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腰痛患者接受与不接受行为治疗的感觉运动稳定训练:一项多中心随机对照试验的可行性与效果

Sensorimotor Stabilization Exercises With and Without Behavioral Treatment in Low Back Pain: Feasibility and Effects of a Multicenter Randomized Controlled Trial.

作者信息

Engel Tilman, Niederer Daniel, Arampatzis Adamantios, Banzer Winfried, Beck Heidrun, Floessel Philipp, Haag Thore, Mueller Steffen, Schiltenwolf Marcus, Schmidt Hendrik, Schneider Christian, Stengel Dirk, Stoll Josefine, Wippert Pia-Maria, Mayer Frank

机构信息

University Outpatient Clinic, Sports Medicine & Sports Orthopedics, University of Potsdam, Potsdam, Germany.

Division of Preventive and Sports Medicine, Institute for Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University Frankfurt, Frankfurt am Main, Germany.

出版信息

Arch Rehabil Res Clin Transl. 2025 Jan 27;7(1):100430. doi: 10.1016/j.arrct.2025.100430. eCollection 2025 Mar.


DOI:10.1016/j.arrct.2025.100430
PMID:40463774
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12128597/
Abstract

OBJECTIVES: To investigate the feasibility and effects of a sensorimotor stabilization exercise intervention with and without behavioral treatment in nonspecific low back pain. DESIGN: A three-armed multicenter randomized controlled trial. SETTING: Five study sites across Germany (3 orthopedic university outpatient clinics, 1 university sports medicine department, and 1 clinical institution). PARTICIPANTS: Six hundred and sixty-two volunteers (N=662) (59% females, age 39±13y) with low back pain. INTERVENTIONS: Sensorimotor training (SMT), sensorimotor training with behavioral therapy (SMT+BT), and usual care group (UCG; continuation of the already ongoing individual treatment regime). Intervention groups performed a 12-week (3wk center-based, 9wk home-based) program. MAIN OUTCOME MEASURES: Adherence, dropout rates, adverse events, and intervention effects on pain intensity, disability, and trunk torque (gain scores, repeated measures analysis of variance, α-level<0.05). RESULTS: In total, 220 participants received SMT, 222 received SMT+BT, and 170 were analyzed as UCG. Dropout rates were 10% for SMT and SMT+BT at week 3, 31% and 30% at week 4, and 49% and 50% at week 12. Adherence rates above 80% were reached in both interventions; 134 adverse events occurred. Intervention effects compared to UCG were found for pain intensity (SMT, =.011, effect size d=0.41), disability (SMT+BT, =.020, d=0.41), and peak torque (SMT, =.045, d=0.38; SMT+BT, =.019, d=0.44), with overall small effect sizes. CONCLUSIONS: Participants were highly adherent to the sensorimotor exercise, but showed increased dropout rates, particularly during home-based training. Both interventions proved to be feasible, and although only SMT showed an increased effect on pain intensity compared to UCG, the SMT+BT showed positive effects on disability. Both interventions led to increases in strength, indicative of a neuromuscular adaptation.

摘要

目的:探讨有无行为治疗的感觉运动稳定训练干预对非特异性下腰痛的可行性及效果。 设计:一项三臂多中心随机对照试验。 地点:德国的五个研究地点(3个骨科大学门诊、1个大学运动医学科和1个临床机构)。 参与者:662名患有下腰痛的志愿者(N = 662)(59%为女性,年龄39±13岁)。 干预措施:感觉运动训练(SMT)、感觉运动训练联合行为疗法(SMT+BT)和常规护理组(UCG;继续进行已有的个体化治疗方案)。干预组进行为期12周(3周中心训练,9周居家训练)的项目。 主要观察指标:依从性、脱落率、不良事件以及干预对疼痛强度、功能障碍和躯干扭矩的影响(增益分数,重复测量方差分析,α水平<0.05)。 结果:总共220名参与者接受了SMT,222名接受了SMT+BT,170名作为UCG进行分析。SMT和SMT+BT在第3周的脱落率为10%,第4周为31%和30%,第12周为49%和50%。两种干预的依从率均达到80%以上;发生了134起不良事件。与UCG相比,干预在疼痛强度(SMT,P = 0.011,效应大小d = 0.41)、功能障碍(SMT+BT组,P = 0.020,d = 0.41)和峰值扭矩方面(SMT,P = 0.045,d = 0.38;SMT+BT,P = 0.019,d = 0.44)有效果,总体效应大小较小。 结论:参与者对感觉运动训练的依从性很高,但脱落率增加,尤其是在居家训练期间。两种干预均被证明是可行的,虽然只有SMT与UCG相比对疼痛强度有更大的效果,但SMT+BT对功能障碍有积极影响。两种干预均导致力量增加,表明存在神经肌肉适应性变化。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b2e3/12128597/2d555e7595f5/gr6.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b2e3/12128597/f4d2f8960854/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b2e3/12128597/aae96fee654b/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b2e3/12128597/85d3fe18cfe9/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b2e3/12128597/6ce974b11fa2/gr4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b2e3/12128597/256ff57d3743/gr5.jpg
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本文引用的文献

[1]
Individualized Exercise in Chronic Non-Specific Low Back Pain: A Systematic Review with Meta-Analysis on the Effects of Exercise Alone or in Combination with Psychological Interventions on Pain and Disability.

J Pain. 2022-11

[2]
Determinants of Dropout from and Variation in Adherence to an Exercise Intervention: The STRRIDE Randomized Trials.

Transl J Am Coll Sports Med. 2022

[3]
Psychological interventions for chronic, non-specific low back pain: systematic review with network meta-analysis.

BMJ. 2022-3-30

[4]
RENaBack: low back pain patients in rehabilitation-study protocol for a multicenter, randomized controlled trial.

Trials. 2021-12-18

[5]
Some types of exercise are more effective than others in people with chronic low back pain: a network meta-analysis.

J Physiother. 2021-10

[6]
Psychosocial Moderators and Mediators of Sensorimotor Exercise in Low Back Pain: A Randomized Multicenter Controlled Trial.

Front Psychiatry. 2021-7-29

[7]
Which Functional Outcomes Can be Measured in Low Back Pain Trials and Therapies?: A Prospective 2-Year Factor-, Cluster-, and Reliability-Multicenter Analysis on 42 Variables in 1049 Individuals.

Spine (Phila Pa 1976). 2021-11-1

[8]
Dose-response-relationship of stabilisation exercises in patients with chronic non-specific low back pain: a systematic review with meta-regression.

Sci Rep. 2020-10-9

[9]
Motor Control Stabilisation Exercise for Patients with Non-Specific Low Back Pain: A Prospective Meta-Analysis with Multilevel Meta-Regressions on Intervention Effects.

J Clin Med. 2020-9-22

[10]
Personalized Treatment Suggestions: The Validity and Applicability of the Risk-Prevention-Index Social in Low Back Pain Exercise Treatments.

J Clin Med. 2020-4-22

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