Changes in spinal motor behaviour are associated with reduction in disability in chronic low back pain: A longitudinal cohort study with 1-year follow-up

IF 3.5 2区医学 Q1 ANESTHESIOLOGY European Journal of Pain Pub Date : 2024-02-01 DOI:10.1002/ejp.2245

Guillaume Christe, Charles Benaim, Brigitte M. Jolles, Julien Favre

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Abstract

Background

The need to improve spinal motor behaviour in chronic low back pain (CLBP) rehabilitation remains unclear. The objective of this study was to test if changes in spinal motor behaviour were associated with changes in disability after an interdisciplinary rehabilitation program (IRP) in patients with CLBP.

Methods

Seventy-one patients with CLBP participating in an IRP were included. Spinal motor behaviour was assessed with biomechanical (lumbar angular amplitude and velocity, erector spinae muscle activity and duration of the task), cognitive-emotional (task-specific fear [PRF]) and pain-related (movement-evoked pain [MEP]) measures during a lifting task before and after the IRP. Disability was measured before and after the IRP, and at 3-month and 1-year follow-ups.

Results

After adjusting for confounders, changes in disability were significantly associated with MEP changes (β adj. = 0.49, p < 0.001) and PRF changes (β adj. = 0.36, p = 0.008), but not with changes in any of the biomechanical measures. MEP at the end of IRP was also associated with disability at 3 months (β adj. = 0.37, p = 0.001) and 1 year (β adj. = 0.42, p = 0.01). Biomechanical measures at the end of the IRP were not associated with disability, except for the duration of the task that was significantly associated with reduction of disability at 3 months (β non-adj = 0.5, p < 0.001).

Conclusions

Pain-related and cognitive-emotional measures of spinal motor behaviour were associated with reduction in disability following an IRP. Future research is needed to further investigate causal relationships between spinal motor behaviour and disability.

Significance statement

This study supports a multidimensional understanding and analysis of spinal motor behaviour, integrating the cognitive-emotional, pain-related and biomechanical domains. It also supports the consideration of spinal motor behaviour as a potentially important treatment target in chronic low back pain management. Moreover, it suggests that reducing movement-evoked pain and task-specific fear may have more influence on disability than changing lumbar amplitude, lumbar angular velocity or erector muscle activity, which may have important implications for rehabilitation.

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脊柱运动行为的变化与慢性腰背痛患者残疾程度的减轻有关：一项为期一年的纵向队列研究。

背景：在慢性腰背痛（CLBP）康复中改善脊柱运动行为的必要性仍不明确。本研究的目的是测试慢性腰背痛患者在接受跨学科康复计划（IRP）后，脊柱运动行为的变化是否与残疾程度的变化有关：研究纳入了 71 名参加 IRP 的 CLBP 患者。在 IRP 之前和之后的一次提举任务中，通过生物力学（腰椎角振幅和速度、竖脊肌活动和任务持续时间）、认知情感（任务特异性恐惧 [PRF]）和疼痛相关（运动诱发痛 [MEP]）测量来评估脊柱运动行为。在 IRP 前后以及 3 个月和 1 年的随访中对残疾情况进行了测量：结果：在对混杂因素进行调整后，残疾程度的变化与 MEP 的变化有显著相关性（β adj：脊柱运动行为的疼痛相关测量和认知情感测量与 IRP 后残疾程度的减轻有关。未来的研究需要进一步探究脊柱运动行为与残疾之间的因果关系：本研究支持对脊柱运动行为进行多维理解和分析，将认知情感、疼痛相关和生物力学领域整合在一起。它还支持将脊柱运动行为视为慢性腰背痛治疗的潜在重要治疗目标。此外，该研究还表明，减少运动诱发的疼痛和任务特异性恐惧对残疾的影响可能大于改变腰椎振幅、腰椎角速度或竖立肌活动，这可能对康复有重要意义。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Journal of Pain 医学-临床神经学

CiteScore

7.50

自引率

5.60%

发文量

163

审稿时长

4-8 weeks

期刊介绍： European Journal of Pain (EJP) publishes clinical and basic science research papers relevant to all aspects of pain and its management, including specialties such as anaesthesia, dentistry, neurology and neurosurgery, orthopaedics, palliative care, pharmacology, physiology, psychiatry, psychology and rehabilitation; socio-economic aspects of pain are also covered. Regular sections in the journal are as follows: • Editorials and Commentaries • Position Papers and Guidelines • Reviews • Original Articles • Letters • Bookshelf The journal particularly welcomes clinical trials, which are published on an occasional basis. Research articles are published under the following subject headings: • Neurobiology • Neurology • Experimental Pharmacology • Clinical Pharmacology • Psychology • Behavioural Therapy • Epidemiology • Cancer Pain • Acute Pain • Clinical Trials.