Frost H, Lamb S E, Klaber Moffett J A, Fairbank J C, Moser J S
Department of Physiotherapy Research, Nuffield Orthopaedic Centre, NHS Trust, Oxford, UK.
Pain. 1998 Apr;75(2-3):273-9. doi: 10.1016/s0304-3959(98)00005-0.
The aim of this study was to assess the long-term effect of a supervised fitness programme on patients with chronic low back pain. The design of the study was a single blind randomised controlled trial with follow-up, by postal questionnaire, 2 years after intervention. The Oswestry Low Back Pain Disability Index was used as the outcome measure to assess daily activity affected by back pain. Eighty-one patients with chronic low back pain, who were referred to the physiotherapy department of a National Health Service orthopaedic hospital, were randomised to either a supervised fitness programme or a control group. Patients in the intervention group and control group were taught specific exercises to be continued at home and referred to a backschool for back care education. In addition, the intervention group attended eight sessions of a supervised fitness programme. Sixty-two patients (76%) with a mean age of 37 years, returned the Oswestry Low Back Pain Disability Index questionnaire. Of these, 29 were in the intervention group and 31 in the control group. Patients in the intervention group demonstrated a mean reduction of 7.7% in the Oswestry Low Back Pain Disability Index score (95% confidence interval of mean paired difference 3.9, 11.6 P < 0.001), compared with only 2.4% in the control group (95% confidence interval of mean paired difference -2.0, 6.9 P > 0.05). Between group comparisons demonstrated a statistically significant difference in disability scores between the treatment and control group (mean difference 5.8, 95% confidence interval 0.3, 11.4 P < 0.04). This study supports the current trend towards a more active treatment approach to low back pain. We have demonstrated clinical effectiveness of a fitness programme 2 years after treatment but this needs to be replicated in a larger study which should include a cost effectiveness analysis, further analysis of objective functional status and a placebo intervention group.
本研究旨在评估一项有监督的健身计划对慢性下腰痛患者的长期影响。该研究设计为单盲随机对照试验，并在干预两年后通过邮寄问卷进行随访。采用奥斯威斯瑞下腰痛残疾指数作为评估指标，以衡量受背痛影响的日常活动。81名被转介至国民健康服务体系骨科医院理疗科的慢性下腰痛患者被随机分为有监督的健身计划组或对照组。干预组和对照组的患者均接受了特定的在家中持续进行的锻炼指导，并被转介至背部护理学校接受背部护理教育。此外，干预组参加了八节有监督的健身课程。62名平均年龄为37岁的患者（76%）返回了奥斯威斯瑞下腰痛残疾指数问卷。其中，29名在干预组，31名在对照组。干预组患者的奥斯威斯瑞下腰痛残疾指数评分平均降低了7.7%（平均配对差异的95%置信区间为3.9, 11.6；P < 0.001），而对照组仅降低了2.4%（平均配对差异的95%置信区间为-2.0, 6.9；P > 0.05）。组间比较显示，治疗组和对照组在残疾评分上存在统计学显著差异（平均差异为5.8，95%置信区间为0.3, 11.4；P < 0.04）。本研究支持当前对下腰痛采取更积极治疗方法的趋势。我们已证明治疗两年后健身计划具有临床有效性，但这需要在更大规模的研究中进行重复验证，该研究应包括成本效益分析、对客观功能状态的进一步分析以及一个安慰剂干预组。
