Prentice Caitlin Lauren Siobhan, Flavell Carol Ann, Massy-Westropp Nicola, Milanese Steve
Allied Health and Human Performance, University of South Australia, Adelaide, Australia.
College of Healthcare Sciences, James Cook University, Townsville, Australia.
Physiother Res Int. 2025 Apr;30(2):e70060. doi: 10.1002/pri.70060.
Exercise is commonly prescribed for patients with low back pain (LBP) and maladaptive changes in lateral abdominal muscle (LAM) activation. The literature has considered various exercise programs, but the evidence has not consistently identified exercise parameters associated with superior outcomes. The aim of this study was to determine how physiotherapists should prescribe exercise for patients with persistent LBP who present with maladaptive LAM activation.
This was a three round Delphi survey. The international expert panel comprised physiotherapy clinicians with postgraduate orthopaedic manipulative physiotherapy training. Round 1 included open ended questions. Responses were collated and coded using content analysis. In Rounds 2 and 3, participants were provided with the collated responses and rated their agreement with or chose their preferred options regarding exercise prescription for patients with maladaptive LAM activation. Items were defined as meeting consensus when ≥ 70% of participants agreed/disagreed or chose the same option.
Twenty-three physiotherapists consented to participate. Seventeen, 20 and 15 participants completed Rounds 1, 2 and 3, respectively. The exercise prescription suggestions consisted of 46 items reaching consensus across the domains of exercise: goals, considerations, agreement on prescribing exercise for the LAM and other muscles, muscle activation during exercise, the exercise prescription and its focus.
This study provides clinically informed recommendations for physiotherapists prescribing exercise for patients with persistent LBP and maladaptive LAM activation. Findings align with motor control exercise approaches outlined in the literature. Participants emphasised the consideration of patient preferences and balancing motor control exercise with moderate/vigorous physical activity.
对于下腰痛（LBP）患者以及腹外侧肌（LAM）激活存在适应不良变化的患者，运动疗法是常用的治疗手段。文献中已探讨了各种运动方案，但现有证据尚未始终确定与更优治疗效果相关的运动参数。本研究的目的是确定物理治疗师应如何为存在LAM激活适应不良的持续性LBP患者制定运动处方。
这是一项三轮德尔菲调查。国际专家小组由接受过骨科手法物理治疗研究生培训的物理治疗临床医生组成。第一轮包括开放式问题。使用内容分析法对回答进行整理和编码。在第二轮和第三轮中，向参与者提供整理后的回答，并让他们对针对LAM激活适应不良患者的运动处方表示同意程度或选择他们偏好的选项。当≥70%的参与者同意/不同意或选择相同选项时，项目被定义为达成共识。
23名物理治疗师同意参与。分别有17名、20名和15名参与者完成了第一轮、第二轮和第三轮调查。运动处方建议包括46项在运动领域达成共识的内容：目标、注意事项、关于为LAM和其他肌肉开具运动处方的共识、运动期间的肌肉激活、运动处方及其重点。
本研究为物理治疗师为存在持续性LBP和LAM激活适应不良的患者开具运动处方提供了基于临床的建议。研究结果与文献中概述的运动控制锻炼方法一致。参与者强调要考虑患者偏好，并在运动控制锻炼与中等/剧烈身体活动之间取得平衡。
