Intervention Effect of a Novel Core Stability Rehabilitation Training Program on Chronic Non-specific Low Back Pain

doi:10.12114/j.issn.1007-9572.2022.0608

Abstract

Abstract:

Background

The traditional core stability rehabilitation training has been proven to be effective in improving the rehabilitation in patients with chronic non-specific low back pain (CNSLBP) , but with poor long-term compliance. We independently developed a new core stabilization rehabilitation training program (NO.2021107165452) for CNSLBP patients, but the intervention effects of which are still unclear.

Objective

To explore the intervention effect of a novel core stabilization rehabilitation training program in CNSLBP patients.

Methods

Twenty-one male CNSLBP patients were recruited from Guangxi Normal University and Guilin College from December 2021 to January 2022, and randomly divided into an experimental group (n=11) and a control group (n=10) , receiving a six-week intervention using the core stabilization rehabilitation training program independently developed by our research group, and traditional core stability rehabilitation training, respectively. The visual analogue scale (VAS) was used to evaluate the pain level. The Oswestry Disability Index (ODI) was used to evaluate the status of lumbar dysfunction. The Hoggan MicroFET 2 was used to measure muscle force and muscle force signals of the flexor muscles, extensor muscles, and rotatores muscles of the low back. The Y-balance test (YBT) was used to assess the dynamic balance ability.

Results

The values of VAS and ODI were significantly reduced in both groups after the intervention (P<0.05) , and they were more lower in the experimental group (P<0.05) . The muscle strength of upper abdominal flexors, spinal extensors, spinal left rotators, and spinal right rotators increased significantly in both groups after the intervention (P<0.05) . The left and right YBT scores were increased notably in both groups after the intervention (P<0.05) , and they were more higher in the experimental group (P<0.05) .

Conclusion

Both kinds of intervention programs could improve the lumbar pain, lumbar dysfunction, the muscle strength of upper abdominal flexors, spinal extensors, and spinal rotators, and dynamic balance in CNSLBP patients, but our core stability rehabilitation training program was more effective in reducing lumbar pain, improving lumbar dysfunction, and enhancing dynamic balance, so this novel program is worth promoting.

Key words: Core stability, Rehabilitation, Rehabilitation training system, Chronic non-specific, Low back pain, Intervention effect

摘要：

背景

传统核心稳定康复训练在慢性非特异性腰痛（CNSLBP）患者康复训练中的效果确切，但存在患者长期依从性差的问题。本课题组自主研发了核心稳定康复训练系统（专利号：2021107165452），但其在CNSLBP患者中的干预效果尚不明晰。

目的

探究核心稳定康复训练系统对CNSLBP患者的干预效果。

方法

选取2021年12月至2022年1月在广西师范大学、桂林学院内招募的21例男性CNSLBP患者为研究对象，将其随机分为试验组（n=11）与对照组（n=10）。试验组采用课题组自主研发的核心稳定康复训练系统进行训练，对照组采用传统核心稳定训练，共干预6周。干预前后分别采用视觉模拟评分法（VAS）评估患者疼痛程度，采用功能障碍指数（ODI）评价腰部功能障碍，采用Hoggan MicroFet 2肌肉与骨骼检测仪测定患者腰部前屈肌群、后伸肌群、回旋肌群肌力及肌力信号，采用Y平衡测试（YBT）评定动态平衡能力。

结果

试验组、对照组干预后VAS值、ODI值低于干预前（P<0.05），上腹屈、脊柱伸、脊柱左旋、脊柱右旋肌力高于干预前（P<0.05）；干预后试验组VAS值、ODI值低于对照组（P<0.05）；试验组与对照组干预后左侧、右侧YBT得分高于干预前（P<0.05），干预后试验组左侧、右侧YBT得分高于对照组（P<0.05）。

结论

传统核心稳定训练与采用核心稳定康复训练系统进行训练均能减轻CNSLBP患者腰部疼痛，改善腰部功能障碍，增加上腹屈、脊柱伸和脊柱回旋肌力，提高动态平衡能力，而采用核心稳定康复训练系统进行训练在减轻腰部疼痛、改善腰部功能障碍、提高动态平衡能力方面效果更好。

关键词: 腰痛, 医学康复, 核心稳定, 康复训练系统, 慢性非特异性, 干预效果

LIU Xiaolong,HE Mengxiao,YIN Yikun, et al. Intervention Effect of a Novel Core Stability Rehabilitation Training Program on Chronic Non-specific Low Back Pain[J]. Chinese General Practice, 2023, 26(09): 1064-1074. DOI: 10.12114/j.issn.1007-9572.2022.0608.
刘晓龙,何梦晓,尹贻锟等. 核心稳定康复训练系统对慢性非特异性腰痛干预效果研究[J]. 中国全科医学, 2023, 26(09): 1064-1074. DOI: 10.12114/j.issn.1007-9572.2022.0608.

Figures/Tables 16

Figure 1 Intervention using the core stabilization rehabilitation training program for the experimental group

Figure 2 Intervention using the usual Bobath ball core stabilization training program for the control group

Table 1 Comparison of general information of subjects in the two groups

组别	例数	年龄（岁）	BMI（kg/m²）	病程（周）
对照组	10	21.3±1.2	22.8±2.9	52.6±9.1
试验组	11	21.2±1.2	22.7±1.6	57.3±13.4
t值		0.232	0.047	-0.922
P值		0.819	0.963	0.368

Table 2 Comparison of VAS and ODI values of subjects before and after intervention in two groups

组别	例数	VAS值（分）				ODI值（%）
组别	例数	干预前	干预后	t_配对值	P值	干预前	干预后	t_配对值	P值
对照组	10	5.40±2.22	4.260±1.93	6.000	<0.001	28.40±12.39	16.70±9.93	9.121	<0.001
试验组	11	5.73±1.62	2.09±1.22	8.414	<0.001	30.36±14.53	8.09±8.09	8.575	<0.001
t值		-0.389	-3.021			-0.331	-2.186
P值		0.702	0.007			0.744	0.041

Table 3 Comparison of in lumbar muscle strength before and after the intervention in two groups

组别	例数	上腹屈肌力				下腹屈肌力
组别	例数	干预前	干预后	t_配对值	P值	干预前	干预后	t_配对值	P值
对照组	10	21.64±2.24	27.69±5.24	-3.155	0.012	19.19±3.35	18.69±5.24	0.219	0.832
试验组	11	20.56±3.36	26.87±5.17	-4.996	0.001	18.42±2.57	19.60±6.51	-0.581	0.574
t值		0.853	-0.359			0.596	0.320
P值		0.404	0.723			0.558	0.752
组别	脊柱伸肌力				脊柱左旋肌力				脊柱右旋肌力
组别	干预前	干预后	t_配对值	P值	干预前	干预后	t_配对值	P值	干预前	干预后	t_配对值	P值
对照组	20.93±1.12	32.81±8.44	-4.501	0.001	14.11±1.28	16.62±1.11	-6.617	<0.001	14.26±1.52	16.41±1.87	-2.335	0.044
试验组	21.23±3.17	29.86±2.69	-6.952	<0.001	14.10±1.53	17.50±2.21	-3.969	0.003	14.22±1.55	16.81±2.15	-3.833	0.003
t值	-0.291	-1.101			0.016	1.135			0.062	0.452
P值	0.775	0.285			0.987	0.270			0.951	0.656

Figure 3 Signal changes of upper abdominal flexor strength before and after the intervention in one patient with CNSLBP in the experimental group

Figure 4 Signal changes of upper abdominal flexor strength before and after intervention in one control CNSLBP patient

Figure 5 Signal changes of lower abdominal flexor strength before and after intervention in one patient with CNSLBP in the experimental group

Figure 6 Signal changes of lower abdominal flexor strength before and after intervention in one control CNSLBP patient

Figure 7 Signal changes of spinal extensor before and after intervention in one patient with CNSLBP in the experimental group

Figure 8 Signal changes of spinal extensor before and after intervention in one control CNSLBP patient

Figure 9 Signal changes of spinal levator muscle strength before and after intervention in one patient with CNSLBP in the experimental group

Figure 10 Signal changes of spinal levator muscle strength before and after intervention in one control CNSLBP patient

Figure 11 Signal changes of right spinal muscle strength before and after intervention in one patient with CNSLBP in the experimental group

Figure 12 Signal changes of right spinal muscle strength before and after intervention in one control CNSLBP patient

Table 4 Pre-and post-intervention dynamic balance abilities in two groups

组别	例数	左侧				右侧
组别	例数	干预前	干预后	t_配对值	P值	干预前	干预后	t_配对值	P值
对照组	10	80.37±4.83	86.23±5.40	-19.672	<0.001	79.15±5.04	85.12±5.82	-16.903	<0.001
试验组	11	81.91±5.26	95.61±1.37	-10.633	<0.001	79.21±6.66	95.12±2.53	-9.942	<0.001
t值		-0.696	5.574			-0.023	5.192
P值		0.495	<0.001			0.982	<0.001

References 31

[1]	KNEZEVIC N N, CANDIDO K D, VLAEYEN J W S，et al. Low back pain[J]. Lancet，2021，398(10294):78-92. DOI：10.1016/S0140-6736(21)00733-9.
[2]	王雪强，陈佩杰，矫玮，等. 运动疗法治疗腰痛的专家共识[J]. 体育科学，2019，39(3):19-29. DOI：10.16469/j.css.201903003.
[3]	许思毛，张敬之，刘晓龙. 核心稳定训练对慢性非特异性腰痛影响的Meta分析[J]. 河南师范大学学报（自然科学版），2022，50(2):150-156. DOI：10.16366/j.cnki.1000-2367.2022.02.019.
[4]	王雪强. 核心稳定训练对非特异性腰痛患者神经肌肉功能的作用[D]. 上海：上海体育学院，2016.
[5]	刘芳，敖丽娟. 核心肌稳定性训练对腰痛康复治疗的意义[J]. 中国康复医学杂志，2017，32(2):231-234.
[6]	刘合建. 一种核心稳定训练康复系统：CN209348030U[P]. 2019-09-06.
[7]	刘丽辉，朱立斌，刘书勇，等. 带测速功能的转髋核心力量训练装置研制[J]. 实验技术与管理，2018，35(3):101-104. DOI：10.16791/j.cnki.sjg.2018.03.025.
[8]	张婵娟，李悦龙，张洲，等. 运动控制训练改善慢性非特异性腰痛的fMRI研究[J]. 中国康复医学杂志，2022，37(3):303-310.
[9]	中国康复医学会脊柱脊髓专业委员会专家组. 中国急/慢性非特异性腰背痛诊疗专家共识[J]. 中国脊柱脊髓杂志，2016，26(12):1134-1138. DOI：10.3969/j.issn.1004-406X.2016.12.16.
[10]	万丽，赵晴，陈军，等. 疼痛评估量表应用的中国专家共识（2020版）[J]. 中华疼痛学杂志，2020(3):177-187.
[11]	严广斌.视觉模拟评分法[J].中华关节外科杂志（电子版），2014，8(2):34.
[12]	程继伟，王振林，刘伟，等. Oswestry功能障碍指数的改良及信度和效度检验[J]. 中国脊柱脊髓杂志，2017，27(3):235-241.
[13]	苏朕鑫，杨贤罡，何文革. 运动人群动态平衡能力测试：YBT的产生及发展[J]. 中国运动医学杂志，2021，40(9):737-744. DOI：10.16038/j.1000-6710.2021.09.014.
[14]	唐桥，张海忠. FMS和YBT预测中国优秀军事五项运动员损伤发生率的研究[J]. 成都体育学院学报，2019，45(3):94-99. DOI：10.15942/j.jcsu.2019.03.015.
[15]	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.
[16]	PAUNGMALI A, SITILERTPISAN P, TANEYHILL K，et al. Intrarater reliability of pain intensity，tissue blood flow，thermal pain threshold，pressure pain threshold and lumbo-pelvic stability tests in subjects with low back pain[J]. Asian J Sports Med，2012，3(1):8-14. DOI：10.5812/asjsm.34718.
[17]	宋晓动，周红海，朱顺昌，等. 脊柱整体性理论与临床相关研究概述[J]. 中华中医药杂志，2019，34(3):1134-1138.
[18]	陈景洲，王惠娟，石真润，等. 慢性非特异性腰痛患者躯干肌的等速力学特征和肌电信号研究[J]. 中国康复医学杂志，2021，36(1):51-56.
[19]	崔东，李泽华，宋学军. 慢性疼痛的脊髓机制[J]. 中国疼痛医学杂志，2017，23(9):641-647.
[20]	翟永夷，崔燕红，徐浩坤. 核心稳定运动对慢性非特异性腰痛患者β-内啡肽和皮质醇水平的影响[J]. 颈腰痛杂志，2021，42(1):100-102.
[21]	NORRIS C, MATTHEWS M. The role of an integrated back stability program in patients with chronic low back pain[J]. Complement Ther Clin Pract，2008，14(4):255-263. DOI：10.1016/j.ctcp.2008.06.001.
[22]	刘艳丽，赵祥虎，夏扬，等. 悬吊训练对产后腰痛的效果[J]. 中国康复理论与实践，2018，24(12):1456-1460.
[23]	KLIZIENE I, SIPAVICIENE S, KLIZAS S，et al. Effects of core stability exercises on multifidus muscles in healthy women and women with chronic low-back pain[J]. J Back Musculoskelet Rehabil，2015，28(4):841-847. DOI：10.3233/BMR-150596.
[24]	王万宏，李琳琳，徐朦婷，等. 悬吊训练对慢性下腰背痛患者疼痛、残障、肌力和焦虑的影响[J]. 康复学报，2019，29(1):54-57.
[25]	陈炳霖，郭佳宝，李欣，等. 青年慢性非特异性腰痛患者腰部本体感觉及其与肌力的相关性[J]. 中国康复医学杂志，2017，32(2):187-191. DOI：10.3969/j.issn.1001-1242.2017.02.012.
[26]	HOOPER T L, JAMES C R, BRISMÉE J M，et al. Dynamic balance as measured by the Y-Balance Test is reduced in individuals with low back pain：a cross-sectional comparative study[J]. Phys Ther Sport，2016，22:29-34. DOI：10.1016/j.ptsp.2016.04.006.
[27]	章礼勤，高崇，许世波，等. 腰痛患者和健康人动态平衡功能的研究[J]. 中国康复医学杂志，2015，30(7):720-722.
[28]	陈昕，王盛，朱奕，等. 人体平衡功能与上肢活动关系研究进展[J]. 中国康复医学杂志，2018，33(1):114-117.
[29]	付光亮，孟庆华，鲍春雨. 功能性踝关节不稳者本体感觉力学差异及平衡训练干预效果[J]. 应用力学学报，2021，38(6):2426-2431.
[30]	葛乐，余秋华，郑福明，等. 腰痛对老年女性动静态平衡功能的影响[J]. 中国康复医学杂志，2022，37(6):760-764.
[31]	陈璟，王纯. 核心稳定性训练可改善背肌肌耐力及等速肌力峰值[J]. 中国组织工程研究，2018，22(36):5797-5802.