Friedrich M, Gittler G, Halberstadt Y, Cermak T, Heiller I
Department of Orthopedic Physiotherapy, Orthopedic Hospital Speising, Vienna, Austria.
Arch Phys Med Rehabil. 1998 May;79(5):475-87. doi: 10.1016/s0003-9993(98)90059-4.
To assess the effect of a combined exercise and motivation program on the compliance and level of disability of patients with chronic and recurrent low back pain.
A double-blind prospective randomized controlled trial.
Physical therapy outpatient department, tertiary care.
Ninety-three low back pain patients were randomly assigned to either a standard exercise program (n = 49) or a combined exercise and motivation program (n = 44).
Patients were prescribed 10 physical therapy sessions and were advised to continue exercising after treatment termination. The motivation program consisted of five compliance-enhancing interventions. Follow-up assessments were performed at 3 1/2 weeks, 4 months, and 12 months.
Disability (low back outcome score), pain intensity, physical impairment (modified Waddell score, fingertip-to-floor distance, abdominal muscle strength), working ability, motivation, and compliance.
The patients in the motivation group were significantly more likely to attend their exercise therapy appointments (p = .0005). Four and 12 months after study entry there was a significant difference in favor of the motivation group with regard to the disability score (p = .004) and pain intensity (p < or = .026). At 4 months, there was a significant advantage for the motivation group in the fingertip-to-floor distance (p = .01) and in abdominal muscle strength (p = .018). No significant differences were found in motivation scores, self-reported compliance with long-term exercise, and modified Waddell score. In terms of working ability, there was a trend favoring the combined exercise and motivation program.
The combined exercise and motivation program increased the rate of attendance at scheduled physical therapy sessions, ie, short-term compliance, and reduced disability and pain levels by the 12-month follow-up. However, there was no difference between the motivation and control groups with regard to long-term exercise compliance.
评估运动与激励相结合的方案对慢性复发性下腰痛患者的依从性及残疾程度的影响。
双盲前瞻性随机对照试验。
三级护理机构的物理治疗门诊部。
93名下腰痛患者被随机分为标准运动方案组（n = 49）或运动与激励相结合的方案组（n = 44）。
为患者安排10次物理治疗，并建议他们在治疗结束后继续锻炼。激励方案包括五项提高依从性的干预措施。在3.5周、4个月和12个月时进行随访评估。
残疾程度（下腰结局评分）、疼痛强度、身体功能障碍（改良瓦德尔评分、指尖至地面距离、腹肌力量）、工作能力、积极性和依从性。
激励组患者参加运动治疗预约的可能性显著更高（p = 0.0005）。在研究开始后的4个月和12个月，激励组在残疾评分（p = 0.004）和疼痛强度方面（p≤0.026）有显著优势。在4个月时，激励组在指尖至地面距离（p = 0.01）和腹肌力量方面（p = 0.018）有显著优势。在积极性评分、自我报告的长期锻炼依从性和改良瓦德尔评分方面未发现显著差异。在工作能力方面，有倾向于运动与激励相结合方案的趋势。
运动与激励相结合的方案提高了按计划进行物理治疗的出勤率，即短期依从性，并在12个月的随访中降低了残疾程度和疼痛水平。然而，在长期运动依从性方面，激励组与对照组之间没有差异。
