MULTIDISCIPLINARY PAIN ABSTRACTS: 49

The purpose of this multicenter, randomized, controlled trial was to compare the effect of manual therapy to exercise therapy in sick-listed patients with chronic low back pain. The effects of exercise therapy and manual therapy on chronic low back pain with respect to pain, function, and sick leave have been investigated in a number of studies. The results are, however, conflicting. Patients with chronic low back pain or radicular pain sick-listed for more than 8 weeks and less than 6 months were included. A total of 49 patients were randomized to either manual therapy (n=27) or to exercise therapy (n=22). Sixteen treatments were given over the course of 2 months. Pain intensity, functional disability (Oswestry disability index), general health (Dartmouth Care Cooperative function charts), and return to work were recorded before, immediately after, at 4 weeks, 6 months, and 12 months after the treatment period. Spinal range of motion (Schober test) was measured before and immediately after the treatment period only. Although significant improvements were observed in both groups, the manual therapy group showed significantly larger improvements than the exercise therapy group on all outcome variables throughout the entire experimental period. Immediately after the 2-month treatment period, 67% in the manual therapy and 27% in the exercise therapy group had returned to work. It was concluded that improvements were found in both intervention groups, but manual therapy showed significantly greater improvement than exercise therapy in patients with chronic low back pain. The effects were reflected on all outcome measures, both on short- and long-term follow-up.     

Verbesserung der ambulanten Versorgung von Patienten mit chronischen Rückenschmerzen

BACKGROUND: Treatment for chronic low back pain in primary care has a poor-quality outcome. There is evidence that multimodal therapy is the most successful approach to its management. We tried to evaluate whether giving primary care physicians evidence-based recommendations on therapy of chronic back pain or directly implementing a multimodal program would improve the outcome of patients with low back pain treated in primary care. METHODS: In the first phase, physicians were asked to document the course of patients suffering from low back pain of at least 4 weeks' duration with no decrease in intensity, noting pain intensity before and after 6 months of conventional, nonsurgical treatments. In the present, second, phase of the study, recommendations issued by the Medicines Committee of the German Medical Profession and the U.S. Agency for Health Care Policy and Research for the management of back pain were presented to doctors in printed form and at conferences. In parallel with this, a multimodal program for the treatment of chronic low back pain (4 h/day for 20 days: medical training therapy, cognitive-behavioral therapy, physiotherapy, and patient education) was organized in a private health-oriented sports center in cooperation with three private physiotherapy practices, and a psychologist and a pain specialist from the outpatient pain clinic at the University Hospital in Erlangen. We examined how physicians changed the therapy and how effective it was, the latter as reflected in the mean sum value of the percent pre- to posttreatment changes in pain intensity, how much pain interfered with daily living, depressivity, and quality of life. Data after interventions were compared with baseline data from the first phase. RESULTS: Data relating to 36 patients following treatment by 14 primary care physicians who had been given information about therapy recommendations and to 51 patients who had participated in the multimodal therapy program were compared with baseline data recorded in 157 patients. Recommendations changed neither the therapy preferred by primary care physicians nor the quality of outcome of conventional treatment. In contrast, the multimodal program of therapy for chronic low back pain improved the outcome significantly more than conventional therapy (mean improvement in general outcome score 22 vs. 7%, respectively, compared with baseline data; P<0.001). CONCLUSIONS: Giving primary care physicians information on the therapy recommended for treatment of low back pain does not lead to any change in physicians' preferred therapy. Multimodal programs for treatment of chronic low back pain should be organized locally, with existing health care providers joining forces to improve the quality of outcome in chronic low back pain managed in primary care.     

Structure quality of independent physicians for pain management--is there a standard?

BACKGROUND: Evidence based standards for structure quality in out-patient management of chronic pain states do not exist. Therefore we tried to evaluate if german standards for outpatient management of chronic pain states which are based on opinions of experts for pain management influence the outcome quality of independent physicians for treatment of chronic low back pain. METHODS: 35 independent physicians, selected on a voluntary basis from 2100 physicians of a bavarian greater district with 1,6 Mio. inhabitants, and one outpatient treatment facility for pain patients of the university of Erlangen-Nuremberg have been evaluated by questionnaires. Questions examined certain structural conditions of the treatment facility as compared to german guidelines for outpatient treatment of pain patients ("Schmerztherapievereinbarung"). 157 patients suffering from chronic low back pain documented before and after a treatment interval of 6 months their pain intensity during the last 24 hours (numeric rating scale), the interference of pain with daily living (german version of the Brief Pain Inventory) and their quality of life (SF-36). Pre-post changes have been used as parameters for outcome quality. RESULTS: Neither baseline data nor pre-post differences of outcome parameter did correlate significantly with the scores of structure quality (17-71% of maximum) of the treatment facilities. However, multimodal therapy programs have not been used for pain management. CONCLUSIONS: Structural indicators of german guidelines for outpatient treatment of pain patients ("Schmerztherapievereinbarung") are not sufficient to improve outcome quality of patients with chronic back pain. Multimodal therapy programs have been shown to be effective in chronic back pain and should be implemented in the guidelines.     

Fear-avoidance beliefs as measured by the fear-avoidance beliefs questionnaire: change in fear-avoidance beliefs questionnaire is predictive of change in self-report of disability and pain intensity for patients with acute low back pain

OBJECTIVES: The purposes of this study were to investigate the association among measures of fear-avoidance beliefs, pain intensity, and lumbar flexion and to determine if changes in these measures were predictive of treatment outcome following physical therapy for acute low back pain. It was hypothesized that items of the Fear-Avoidance Beliefs Questionnaire would be correlated with concurrent measures of pain intensity and lumbar flexion. In addition, it was hypothesized that changes in fear-avoidance beliefs would be predictive of changes in self-report of pain intensity and disability. STUDY DESIGN: Patients underwent a standard examination that included measures of fear-avoidance beliefs, pain intensity, lumbar flexion, and disability from low back pain. Patients were then re-examined after 4 weeks of physical therapy treatment. PATIENTS: Sixty-three patients with acute low back pain enrolled in a clinical trial of physical therapy treatment. RESULTS: Fear-Avoidance Beliefs Questionnaire items were consistently correlated with lumbar flexion, but not with measures of pain intensity. Pearson correlations indicated that changes in disability were significantly associated with changes in fear-avoidance beliefs and pain intensity, but not changes in lumbar flexion. Changes in fear-avoidance beliefs explained significant amounts of variance in changes in average pain intensity while controlling for changes in lumbar flexion. Changes in fear-avoidance beliefs explained significant amounts of variance in changes in disability while controlling for changes in average pain intensity. CONCLUSIONS: These results suggest that fear-avoidance beliefs have a similar association with pain intensity, physical impairment, and disability for patients with acute and chronic low back pain. This study provides preliminary support for the use of the Fear-Avoidance Beliefs Questionnaire as an outcome measure for patients with acute low back pain.     

Disability, pain, psychological factors and physical performance in healthy controls, patients with sub-acute and chronic low back pain: a case-control study.

OBJECTIVE: To compare measures of disability, psychological factors, pain and physical performance in healthy controls, and patients with sub-acute and chronic low back pain. To evaluate the concept of the deconditioning syndrome and to explore factors that may contribute to chronicity. DESIGN: Case-control study. SUBJECTS: Three age- and gender-matched groups were included in the study; healthy controls (n = 45), patients sick-listed 8-12 weeks (n = 46) and patients with chronic low back pain on a waiting list for lumbar instrumented fusion (n = 45). METHODS: Measures of disability, pain, psychological factors, and physical performance were obtained from the 3 groups using validated measures. RESULTS: Gender, age, body weight and height were not significantly different between the groups. Comparable scores were found for self-rated working ability, fear-avoidance beliefs for physical activity and aerobic capacity in the 2 patient groups. Oswestry Disability Index, pain, emotional distress, abdominal and back muscle endurance were significantly different between the 3 groups. Self-efficacy for pain and fear-avoidance beliefs for work was significantly different between the 2 patient groups. CONCLUSION: The results suggest a stepwise deterioration of impairment and disability from healthy controls to patients with chronic low back pain. Most variables distinguished between healthy controls and patients with sub-acute or chronic low back pain. Deconditioning was more related to psychophysical measures of abdominal and back muscle endurance than to cardiovascular fitness. Comparable scores for fear-avoidance and working ability in the 2 patient categories suggest that these factors appear at an early stage and contribute to the transition from acute to chronic low back pain.     

Effects of capacitive and resistive electric transfer therapy on pain and lumbar muscle stiffness and activity in patients with chronic low back pain

[Purpose] In this study, we investigated the therapeutic effects of capacitive and resistive electric transfer therapy in patients with chronic low back pain. [Participants and Methods] The study included 24 patients with chronic low back pain (12 patients each in the intervention and sham groups). Pain intensity, superficial and deep lumbar multifidus stiffness and maximum forward trunk flexion and associated activation level of the iliocostalis (thoracic and lumbar component) and lumbar multifidus muscles were measured. [Results] Post-intervention pain intensity and muscle stiffness were significantly lower than pre-intervention measurements in the intervention group. However, no between-group difference was observed in the muscle activation level at the end-point of standing trunk flexion. [Conclusion] Our findings highlight a significant therapeutic benefit of capacitive and resistive electric transfer therapy in patients with chronic low back pain and muscle stiffness.     

Factors predicting pain reduction in chronic back and neck pain after multimodal treatment

OBJECTIVES: To determine whether treatment related pain reduction on the short- and long-term is predicted by different baseline variables, and with different accuracy, in patients with chronic low back pain as compared with those with chronic neck pain. DESIGN AND METHODS: A single blinded prospective cohort study based on patients with chronic musculoskeletal pain in the lower back (N = 167) or the neck (N = 136) who completed a 4-week multimodal rehabilitation program. At admission, each patient was evaluated on 17 potential predictors, including pain characteristics and physical, sociodemographic, and psychosocial-behavioral variables. Changes in self-reported pain intensity in the lower back or the neck between the pretreatment evaluation and those performed immediately after, and 12 months after the rehabilitation program, were assessed. RESULTS: Logistic regression models revealed that change in pain intensity could be predicted with good specificity but with poor sensitivity both for patients with chronic low back pain and chronic neck pain. Significant predictors among the neck pain patients were high endurance, low age, high pain intensity, few other symptoms, low need of being social, to do things with others, and to be helped, along with optimistic attitudes on how the pain will interfere with daily life. Among the low back pain patients, high pain intensity, low levels of pain severity, and high affective distress were important predictors. Variables such as sex, sick leave history, working status, accident, pain duration, and depressive symptoms demonstrated no predictive value. Short- and long-term pain outcome was equally predictable and predicted by almost the same variables. CONCLUSIONS: Patients who reported unchanged or increased pain after multimodal treatment could be predicted with good accuracy, whereas those who reported decreased pain were more difficult to identify. Treatment-related pain alteration in chronic low back pain seems to be predicted by partly different variables than in chronic neck pain.     

Electrical muscle stimulation as an adjunct to exercise therapy in the treatment of nonacute low back pain: a randomized trial.

A prospective, randomized, double-blind, placebo-controlled clinical trial was performed to investigate the efficacy of electrical muscle stimulation when combined with a therapist-guided, standardized exercise therapy program in the treatment of nonacute low back pain. Eighty patients with low back pain of at least 6 weeks' duration were randomized into the following 2 groups: standardized exercise therapy with functional electrical muscle stimulation or standardized exercise therapy with placebo electrical stimulation. Subjects were evaluated at baseline, 2 months, and 6 months with a standardized back pain questionnaire and objective measurements of lumbar spine function. Exercise therapy was continued for 6 months, but electrical stimulation was discontinued at the 2-month interval. Of the 80 patients initially enrolled, 42 discontinued or withdrew before completing the entire study protocol. At the 2-month follow-up interval, subjects in the treatment group had statistically significantly improved lumbar spine function compared with the control subjects. This effect continued during the last 4 months of the study after electrical stimulation had been discontinued. This suggests that electrical muscle stimulation can be an effective adjunctive treatment modality for nonacute low back pain. The effects of this combined therapy seem to last beyond the duration of electrical stimulation treatment.     

A comparison of the effectiveness of spinal manipulative therapy for low back pain patients with and without spondylolisthesis

The effectiveness of spinal manipulative therapy for low back pain is compared between two groups of patients: a small group (25) of patients with lumbar spondylolisthesis and a larger group (260) of patients without spondylolisthesis. This data, which was collected from a previously published study on the effectiveness of manipulation for chronic low back pain, shows that the results of manipulative treatment are not significantly different in those patients with or without lumbar spondylolisthesis.     

主动抗阻运动疗法治疗慢性颈部疼痛的临床研究

目的观察主动抗阻运动疗法对于慢性颈部疼痛患者的治疗效果。方法门诊选择39例病程超过6个月的女性慢性颈部疼痛的患者作为治疗组;选择21例正常女性作为对照组。对照组不进行功能锻炼。治疗组应用主动抗阻运动疗法进行功能锻炼。治疗前、治疗后12个月,观察颈椎生理曲度、项背肌肌肉CT值、项背肌肌力和耐力、颈部疼痛视觉模拟评分。结果与对照组相比,治疗组治疗前颈椎生理曲度降低(P<0.05),治疗前后无显著性差异(P>0.05)。年长对照组的颈椎后部肌肉总体平均CT值较年轻对照组降低(P<0.05);治疗组项背肌肌肉总体平均CT值比对照组降低(P<0.05);治疗组治疗前后项背肌肌肉总体平均CT值无显著性差异(P>0.05)。治疗组较对照组项背肌肌肉的肌力和耐力降低(P<0.05);治疗后治疗组项背肌肌力和耐力都较治疗前提高(P<0.05)。治疗组在治疗后1个月疼痛评分改善(P<0.05),治疗后1年所有患者疼痛完全消失。结论主动抗阻运动疗法能够提高项背肌肌力和耐力,消除疼痛。     

Widespread Proprioceptive Acuity Impairment in Chronic Back Pain: A Cross-sectional Study

ObjectiveTo investigate whether proprioceptive accuracy measured with the Joint Position Sense (JPS) in patients with chronic neck and low back pain is impaired exclusively in affected areas or also in distant areas, not affected by pain.DesignCross-sectional study.SettingInterdisciplinary outpatient rehabilitation clinic for back and neck pain.ParticipantsPatients with chronic neck pain (n=30), patients with chronic low back pain (n=30), and age- and sex-matched asymptomatic control subjects (n=30; N=90).InterventionsNot applicable.Main Outcome MeasuresPatients and asymptomatic control subjects completed a test procedure for the JPS of the cervical spine, lumbar spine, and ankle in a randomized order. Between group differences were analyzed with the univariate analysis of variance and associations of the JPS with clinical features using the Pearson's correlation coefficient.ResultsBoth patients with chronic neck pain (P<.001) and patients with chronic low back pain (P<.01) differed significantly from asymptomatic controls in the JPS of the cervical spine, lumbar spine and ankle joint, regardless of the painful area. No difference was shown between patient groups (P>.05). An association of the JPS with clinical characteristics, however, could not be shown.ConclusionThese results suggest widespread impairment of proprioceptive accuracy in patients with chronic and low back pain and a role for central sensorimotor processes in musculoskeletal pain conditions.     

脊柱手法治疗对慢性非特异性腰痛的疗效观察

目的:观察脊柱手法治疗与常规理疗方案(中、高频)对慢性非特异性腰痛患者的临床疗效.方法:将40例慢性非特异性腰痛患者随机分为研究组20例和对照组20例.对照组予以常规理疗方案(中、高频)治疗,研究组另外予以脊柱手法治疗.2组患者均于治疗前、治疗后、治疗后1个月、3个月,进行视觉模拟评分(VAS)、Oswe-stry 功...     

Lumbale Rückenschmerzen Vergleich von drei aktiven Therapieverfahren

The present study was a randomised prospective clinical trial of the relative efficacy of three active therapies for chronic low back pain. A total of 148 subjects with chronic low back pain were randomly assigned to one of the following treatments, which they attended twice a week for 3 months: (1) modern active physiotherapy; (2) muscle reconditioning on training devices; (3) low impact aerobics. Pre- and post-therapy, and at the 6- and 12-month follow-up examinations, questionnaires were administered enquiring about self-rated pain and disability. At all four time-points 127 questionnaires were available for analysis. The three treatments were equally efficacious in their ability to reduce pain intensity and pain frequency significantly for up to a year after discharge from the programme. The groups showed divergent behaviour, however, with respect to self-rated disability (p=0.03): in the physiotherapy group, disability had already regressed back towards pre-therapy levels within the first 6 months, whilst in the other two groups the positive effects of therapy were maintained up to a year later. The costs of the three treatments varied greatly: the one with the lowest costs was low-impact aerobics. Using this treatment as the first choice in primary care could significantly reduce the costs of the treatment of chronic low back pain.     

Decrease in elbow flexor inhibition after cervical spine manipulation in patients with chronic neck pain

OBJECTIVE: This study measured functional capacity and subjective pain in patients with chronic neck pain before and after manipulation of the cervical spine. DESIGN: Outcomes study on 16 patients with chronic neck pain. BACKGROUND: Muscle inhibition, i.e., the inability to fully activate a muscle, has been observed following joint pathologies and in low back pain conditions. Although chronic neck pain has been associated with changes in muscle recruitment and coordination in the shoulder and arms, the possibility of muscle inhibition has not been explored. METHODS: Biceps activation during a maximal voluntary elbow flexor contraction was assessed using the interpolated twitch technique and electromyography. Cervical range of motion and pressure pain thresholds were measured using a goniometer and an algometer. Manipulation of the cervical spine was applied at the level of C5/6/7, and functional assessments were repeated. RESULTS: Patients showed significant inhibition in their biceps muscles. Cervical range of motion was restricted laterally, and increased pressure pain sensitivity was evident. After cervical spine manipulation, a significant reduction in biceps inhibition and an increase in biceps force occurred. Cervical range of motion and pressure pain thresholds increased significantly. CONCLUSIONS: Significant dysfunction in biceps activation was evident in patients with chronic neck pain, indicating that this muscle group cannot be used to the full extent. Spinal manipulation decreased muscle inhibition and increased elbow flexor strength at least in the short term. RELEVANCE: Muscle inhibition in the biceps has not been previously documented in patients with chronic neck pain. Further research is needed to establish whether muscle inhibition is related to clinical symptoms and functional outcome. Spinal manipulation improved muscle function, cervical range of motion and pain sensitivity, and might therefore be beneficial for treating patients with chronic neck pain.     

The role of fear-avoidance beliefs in acute low back pain: relationships with current and future disability and work status

Fear-avoidance beliefs have been identified as an important psychosocial variable in patients with chronic disability doe to low back pain. The importance of fear-avoidance beliefs for individuals with acute low back pain has not been explored. Seventy-eight subjects with work-related low back pain of less than 3 weeks'duration were studied. Measurements of pain intensity, physical impairment, disability, nonorganic signs and symptoms, and depression were taken at the initial evaluation. Fear-avoidance beliefs were measured with the work and physical activity subscales of the Fear-avoidance Beliefs Questionnaire. Disability and work status were re-assessed after 4 weeks of physical therapy. Patterns of correlation between fear-avoidance beliefs and other concurrently-measured variables were similar to those reported in patients with chronic low back pain. Fear-avoidance beliefs did not explain a significant amount of the variability in initial disability levels after controlling for pain intensity and physical impairment. Fear-avoidance beliefs about work were significant predictors of 4-week disability and work status even after controlling for initial levels of pain intensity, physical impairment, and disability, and the type of therapy received. Fear-avoidance beliefs are present in patients with acute low back pain, and may be an important factor in explaining the transition from acute to chronic conditions. Screening for fear-avoidance beliefs may be useful for identifying patients at risk of prolonged disability and work absence.     

Spinal pain made worse by recumbency: a clue to spinal cord tumors

In the absence of physical findings, pain in the low back, cervical or thoracic spine, or the extremities presents a diagnostic problem. On occasion the pain is present or made worse only when the patient lies down. We have attended four patients with underlying extradural tumors of the spinal canal. A 75-year-old woman with chronic back pain was treated for multiple myeloma with intravenous dexamethasone and 400 rads of x-ray irradiation to the lumbar spine and experienced marked pain relief in 24 hours. A 76-year-old woman with neck pain had complete pain relief after a vascular, calcified meningioma was removed surgically from under the 2nd and 3rd cervical nerve roots. A 38-year-old male with constant pain in the lumbar area and right leg and foot experienced marked relief from pain after a neurolemmoma of the cauda equina was surgically removed. A 57-year-old woman with knee pain became pain free 24 hours after radiation therapy to an enlarged nodular cauda equina. These four cases illustrate a diagnostic clue rarely mentioned in the literature.     

The role of fear-avoidance beliefs in patients with neck pain: relationships with current and future disability and work capacity

OBJECTIVES: To investigate the relationship between fear-avoidance beliefs and future disability and work capacity in patients with neck pain. DESIGN: A prospective observational study. SETTING: Physiotherapy outpatient departments. PATIENTS: One hundred and twenty patients with neck pain intensity sufficient to affect their work capacity. INTERVENTIONS: Patients participated in either six-week conventional physiotherapy or an exercise training programme to test whether the type of treatment received by the patients together with other outcome measures affected the predictive power of fear-avoidance beliefs. MAIN OUTCOME MEASURES: Patients underwent examination of the active neck range of movements and neck muscle strength and completed the Fear-Avoidance Beliefs Questionnaire, the Northwick Park Neck Pain Questionnaire, the Medical Outcomes 36-Item Short-Form Health Survey and the 11-point pain numerical rating scale. These were assessed at the beginning and at week 6 of the rehabilitation programme. Patients' work capacity was assessed at week 6 and three months after the six-week rehabilitation programme. RESULTS: Spearman's correlation coefficients between fear-avoidance beliefs and initial and week 6 disability levels were 0.47 and 0.48, respectively. Regression analysis showed that the fear-avoidance beliefs significantly improved the goodness of fit of the model for predicting week 6 disability levels and return to complete work capacity at week 6 and three months after the rehabilitation programme, even after controlling for the physical impairments, the health status, the pain intensity and the type of treatment received. CONCLUSIONS: The fear-avoidance beliefs factor is an important biopsychosocial variable in predicting future disability level and return to complete work capacity in patients with neck pain.     

Coping and convalescence course after lumbar disk operations

BACKGROUND: Aim of the present prospective longitudinal study was the statistical foundation and thus further replication of recent findings of Hasenbring [13], who postulated a significant importance of specific, within the psychological pain research long neglected pain coping strategies as risk factors concerning pain chronification: appeals to "stick it out" on the cognitive level and endurance strategies on the behavioural level. METHODS: In contrast to Hasenbring's heterogeneous chronic pain patients sample (first plus repeated surgical or conservative treatment) the present 82 low back pain patients with acute radicular pain and simultaneous lumbar disc prolapse all underwent first time lumbar nucleotomy. Prior to treatment we conducted an extensive psychological and neurological examination. The psychological tests included a general depression scale (Allgemeine Depressionsskala; ADS) and the Kiel Pain Inventory (KPI). Based on these scales a cluster analysis was performed, which allocated patients to four distinct groups resembling the group structure ascertained by Hasenbring [12, 13]: A first group of patients characterized by a positive mood and marked endurance strategies (n=7); another cluster with depressive mood and simultaneous cognitive appeals to stick it out (n=10); a third group of emotionally depressed patients who preferably applied social and physical avoidance strategies in their coping with chronic pain (n=29), plus a last cluster without any psychological risk factors (n=26). RESULTS: As treatment outcome criteria to evaluate the quality of the convalescence process six months later we assessed the pain intensity (11-point self-rating scale), the ability to work, and whether the patients had applied for early retirement or not. Results showed no significant differences in pain intensity between the groups at the 6-month follow up. Concerning the two other outcome variables the two clusters characterized by cognitive or behavioural endurance tendencies turned out to be high risk groups: At the 6-month follow up patients of both groups seemed less likely to return to work. The patients typified by endurance strategies and positive mood had more often applied for early retirement than those patients without psychological risk factors. DISCUSSION: These results corroborate the finding that this subgroup of chronic low back pain patients might indeed carry a bad prognosis and call for further research into this area, especially with regard to rehabilitation potential and facilities of reintegration into working life.     

腰椎融合术后下腰痛与腰椎前凸角的相关性研究

[目的]探讨腰椎融合术后下腰痛与腰椎前凸重建的相关性研究.[方法]回顾性分析2011年2月至2012年2月124例因退行性病变行腰椎融合手术患者的临床资料,其中术后随访有下腰痛的患者共32例作为观察组,无下腰痛的患者共92例作为对照组.观察两组术前、术后6周、术后3个月、6个月、12个月、24个月及末次随访时,腰椎前凸Cobb角、下腰痛VAS评分及腰椎功能障碍ODI评分;采用Pearson相关性分析检验三者之间关系.[结果]两组术前腰椎前凸Cobb角、下腰痛VAS评分及腰椎功能障碍ODI评分比较差异无统计学意义(P>0.05);两组术后各时间节点的腰椎前凸Cobb角、下腰痛VAS评分及腰椎功能障碍ODI评分均较术前明显改善,差异具有统计学意义(P<0.05);对照组术后各时间节点的腰椎前凸Cobb角均明显大于观察组,差异具有统计学意义(P<0.05);随着随访时间的延长,观察组患者腰椎前凸Cobb角呈逐渐降低的趋势,下腰痛VAS评分及腰椎功能障碍ODI评分呈逐渐升高的趋势;术后1年、2年及末次随访时观察组三项指标与术后6周比较差异具有统计学意义(P<0.05).Pearson相关性分析结果显示:观察组患者下腰痛VAS评分、腰椎功能障碍ODI评分均与腰椎前凸Cobb角之间存在线性相关性,呈负相关(r=0.702、0.682,P<0.05).[结论]退行性病变腰椎融合术后患者下腰痛和腰椎功能障碍与腰椎前凸角丢失有关,应尽量矫正腰椎前凸角.     

The effects of stabilizing exercises on pain and disability of patients with lumbar segmental instability

Background data: Lumbar segmental instability (LSI) is one of the subgroups of non-specific chronic low back pain. Pain, functional disability and reduced muscle endurance are common in such patients. Objective: The aim of this study was to determine the effects of stabilization exercise on pain, functional disability and muscle endurance in patients with LSI. Methods: A randomized clinical trial was carried out on 30 patients who had LSI aged between 18-45 years. They were divided into two groups; the control group underwent routine exercise only while the experimental group performed routine exercise plus stabilization training for 8 weeks. Both had 3 months follow-up. The variables included pain intensity, functional disability and flexion and extension range of motion and flexor, extensor and lateral flexor muscles endurance which were evaluated 3 times; before, post treatment and after three months. The data were analyzed using repeated measurement ANOVA.Results: The results revealed that after treatment, the trunk muscle endurance and flexion range of motion increased significantly and the pain intensity and functional disability decreased significantly in both groups; however the rate of improvement was significantly higher in the experimental group. The process of decreasing pain intensity and functional disability in addition to increasing muscle endurance time %was were significantly faster in the experimental group during the three months follow up. Conclusion: Regarding the positive effects of stabilizing exercises with routine exercises in reduction of pain intensity, increasing functional ability and muscle endurance, it is recommended to use this method in treatment of patients with lumbar segmental instability.