两种腰痛家庭训练方案的临床疗效

Clinical effectiveness of two home exercise programs in patients with low back pain

目的:比较两种家庭训练方案对腰痛患者的临床疗效。方法:门诊招募60例腰痛患者随机分为常规组(n=30)和核心组(n=30)。两组患者均接受腰痛防护知识宣教及评估。常规组接受常规家庭训练方案指导;核心组接受麦吉尔(McGill)"三大训练"(Big3)家庭方案指导。之后两组患者独立完成6周家庭训练。训练前后采用汉化Oswestry功能障碍指数(Oswestry disability index,ODI)和疼痛目测类比定级法(visual analogus scale,VAS)作为主要评估指标,腰部活动度和躯干肌群的肌耐力作为次要评估指标对患者治疗效果进行评估。根据患者训练的完成度、自觉帮助度及满意度评估患者治疗依从性及家庭训练方案的可行性。结果:常规组和核心组分别有24例和25例完成了家庭训练。经过6周家庭训练后,两组患者的ODI及VAS均有明显降低(P<0.01)、腰部ROM均有明显增加(P<0.01);常规组部分躯干肌群和核心组全部躯干肌群的肌耐力明显增强(P<0.01);核心组的ODI、VAS和右侧侧方肌的肌耐力与常规组比较差异具有显著性意义(P<0.05);核心组患者的自觉帮助度及满意度得分与常规组比较差异具有显著性意义(P<0.01)。结论:两种腰痛家庭训练方案均可行并有效。与常规家庭训练方案相比,Big3家庭训练方案对于改善腰痛患者疼痛和功能障碍方面具有更好的临床疗效,并且患者的接受度更高。

Objective:To compare the clinical effectiveness of two home exercise programs in patients with low back pain.Method:Sixty patients with low back pain were recruited in the rehabilitation department and randomly divided into the regular group(n=30) and the core group(n=30). Both groups received evaluation and patient education on the knowledge of low back pain protection. The regular group received the guidance of the regular home exercise program,and the core group received the guidance of Mc Gill’s "Big3" home exercise program.After that, both groups of patients completed 6 weeks of home exercises independently. Before and after home exercises,evaluate the treatment effect:the modified Oswestry Disability Index(ODI) and pain Visual Analogue Scale(VAS) were measured as the main evaluation indicators,lumbar range of motion(ROM)and trunk muscle endurance were measured as secondary evaluation indicators. The patient’s adherence and the feasibility of the home exercise programs were evaluated according to the patient’s exercises completion,perceived helpfulness scale and treatment satisfaction scale.Result: There were 24 patients in the regular group and 25 patients in the core stabilization group who completed home exercises. After 6 weeks of home exercises,in both groups,the scale of ODI and VAS were significantly reduced(P<0.01), and the low back ROM was significantly increased(P<0.01). The endurance of some trunk muscles in the regular group and all in the core stabilization groups were significantly enhanced(P<0.01). In the core group,the ODI,VAS and the endurance of right lateral trunk muscles was significantly better than that of the regular group(P<0.05). There were statistically significant differences in the scores of perceived helpfulness and treatment satisfaction between the core group and the regular group(P<0.01).Conclusion:The "Big3" home exercise program is significantly better than the regular home exercise program in improving the pain and dysfunction of patients with low back pain. Patients are more likely to accept the "Big3" home exercise program.