目的 探讨悬吊运动疗法治疗慢性非特异性腰痛(CNLBP)的临床疗效。方法 计算机检索2007年6月至2017年6月CNKI、维普数据库(VIP)、万方数据库、PubMed、Web of Science、The Cochrane Library及Embase,搜集悬吊运动疗法治疗CNLBP的随机对照试验(RCT)。对纳入文献进行筛选,资料提取,质量评价和风险评估后,采用RevMan 5.3软件进行Meta分析。结果 共纳入15个RCT,789例患者。悬吊运动疗法在改善视觉模拟量表(VAS)评分 [MD=-1.15, 95%CI (-1.41, -0.90), Z=8.82, P<0.00001]和Oswestry腰痛功能障碍指数评定量表(ODI)评分[MD=-1.29, 95%CI(-1.80, -0.78), Z=4.94, P<0.00001]方面优于物理治疗;悬吊运动疗法在改善VAS评分[MD=-0.94, 95%CI(-1.52, -0.37), Z=3.21, P=0.001]和ODI评分[MD=-5.96, 95%CI (-9.41, -2.51), Z=3.38, P=0.0007]优于其他运动疗法,但悬吊运动疗法在改善疼痛数字评分量表(NPRS)评分方面与其他运动疗法无显著性差异[MD=0.35, 95%CI (-0.23, 0.93), Z=1.19, P=0.23];悬吊运动疗法在改善VAS评分方面与中医疗法无显著性差异[MD=-5.29, 95%CI (-20.27, 9.70), Z=0.69, P=0.49]。结论 悬吊运动疗法在一定程度上可以改善患者疼痛和功能受限。因纳入文献数量有限及质量不高,上述确切结论仍需开展大样本高质量的RCT加以验证。
Objective To systematically review the clinical efficacy of sling exercise therapy (SET) on patients with chronic non-specific low back pain (CNLBP). Methods Randomized controlled trials (RCT) about SET for CNLBP were electronically searched in CNKI, VIP, Wanfang Data, PubMed, Web of Science, The Cochrane Library and Embase from June, 2007 to June, 2017. After literatures screening, data extraction, quality evaluation and risk assessment, the results of meta-analysis were conducted by RevMan 5.3 software. Results Finally, 15 RCTs involving 789 patients were included. SET was better in improving Visual Analogue Scale (VAS) score (MD=-1.15, 95%CI [-1.41, -0.90], Z=8.82, P<0.00001) and Oswestry Low Back Pain Disability Index (ODI) score (MD=-1.29, 95%CI [-1.80, -0.78], Z=4.94, P<0.00001) than physical therapy, and was better than other exercise therapies in improving the VAS score (MD=-0.94, 95%CI [-1.52, -0.37], Z=3.21, P=0.001) and ODI score (MD=-5.96, 95%CI [-9.41, -2.51], Z=3.38, P=0.0007). However, no significant difference was found in improving the NPRS score between SET and other exercise therapies (MD=0.35, 95%CI [-0.23, 0.93], Z=1.19, P=0.23), nor in improving VAS score between SET and traditional Chinese medical therapies (MD=-5.29, 95%CI [-20.27, 9.70], Z=0.69, P=0.49). Conclusion SET may play a role in relieving pain and functional limitations in patients with CNLBP. Due to the limited quantity and quality of the included studies, larger scale and high quality RCTs are needed to verify the aforementioned conclusion.
[1] Deyo RA, Weinstein JN. Low back pain [J]. N Engl J Med, 2001, 344(5): 363-370.
[2] Balague F, Mannion AF, Pellise F, et al. Non-specific low back pain [J]. Lancet, 2012, 379(9814): 482-491.
[3] Brox JI, Storheim K, Grotle M, et al. Systematic review of back schools, brief education, and fear-avoidance training for chronic lowback pain [J]. Spine J, 2008, 8(6): 948-958.
[4] Knezevic O, Mirkov D. Trunk muscle activation patterns in subjects with low back pain [J]. Vojnosanit Pregl, 2013, 70(3): 315-318.
[5] Sheeran L, Sparkes V, Caterson B, et al. Spine position sense and trunk muscle activity during sitting and standing in nonspecific chronic low back pain: classification analysis [J]. Spine (Phila Pa1976), 2012, 37(8): E486-E495.
[6] 万勇,刘洁,陈启明,等. 悬吊运动治疗的临床应用进展[J]. 中国康复, 2015, 30(4): 304-306.
[7] Higgins JP, Green S. Cochrane Handbook for Systematic Reviews of Interventions (Version 5.1.0) [DB/OL]. [2017-07-07]. http//www.cochrane-handbook.org.
[8] 高宝龙,荣湘江,梁丹丹,等. 悬吊运动技术对运动引起的腰痛的疗效分析[J]. 中国康复医学杂志, 2008, 23(12): 1095-1097.
[9] 卢玮. 悬吊运动训练对慢性腰痛患者疼痛及静态平衡能力的影响[D]. 北京:北京体育大学, 2009.
[10] 秦江,胡鸢,唐金树,等. 磁振热治疗仪配合悬吊运动疗法治疗慢性非特异性腰痛临床疗效观察[J]. 中国骨肿瘤骨病, 2010, 9(5): 437-440.
[11] 郭险峰,张大成,陶莉. 216例慢性非特异性腰痛患者的康复疗效观察[J]. 中国康复理论与实践, 2010, 16(6): 556-559.
[12] Unsgaard-Tondel M, Fladmark AM, Salvesen O, et al. Motor control exercises, sling exercises, and general exercises for patients with chronic low back pain: a randomized controlled trial with 1-year follow-up [J]. Phys Ther, 2010, 90(10): 1426-1440.
[13] 胡鸢,秦江,唐金树. 腰椎稳定性训练治疗慢性非特异性腰痛的研究[J]. 中国疼痛医学杂志, 2011, 17(3): 146-149.
[14] 王聪,郭险峰. 悬吊训练治疗慢性非特异性腰痛的疗效观察[J]. 中国康复医学杂志, 2012, 27(8): 760-762.
[15] Vasseljen O, Unsgaard-Tondel M, Westad C, et al. Effect of core stability exercises on feed-forward activation of deep abdominal muscles in chronic low back pain: a randomized controlled trial [J]. Spine (Phila Pa 1976), 2012, 37(13): 1101-1108.
[16] 刘攀. 针刺结合悬吊运动训练治疗慢性非特异性腰痛的临床疗效观察[D]. 济南:山东中医药大学, 2012.
[17] Kim JH, Kim YE, Bae SH, et al. The effect of the neurac sling exercise on postural balance adjustment and muscular response patterns in chronic low back pain patients [J]. J Phys Ther Sci, 2013, 25(8): 1015-1019.
[18] 林科宇,许轶,王楚怀,等. 悬吊式核心稳定训练对慢性非特异性下背痛的疗效[J]. 中国康复医学杂志, 2014, 29(10): 923-928.
[19] Oh BH, Kim HH, Kim CY, et al. Comparison of physical function according to the lumbar movement method of stabilizing a patient with chronic low back pain [J]. J Phys Ther Sci, 2015, 27(12): 3655-3658.
[20] 曾远生. 慢跑与悬吊运动对慢性腰痛患者康复治疗效果的比较[J]. 西南师范大学学报(自然科学版), 2016, 41(2): 167-172.
[21] Roh HS, Cho WJ, Ryu WJ, et al. The change of pain and lumbosacral sagittal alignment after sling exercise therapy for patients with chronic low back pain [J]. J Phys Ther Sci, 2016, 28(10): 2789-2792.
[22] Lee SB, Cho WJ. The effect of sling exercise on sagittal lumbosacral angle and intervertebral disc area of chronic low back pain patients [J]. J Exerc Rehabil, 2016, 12(5): 471-475.
[23] 于瑞,王楚怀,潘翠环,等. 悬吊运动疗法治疗慢性非特异性下腰痛后站立位腰屈伸运动表面肌电信号的变化[J]. 中国康复理论与实践, 2015, 21(8): 943-946.
[24] Ghamkhar L, Kahlaee AH. Trunk muscles activation pattern during walking in subjects with and without chronic low back pain: a systematic review [J]. PM R, 2015, 7(5): 519-526.
[25] 冯能,李跃红,缪芸,等. 慢性腰痛患者站立位躯干屈伸运动时腰背肌的功能变化研究[J]. 中国康复医学杂志, 2012, 27(7): 600-604.
[26] 卫小梅,郭铁成. 悬吊运动疗法&#x#x02014;&#x#x02014;一种主动训练及治疗肌肉骨骼疾患的方法[J]. 中华物理医学与康复杂志, 2006, 28(4): 281-283.
