慢性非特异性下腰痛患者的疼痛强度变化与平衡控制变化有关吗？一项系统评价和荟萃分析。

Are changes in pain intensity related to changes in balance control in individuals with chronic non-specific low back pain? A systematic review and meta-analysis.

作者信息

Zheng Daniel K Y, Liu Jae Q J, Chang Jeremy R, Ng Jeffrey C Y, Zhou Zhixing, Wu Jinlong, Cheung Chelsia K C, Huang Frank F, Pinto Sabina M, Samartzis Dino, Ferreira Manuela L, Ekanayake Kanchana, Lord Stephen, Wang Xueqiang, Wong Arnold Y L

机构信息

Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong 999077, China.

College of Physical Education, Southwest University, Chongqing 400715, China.

出版信息

J Sport Health Sci. 2024 Sep 17;14:100989. doi: 10.1016/j.jshs.2024.100989.

DOI:10.1016/j.jshs.2024.100989

PMID:39293716

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11809200/

Abstract

PURPOSE

The aim of this study was to summarize the evidence regarding whether pain reduction in individuals with chronic non-specific low back pain (CNSLBP) following conservative interventions is related to corresponding improvements in balance control.

METHODS

Randomized controlled trials were identified from 5 databases (MEDLINE, Cochrane Library, Embase, Web of Science, and PsycINFO). Two reviewers independently screened and identified relevant studies that investigated the effects of non-surgical or non-pharmacological CNSLBP treatments on both pain intensity and balance control. Meta-regression analyses were performed to establish the associations between post-treatment changes in these 2 variables.

RESULTS

Thirty one studies involving 1280 participants with CNSLBP were included. Moderate-quality evidence suggested that pain reduction was associated with and explained 34%-45% of decreases in body sway, as measured by center-of-pressure (CoP) area and CoP velocity with eyes open. However, no significant association was observed between pain reduction and CoP area or velocity in anteroposterior/mediolateral directions. Similarly, there was no significant association between pain reduction and CoP distance or radius. Low-quality evidence indicated that pain relief explained a 15% improvement in one-leg stance with eyes open but not in the eyes-closed condition. Additionally, very low-quality evidence suggested that pain relief explained a 44% decrease in the static anteroposterior stability index with eyes closed but not in the eyes-open, mediolateral, or overall conditions. Furthermore, low-quality evidence indicated that reduced pain was associated with and accounted for 25%-43% of the improved composite and posteromedial scores of the star-excursion balance test, rather than the anterior and posterolateral scores.

CONCLUSION

Depending on the type of balance assessment, pain relief following conservative interventions may slightly to moderately enhance balance control in individuals with CNSLBP. Clinicians should pay close attention to the balance control in patients with CNSLBP, particularly among older adults.

摘要

目的

本研究的目的是总结关于慢性非特异性下腰痛（CNSLBP）患者在保守干预后疼痛减轻是否与平衡控制相应改善相关的证据。

方法

从5个数据库（MEDLINE、Cochrane图书馆、Embase、科学网和PsycINFO）中识别随机对照试验。两名评审员独立筛选并确定了相关研究，这些研究调查了非手术或非药物CNSLBP治疗对疼痛强度和平衡控制的影响。进行了Meta回归分析以建立这两个变量治疗后变化之间的关联。

结果

纳入了31项研究，涉及1280名CNSLBP患者。中等质量的证据表明，疼痛减轻与身体摆动减少相关，并解释了通过睁眼时压力中心（CoP）面积和CoP速度测量的身体摆动减少的34%-45%。然而，在疼痛减轻与前后/内外侧方向的CoP面积或速度之间未观察到显著关联。同样，疼痛减轻与CoP距离或半径之间也没有显著关联。低质量的证据表明，疼痛缓解解释了睁眼单腿站立改善15%，但闭眼时未改善。此外，极低质量的证据表明，疼痛缓解解释了闭眼时静态前后稳定性指数降低44%，但睁眼、内外侧或整体情况下未降低。此外，低质量的证据表明，疼痛减轻与星形偏移平衡测试的综合和后内侧评分改善相关，并占其改善的25%-43%，而不是前侧和后外侧评分。