（运动诱发疼痛[MEP]）措施评估脊柱运动行为。在 IRP 前后、3 个月和 1 年随访时测量残疾情况。
在调整混杂因素后，残疾的变化与 MEP 的变化显著相关（β 调整=0.49，p<0.001）和 PRF 的变化（β 调整=0.36，p=0.008），但与任何生物力学测量的变化无关。IRP 结束时的 MEP 也与 3 个月（β 调整=0.37，p=0.001）和 1 年（β 调整=0.42，p=0.01）的残疾相关。IRP 结束时的生物力学测量与残疾无关，除了任务持续时间与 3 个月时残疾的减少显著相关（β 非调整=0.5，p<0.001）。
脊柱运动行为的疼痛相关和认知-情绪测量与 IRP 后残疾的减少相关。需要进一步的研究来进一步探讨脊柱运动行为和残疾之间的因果关系。
本研究支持对脊柱运动行为的多维理解和分析，整合了认知-情绪、疼痛相关和生物力学领域。它还支持将脊柱运动行为视为慢性下腰痛管理中一个潜在重要的治疗目标。此外，它表明减少运动诱发疼痛和特定任务恐惧可能比改变腰椎幅度、腰椎角速度或竖脊肌活动对残疾的影响更大，这可能对康复有重要意义。
