不同感觉条件干扰对慢性非特异性腰痛消防员姿势控制能力的影响

Effects of Various Sensory Conditioning Disturbances on Postural Control in Firefighters with Chronic Non-specific Low Back Pain

目的:探讨患有慢性非特异性腰痛(chronic nonspecific low back pain,CNLBP)消防员和正常消防员在不同感觉条件下自身姿势控制能力的差异,剖析CNLBP消防员姿势控制的特征和问题,以期为CNLBP消防员制订训练康复计划和提升姿势控制能力提供科学依据。方法:以CNLBP组消防员(n=10)和对照组消防员(n=10)为受试者。采用视觉模拟评分量表(visual analogue scale,VAS)、Oswestry功能障碍指数问卷(Oswestry disability index,ODI)评估CNLBP组疼痛和功能障碍程度,并收集所有受试者睁眼、闭眼、睁眼+平衡垫、闭眼+平衡垫站立时压力中心的横向速度(V_(x))、纵向速度(Vy)、路径长度和摇摆速度,通过平板支撑、3 min屈腿仰卧起坐评估消防员的核心力量,对测试结果进行双因素重复测量方差分析与相关性分析。结果:感觉条件对V_(x)(F=51.557,P<0.01,η_(p)^(2)=0.741)、Vy(F=75.846,P<0.01,η_(p)^(2)=0.808)、路径长度(F=76.667,P<0.01,η_(p)^(2)=0.810)和摇摆速度(F=76.592,P<0.01,η_(p)^(2)=0.810)的主效均显著;CNLBP对V_(x)(F=13.154,P<0.01,η_(p)^(2)=0.422)、Vy(F=6.106,P<0.05,η_(p)^(2)=0.253)、路径长度(F=13.059,P<0.01,η_(p)^(2)=0.420)和摇摆速度(F=13.058,P<0.01,η_(p)^(2)=0.420)的主效应均显著;CNLBP和感觉条件对V_(x)(F=11.822,P<0.01,η_(p)^(2)=0.396)、Vy(F=4.961,P<0.05,η_(p)^(2)=0.216)、路径长度(F=9.206,P<0.01,η_(p)^(2)=0.338)和摇摆速度(F=9.203,P<0.01,η_(p)^(2)=0.338)的交互作用均显著。闭眼时,CNLBP组的VAS评分和ODI评分与摇摆速度和路径长度呈显著正相关(P<0.05);闭眼+平衡垫时,CNLBP组VAS评分与和ODI评分与V_(x)、摇摆速度和路径长度呈显著正相关(P<0.05),平板支撑成绩与V_(x)、摇摆速度和路径长度呈显著负相关(P<0.05),3 min曲腿仰卧起坐成绩与Vy、摇摆速度和路径长度呈显著负相关(P<0.05)。结论:1)躯体感觉和视觉双重干扰对CNLBP组消防员的影响最大,同时视觉单一干扰大于躯体感觉单一干扰;视觉与躯体感觉单一干扰对CNLBP组消防员侧方向稳定性的影响大于对前后方向的影响,对对照组消防员前后稳定性的影响大于对侧方向的影响;双重干扰对2组消防员前后稳定性的影响均大于对侧方向的影响。2)视觉干扰对CNLBP组消防员的侧方向稳定性影响大于对照组,双重感觉干扰对2组消防员姿势控制能力的影响较大;CNLBP组在双重感觉干扰下姿势稳定性显著下降,这可能与CNLBP消防员腰部疼痛程度、核心肌肉力量有关。

Objective:The paper investigates variations in postural control abilities across different sensory conditions among firefighters with chronic nonspecific low back pain(CNLBP)compared to those without,and scrutinizes the characteristics and challenges of postural control in firefighters afflicted with CNLBP.Its objective is to establish a scientific foundation for developing training and rehabilitation plans aimed at enhancing the postural control abilities of CNLBP-afflicated firefighters.Methods:Firefighters with CNLBP(n=10)contrasting firefighters(n=10)were enrolled as subjects.The former group underwent assessment using the visual analogue scale(VAS)and the Oswestry disability index(ODI)questionnaire to evaluate the degree of pain and functional disability.The V_(x),Vy,path length and sway velocity of the standing pressure center of all subjects were collected under conditions of eyes open,eyes closed,eyes open with a balance pad,and eyes closed with a balance pad.Subsequently,the core strength was evaluated by assessing plank hold and 3 min bent-leg sit-ups,in order for a two-way repeat‐ed measures ANOVA and correlation analysis on the test results.Results:Significant differences emerged in the main effects of sensory conditions on V_(x)(F=51.557,P<0.01,η_(p)^(2)=0.741),Vy(F=75.846,P<0.01,η_(p)^(2)=0.808),path length(F=76.667,P<0.01,η_(p)^(2)=0.810),and sway velocity(F=76.592,P<0.01,η_(p)^(2)=0.810).Moreover,there were significant differences in the main effects of CNLBP on V_(x)(F=13.154,P<0.01,η_(p)^(2)=0.422),Vy(F=6.106,P<0.05,η_(p)^(2)=0.253),path length(F=13.059,P<0.01,η_(p)^(2)=0.420),and sway velocity(F=13.058,P<0.01,η_(p)^(2)=0.420).Additionally,the results revealed interaction effects between CNLBP and sensory conditions on V_(x)(F=11.822,P<0.01,η_(p)^(2)=0.396),Vy(F=4.961,P<0.05,η_(p)^(2)=0.216),path length(F=9.206,P<0.01,η_(p)^(2)=0.338),and sway velocity(F=9.203,P<0.01,η_(p)^(2)=0.338).Under the eyes closed condition,the VAS and ODI scores of the CNLBP-afflicted subjects showed a significant positive correlation with sway velocity and path length under eyes closed condition(P<0.05).In the eyes closed with a bal‐ance pad condition,the VAS and ODI scores of these subjects were positively correlated with V_(x),sway velocity,and path length(P<0.05);plank hold duration is negatively correlated with V_(x),sway velocity,and path length(P<0.05);the number of sit-ups in 3 min is negatively corre‐lated with Vy,sway velocity,and path length(P<0.05).Conclusions:The combined effects of somatosensory and visual disturbances are the most significant for CNLBP-afflicted firefighters,with visual disturbance being greater than somatosensory disturbance.Both somatosensory and visual disturbances individually exert a greater influence on lateral stability compared to anteri‐or-posterior stability in CNLBP-afflicted firefighters.Regarding the ten contrasting firefighters,their anterior-posterior stability is more affected than their lateral stability.Meanwhile,the combined effects of somatosensory and visual disturbances have a greater impact on anterior posterior stability than on lateral stability in both groups.The results also indicate that visual disturbance has a more pronounced impact on the lateral stability of firefighters with CNLBP than those without.Moreover,the combined effects of somatosensory and visual disturbances significantly decrease postural stability in both groups,particularly in the CNLBP-afflicted group,which may be associated with the severity of low back pain and core muscle strength in this group.