Institut de recherche Robert-Sauvé en santé et en sécurité du travail (IRSST), 505, boul. De Maisonneuve Ouest, Montreal, QC, H3A 3C2, Canada.
Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), 6363, Hudson Road, office 061, Montreal, QC, H3S 1M9, Canada.
BMC Musculoskelet Disord. 2024 May 4;25(1):358. doi: 10.1186/s12891-024-07480-4.
Little is known about why patients with low back pain (LBP) respond differently to treatment, and more specifically, to a lumbar stabilization exercise program. As a first step toward answering this question, the present study evaluates how subgroups of patients who demonstrate large and small clinical improvements differ in terms of physical and psychological changes during treatment.
Participants (n = 110) performed the exercise program (clinical sessions and home exercises) over eight weeks, with 100 retained at six-month follow-up. Physical measures (lumbar segmental instability, motor control impairments, range of motion, trunk muscle endurance and physical performance tests) were collected twice (baseline, end of treatment), while psychological measures (fear-avoidance beliefs, pain catastrophizing, psychological distress, illness perceptions, outcome expectations) were collected at four time points (baseline, mid-treatment, end of treatment, follow-up). The participants were divided into three subgroups (large, moderate and small clinical improvements) based on the change of perceived disability scores. ANOVA for repeated measure compared well-contrasted subgroups (large vs. small improvement) at different times to test for SUBGROUP × TIME interactions.
Statistically significant interactions were observed for several physical and psychological measures. In all these interactions, the large- and small-improvement subgroups were equivalent at baseline, but the large-improvement subgroup showed more improvements over time compared to the small-improvement subgroup. For psychological measures only (fear-avoidance beliefs, pain catastrophizing, illness perceptions), between-group differences reached moderate to strong effect sizes, at the end of treatment and follow-up.
The large-improvement subgroup showed more improvement than the small-improvement subgroup with regard to physical factors typically targeted by this specific exercise program as well as for psychological factors that are known to influence clinical outcomes.
对于为什么腰痛（LBP）患者对治疗的反应不同，更具体地说，对腰椎稳定运动方案的反应不同，人们知之甚少。为了回答这个问题，本研究首先评估在治疗过程中表现出较大和较小临床改善的患者亚组在身体和心理变化方面有何不同。
参与者（n=110）在八周内完成了运动方案（临床课程和家庭运动），其中 100 人在六个月随访时保留下来。在两次（基线、治疗结束时）收集身体测量值（腰椎节段性不稳定、运动控制障碍、活动范围、躯干肌肉耐力和身体表现测试），而心理测量值（恐惧回避信念、疼痛灾难化、心理困扰、疾病认知、预后期望）在四个时间点（基线、治疗中期、治疗结束时、随访时）收集。根据感知残疾评分的变化，将参与者分为三个亚组（大、中、小临床改善）。重复测量的 ANOVA 比较了不同时间的良好对照亚组（大改善与小改善），以测试 SUBGROUP × TIME 交互作用。
观察到几个身体和心理测量值的统计学显著交互作用。在所有这些相互作用中，大改善和小改善亚组在基线时是相等的，但大改善亚组的改善程度随着时间的推移比小改善亚组更明显。仅对于心理测量值（恐惧回避信念、疼痛灾难化、疾病认知），在治疗结束时和随访时，组间差异达到了中等至强的效应量。
与该特定运动方案通常针对的身体因素以及已知影响临床结果的心理因素相比，大改善亚组的改善程度大于小改善亚组。
