慢性下腰痛患者在两种不同康复方案后的等速躯干肌力和耐力变化：一项纵向回顾性研究。
Changes in isokinetic trunk muscle strength and endurance after two different restoration programs in people with chronic low back pain: A longitudinal retrospective study.
作者信息
Coleman Marvin, Linières Jonathan, Thery Camille, Gautier Adrien, Daste Camille, Rannou François, Nguyen Christelle, Lefèvre-Colau Marie-Martine, Rören Alexandra
机构信息
AP-HP, Centre-Université Paris Cité, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, 75014, Paris, France.
Université Paris Cité, Institut des Sciences du Sport-Santé de Paris (URP 3625), F-75015, Paris, France.
出版信息
Heliyon. 2024 Jul 20;10(15):e34914. doi: 10.1016/j.heliyon.2024.e34914. eCollection 2024 Aug 15.
BACKGROUND
Multidisciplinary functional restoration programs (FRPs) aim to improve pain and function in people with chronic low back pain (CLBP). The intensity and content of FRPs varies; the benefits of one program over another are unclear.
OBJECTIVE
To assess changes in trunk muscle strength and endurance after an intensive (IFRP) (for people on sick leave for >6 months with high levels of fear-avoidance beliefs about physical activity and work) or semi-intensive (SIFRP) (for people working) FRP in people with CLBP.
METHODS
Longitudinal retrospective study from March 2016 to December 2019. Setting: rehabilitation department of a tertiary care center. Trunk flexor and extensor muscle strength (60°.s) and endurance (120°.s) were measured with the Humac NORM isokinetic dynamometer at pre and post FRP. Change in isokinetic variables (peak torque, total work and flexor/extensor ratio) after each program was assessed with a paired -test (p < 0.05). Pearson's rho and multiple linear regression assessed associations between changes in isokinetic and clinical variables and demographic characteristics.
RESULTS
125 individuals, 63.2 % female, age 43.5 (10.3) years, were included. Mean low back pain intensity was 49.8 (24.9) and 37.2 (25.8)/100 and mean activity limitation (QBPDS) was 38.8 (16.4) and 32.0 (14.6)/100 in the IFRP and SFRP groups, respectively. Trunk extensor peak torque, flexor total work, extensor total work and flexor/extensor peak ratio improved significantly in both FRPs, p < 0.001. The flexor/extensor total work ratio improved in the IFRP group only, p = 0.003. Trunk extensor endurance increased more in the IFRP than the SIFRP group, the absolute pre-post differences for extensor total work [95%CI] N.m were 611.7 [495.2; 728.3] in the IFRP group and 380.0 [300.8; 459.3] in the SIFRP group. No variables were correlated and none predicted improvement in extensor total work in either group.
CONCLUSION
This study highlights the short-term independence of clinical and trunk muscle strength and endurance changes.
背景
多学科功能恢复计划（FRP）旨在改善慢性下腰痛（CLBP）患者的疼痛和功能。FRP的强度和内容各不相同；一种计划相对于另一种计划的益处尚不清楚。
目的
评估强化功能恢复计划（IFRP）（针对病假超过6个月、对体育活动和工作有高度恐惧回避信念的患者）或半强化功能恢复计划（SIFRP）（针对在职患者）对CLBP患者躯干肌肉力量和耐力的影响。
方法
2016年3月至2019年12月的纵向回顾性研究。地点：三级护理中心的康复科。在功能恢复计划前后，使用Humac NORM等速测力计测量躯干屈伸肌力量（60°·秒）和耐力（120°·秒）。每个计划后等速变量（峰值扭矩、总功和屈伸比）的变化采用配对t检验进行评估（p<0.05）。Pearson相关系数和多元线性回归评估等速变量和临床变量变化与人口统计学特征之间的关联。
结果
纳入125例个体，女性占63.2%，年龄43.5（10.3）岁。IFRP组和SFRP组的平均下腰痛强度分别为49.8（24.9）和37.2（25.8）/100，平均活动受限（QBPDS）分别为38.8（16.4）和32.0（14.6）/100。在两个功能恢复计划中，躯干伸肌峰值扭矩、屈肌总功、伸肌总功和屈伸峰值比均显著改善，p<0.001。仅IFRP组的屈伸总功比有所改善，p=0.003。IFRP组的躯干伸肌耐力增加幅度大于SIFRP组，伸肌总功的绝对前后差值[95%CI]N·m在IFRP组为611.7[495.2；728.3]，在SIFRP组为380.0[300.8；459.3]。两组中均无变量具有相关性，且均未预测伸肌总功的改善情况。
结论
本研究强调了临床变化与躯干肌肉力量和耐力变化的短期独立性。
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