Manniche C
Department of Rheumatology, Hillerød Hospital.
Dan Med Bull. 1995 Sep;42(4):301-13.
Eight articles including 555 low back pain patients have been published. They included the following topics: 1) A ratio interval rating scale (Low Back Pain Rating Scale (RS)) was introduced. The possibility of registering the actual status in low back pain patients including; Back Pain, Sciatica, Functional Disability and Physical Impairment was studied. Methods of evaluating index-scales developed in the field of psychometry were applied in the validation process of RS. RS was found to be both valid and user friendly. 2) Using Low Back Pain Rating Scale the general outcome following first-time lumbar disc surgery was analysed through a survey. The results showed that more than half of the patients still suffered from considerable Back Pain, Sciatica, and Functional Disabilities. Approximately 25% of the patients risked reduced work capabilities, and many receive pensions. 3) By means of a comprehensive statistical analysis of 18 studied preoperative demographic and physical findings, sex, hypoalgesia, smoking and Finneson-index were found to have prognostic value. 4) Attempts at influencing the results obtained from lumbar disc surgery have been tested in 3 randomized trials, including back training and peroperative glucocorticoid administration. 5) Three randomized trials including patients suffering from chronic low back pain (with or without previous lumbar disc surgery) attempted to convey which elements of a training programme provide patients with the greatest effect and the least risk of side-effects. It was concluded that Low Back Pain Rating Scale is a useable assessment instrument in both clinical trials and as a daily quality control instrument of back patients. There is a need of increased patient scrutiny in patient selection prior to lumbar disc surgery. Postoperative rehabilitation should include intensive back training, which has been shown to be of value in behavioural support and restoration of functional deficits. This has resulted in increased work capacities for disc operated patients. The exercise programmes are generally free of side-effects. As regards chronic back pain patients with or without previous lumbar surgery, high dosage exercises with training periods lasting at least 12 to 16 sessions are of crucial importance for success. Exercises should be dynamic and full-range, and carried out following the adage "Don't let the pain be your guide.
已发表了8篇文章，涵盖555名腰痛患者。它们包括以下主题：1）引入了一种比率区间评定量表（腰痛评定量表（RS））。研究了记录腰痛患者实际状况的可能性，包括背痛、坐骨神经痛、功能障碍和身体损伤。在RS的验证过程中应用了心理测量学领域开发的评估指标量表的方法。发现RS既有效又便于使用。2）使用腰痛评定量表通过一项调查分析了首次腰椎间盘手术后的总体结果。结果显示，超过一半的患者仍患有相当程度的背痛、坐骨神经痛和功能障碍。约25%的患者有工作能力下降的风险，许多人领取养老金。3）通过对18项术前人口统计学和身体检查结果进行综合统计分析，发现性别、痛觉减退、吸烟和芬尼森指数具有预后价值。4）在3项随机试验中测试了影响腰椎间盘手术结果的尝试，包括背部训练和术中糖皮质激素给药。5）3项随机试验纳入了慢性腰痛患者（有或无既往腰椎间盘手术史），试图确定训练计划中的哪些要素能为患者带来最大效果且副作用风险最小。得出的结论是，腰痛评定量表在临床试验中以及作为腰痛患者的日常质量控制工具都是可用的评估工具。在腰椎间盘手术前的患者选择中需要加强对患者的审查。术后康复应包括强化背部训练，这已被证明在行为支持和功能缺陷恢复方面具有价值。这提高了接受椎间盘手术患者的工作能力。这些锻炼计划一般没有副作用。对于有或无既往腰椎手术史的慢性背痛患者而言，持续至少12至16节训练课程的高剂量锻炼对成功至关重要。锻炼应该是动态的、全方位的，并且要遵循“不要让疼痛成为你的指引”这一格言来进行。
