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慢性下腰痛患者体格检查及基于表现的测试的可行性:一项描述性研究。

Feasibility of Physical Exam and Performance-Based Tests in Individuals With Chronic Low Back Pain: A Descriptive Study.

作者信息

Piva Sara R, Alfikri Zakiy, Anderst William, Bell Kevin M, Carlesso Cristiane, Darwin Jessa, Delitto Anthony, Greco Carol M, Johnson Marit E, McKernan Gina P, McLoughlin Rachel, Patterson Charity G, Roos Rachel E, Schneider Michael J, Smith Clair, Sowa Gwendolyn A, Vo Nam V, Zhou Leming

机构信息

Department of Physical Therapy University of Pittsburgh School of Health and Rehabilitation Science Pittsburgh Pennsylvania USA.

Clinical and Translational Science Institute University of Pittsburgh Pittsburgh Pennsylvania USA.

出版信息

JOR Spine. 2025 Aug 12;8(3):e70096. doi: 10.1002/jsp2.70096. eCollection 2025 Sep.


DOI:10.1002/jsp2.70096
PMID:40799632
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12340543/
Abstract

BACKGROUND: Despite the wide utilization of physical tests and pain assessments to evaluate individuals with chronic low back pain (cLBP), there is limited information about their feasibility in terms of test duration, the ability of individuals with cLBP to perform these tests, and associated adverse events. The literature also lacks reports on comprehensive characterization of physical tests to serve as a reference for clinicians and researchers. The objectives of the present work are to assess the feasibility of a comprehensive battery of physical tests and pain assessments germane to individuals with cLBP and characterize the tests' values in the context of a large cohort. METHODS: This cross-sectional analysis uses enrollment data from a large observational study conducted by the University of Pittsburgh Mechanistic Research Center-"Low Back Pain: Biological, Biomechanical, Behavioral Phenotypes (LBP)." LBP is part of the National Institutes of Health's Helping to End Addiction Long-term Initiative. Individuals with cLBP were screened by trained clinicians who assessed their safety to partake in up to 37 physical tests based on pre-existing medical conditions. Testers could elect not to administer tests based on their clinical judgment and participants could refuse to partake in tests. The reasons for not performing tests were recorded. The feasibility of the tests was assessed by the time to complete each test, percentages and reasons for tests not done, and adverse events related to test performance. Descriptive statistics for the physical tests were computed for the sample overall, and for the subgroups (male/female and age < 60/≥ 60) to serve as reference values for individuals with cLBP. RESULTS: The testing protocol took on average 130 min. In total, 8.9% of tests were not done. About one third of tests not done were screened out due to medical conditions identified during the safety screening, and two-thirds due to the tester's clinical judgment or participant refusal. Only four adverse events occurred, and they resolved without sequelae. The tests most often omitted were those requiring maximal and submaximal physical effort or could elevate blood pressure in those with hypertension, such as muscle strength testing of the hip, abdomen, and thigh, or hand immersion in cold water. From the 1007 participants enrolled in the study, those who did not complete one or more tests tended to be older, obese, less educated, and experienced more disability and back pain for a longer time. The descriptive statistics of the 37 tests are reported stratified by sex and age. CONCLUSIONS: The results support the safety and feasibility of a comprehensive battery of physical tests and pain assessments in individuals with cLBP. This study also provides novel information on the test's performance frequency, reasons for not being completed, duration, and descriptive results in individuals with cLBP. This comprehensive characterization provides reference values for comparison in future research planning and clinical practice.

摘要

背景:尽管物理测试和疼痛评估被广泛用于评估慢性下腰痛(cLBP)患者,但关于这些测试在测试时长、cLBP患者执行这些测试的能力以及相关不良事件方面的可行性信息有限。文献中也缺乏关于物理测试全面特征描述的报告,以供临床医生和研究人员参考。本研究的目的是评估一系列针对cLBP患者的全面物理测试和疼痛评估的可行性,并在一个大型队列中描述这些测试的价值。 方法:本横断面分析使用了匹兹堡大学机制研究中心——“下腰痛:生物学、生物力学、行为表型(LBP)”进行的一项大型观察性研究的入组数据。LBP是美国国立卫生研究院“帮助终结长期成瘾倡议”的一部分。cLBP患者由经过培训的临床医生进行筛查,这些医生根据患者既往病史评估其参与多达37项物理测试的安全性。测试人员可根据临床判断选择不进行某些测试,参与者也可拒绝参加测试。记录不进行测试的原因。通过完成每项测试的时间、未进行测试的百分比及原因,以及与测试执行相关的不良事件来评估测试的可行性。计算了整个样本以及亚组(男性/女性和年龄<60岁/≥60岁)的物理测试描述性统计数据,作为cLBP患者的参考值。 结果:测试方案平均耗时130分钟。总共8.9%的测试未进行。未进行的测试中,约三分之一是由于安全筛查中发现的医疗状况而被排除,三分之二是由于测试人员的临床判断或参与者拒绝。仅发生了4起不良事件,且均未留下后遗症。最常被省略的测试是那些需要最大和次最大体力消耗的测试,或者会使高血压患者血压升高的测试,如髋部、腹部和大腿的肌肉力量测试,或手浸于冷水中的测试。在参与研究的1007名参与者中,未完成一项或多项测试的人往往年龄较大、肥胖、受教育程度较低,且残疾和背痛经历的时间更长。报告了按性别和年龄分层的37项测试的描述性统计数据。 结论:结果支持对cLBP患者进行一系列全面物理测试和疼痛评估的安全性和可行性。本研究还提供了关于这些测试的执行频率、未完成原因、时长以及cLBP患者描述性结果的新信息。这种全面的特征描述为未来研究规划和临床实践中的比较提供了参考值。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/825d/12340543/49d3d31659ba/JSP2-8-e70096-g023.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/825d/12340543/49d3d31659ba/JSP2-8-e70096-g023.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/825d/12340543/49d3d31659ba/JSP2-8-e70096-g023.jpg

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本文引用的文献

[1]
Demographic and Biomedical Characteristics of an Observational Cohort With Chronic Low Back Pain: A Descriptive Analysis.

JOR Spine. 2025-7-14

[2]
Global, regional, and national burden of low back pain, 1990-2020, its attributable risk factors, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021.

Lancet Rheumatol. 2023-5-22

[3]
Toward the Identification of Distinct Phenotypes: Research Protocol for the Low Back Pain Biological, Biomechanical, and Behavioral (LB3P) Cohort Study and the BACPAC Mechanistic Research Center at the University of Pittsburgh.

Pain Med. 2023-8-4

[4]
Body composition and functional performance of older adults.

Osteoporos Sarcopenia. 2022-6

[5]
Inadequacies of the Lasègue test, and how the Slump and Bowstring tests are useful for the diagnosis of sciatica.

Joint Bone Spine. 2021-1

[6]
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Phys Ther. 2019-4-1

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Centralization and directional preference: An updated systematic review with synthesis of previous evidence.

Musculoskelet Sci Pract. 2018-9-18

[8]
Accuracy and reliability of Babinski sign versus finger and foot tapping in the diagnosis of corticospinal tract lesions.

Neurol India. 2018

[9]
Validity and reliability of evaluating hip abductor strength using different normalization methods in a functional electromechanical device.

PLoS One. 2018-8-20

[10]
What low back pain is and why we need to pay attention.

Lancet. 2018-3-21

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