Application of Pilates exercise combined with pain nursing in patients with nonspecific low back pain

doi:10.3760/cma.j.issn.1007-1245.2024.14.030

Abstract

Abstract:

Objective　To investigate the efficacy of Pilates exercise combined with pain care in patients with nonspecific lower back pain (NLBP). Methods　A total of 100 patients with NLBP admitted to the First Affiliated Hospital of Henan University from February 2021 to March 2023 were selected as the research subjects for a randomized controlled trial and were divided into a control group (50 cases) and an observation group (50 cases) using the random envelope method. In the control group, there were 18 males and 32 females, the age was 28-69 (51.35±8.29) years old, the course of disease was 4-36 (20.26±3.08) months, and the Visual Analog Scale (VAS) score was 4-6 points in 35 cases and ≥7 points in 15 cases. In the observation group, there were 20 males and 30 females, the age was 30-72 (52.06±8.84) years old, the course of disease was 5-36 (19.83±3.14) months, and the VAS score was 4-6 points in 32 cases and ≥7 points in 18 cases. The control group received routine nursing + pain nursing, and the observation group received Pilates exercise on the basis of the control group for 4 weeks. The pain degree (VAS score), Oswestry Disability Index (ODI) score, motivation to participate in exercise [Scale of Situational Motivation (SIMS) score], lumbar electromyographic (EMG) signals [median frequency value (MF) and root mean square value (RMS) of erector spinae and multifidus] were compared between the two groups before and after intervention. Independent sample t test, paired t test, ANOVA, and χ² test were used. Results　After 2 and 4 weeks of intervention, the VAS scores of the observation group [(5.56±0.87) points and (3.25±0.38) points] were lower than those of the control group [(6.13±1.02) points and (4.38±0.59) points] (both P<0.05); the ODI scores of the observation group [(20.38±3.70) points and (17.76±3.09) points] were lower than those of the control group [(24.65±3.64) points and (20.46±3.35) points] (both P<0.05). After 4 weeks of intervention, the scores of identification principle [(16.76±1.75) points], external motivation [(13.26±2.02) points], internal motivation [(15.62±2.12) points], and lack of motivation of the SIMS [(9.35±1.78) points] in the observation group were higher than those in the control group [(15.03±2.03) points, (11.82±2.19) points, (13.08±1.96) points, and (8.02±1.83) points] (all P<0.05). The MF of erector spinae and multifidus [(91.05±8.94) Hz and (89.16±11.03) Hz] in the observation group were lower than those in the control group [(95.16±10.36) Hz and (94.08±12.64) Hz], but the RMS of erector spinae and multifidus [(13.82±2.36) μV and (16.52±3.04) μV] were higher than those in the control group [(12.14±2.29) μV and (13.74±2.68) μV] (all P<0.05). Conclusion　Pain care combined with Pilates exercise can change the motivation of NLBP patients to participate in exercise, reduce their pain, and promote the recovery of muscle function and lumbar spine function.

Key words:

Nonspecific lower back pain, Pilates exercise, Pain care, Pain level, Motivation for sports participation, Lumbar electromyographic signal

摘要：

目的　探讨普拉提运动联合疼痛护理在非特异性下腰痛（NLBP）患者中的应用效果。方法　选取2021年2月至2023年3月河南大学第一附属医院收治的100例NLBP患者开展随机对照试验，采用随机信封法将患者分为对照组（50例）与观察组（50例）。对照组男18例，女32例；年龄28～69（51.35±8.29）岁；病程4～36（20.26±3.08）个月；视觉模拟评分法（VAS）评分：4～6分35例，≥7分15例；采用常规护理+疼痛护理。观察组男20例，女30例；年龄30～72（52.06±8.84）岁；病程5～36（19.83±3.14）个月；VAS评分：4～6分32例，≥7分18例；在对照组基础上采用普拉提运动。两组均干预4周。比较两组干预前后疼痛程度（VAS评分）、Oswestry功能障碍指数（ODI）评分、运动参与动机［情境动机量表（SIMS）评分］、腰部肌电信号［竖脊肌、多裂肌的中位频率值（MF）和均方根值（RMS）］。采用独立样本t检验、配对样本t检验、方差分析和χ²检验。结果　干预2周、4周后，观察组VAS评分［（5.56±0.87）分、（3.25±0.38）分］均低于对照组［（6.13±1.02）分、（4.38±0.59）分］（均P<0.05）；观察组ODI评分［（20.38±3.70）分、（17.76±3.09）分］均低于对照组［（24.65±3.64）分、（20.46±3.35）分］（均P<0.05）。干预4周后，观察组SIMS中的鉴别原则［（16.76±1.75）分］、外部动力［（13.26±2.02）分］、内部动力［（15.62±2.12）分］、缺乏动力［（9.35±1.78）分］评分均高于对照组［（15.03±2.03）分、（11.82±2.19）分、（13.08±1.96）分、（8.02±1.83）分］（均P<0.05）；观察组多裂肌和竖脊肌MF［（91.05±8.94）Hz、（89.16±11.03）Hz］均低于对照组［（95.16±10.36）Hz、（94.08±12.64）Hz］，RMS［（13.82±2.36）μV、（16.52±3.04）μV］均高于对照组［（12.14±2.29）μV、（13.74±2.68）μV］（均P<0.05）。结论　疼痛护理联合普拉提运动能改善NLBP患者运动参与动机，减轻患者疼痛，促进肌肉功能和腰椎功能恢复。

关键词:

非特异性下腰痛, 普拉提运动, 疼痛护理, 疼痛程度, 运动参与动机, 腰部肌电信号

Li Haihua, Zhang Xian.

Application of Pilates exercise combined with pain nursing in patients with nonspecific low back pain [J]. International Medicine and Health Guidance News, 2024, 30(14): 2432-2436.

李海华张显.

普拉提运动联合疼痛护理在非特异性下腰痛患者中的应用研究 [J]. 国际医药卫生导报, 2024, 30(14): 2432-2436.

References

[1] Kim B, Yim J. Core stability and hip exercises improve physical function and activity in patients with non-specific low back pain: a randomized controlled trial[J]. Tohoku J Exp Med, 2020, 251(3):193-206. DOI: 10.1620/tjem.251.193.
[2] 林文飞,刘诗若,王墉琦,等.四维牵引联合针刺整脊手法治疗慢性非特异性下腰痛临床研究[J].陕西中医,2023,44(4):508-511.DOI:10.3969/j.issn.1000-7369.2023.04.023.
[3] 黄玉梅,李立菊,黄婷,等.疼痛护理对腰椎融合术后残余神经痛患者的影响[J].齐鲁护理杂志,2023,29(8):89-91.DOI:10.3969/j.issn.1006-7256.2023.08.030.
[4] 杨森,武文杰,杜诗宇,等.慢性非特异性下腰痛患者腰背肌力量和耐力与生活质量的相关性[J].广西医学,2020,42(5):529-532.DOI:10.11675/j.issn.0253-4304.2020.05.02.
[5] 朱建周,徐雅洁,刘春艳.普拉提运动疗法在慢性腰痛的治疗频次优选方案[J].颈腰痛杂志,2021,42(1):76-78.DOI:10.3969/j.issn.1005-7234.2021.01.019.
[6] 张晶晶,芮晶晶,仇婷.核心稳定性训练联合疼痛护理在髋关节置换术后患者中的应用[J].中国医药导报,2023,20(12):169-172.DOI:10.20047/j.issn1673-7210.2023. 12.38.
[7] 施玉博,郭卫春,余铃.非特异性下腰痛:北美脊柱协会(NASS)循证医学指南解读[J].中国修复重建外科杂志,2021,35(10):1336-1340.DOI:10.7507/1002-1892. 202103131.
[8] Faiz KW. VAS--visual analog scale[J]. Tidsskr Nor Laegeforen, 2014, 134(3):323. DOI: 10.4045/tidsskr.13.1145.
[9] 郑光新,赵晓鸥,刘广林,等.Oswestry功能障碍指数评定腰痛患者的可信性[J].中国脊柱脊髓杂志,2002,12(1):13-15.DOI:10.3969/j.issn.1004-406X.2002.01.004.
[10] 张力为,毛志雄.体育科学常用心理量表评定手册(第二版)[M].北京:北京体育大学出版社,2004,34-36.
[11] Corp N, Mansell G, Stynes S, et al. Evidence-based treatment recommendations for neck and low back pain across Europe: a systematic review of guidelines[J]. Eur J Pain, 2021, 25(2):275-295. DOI: 10.1002/ejp.1679.
[12] Hayden JA, Ellis J, Ogilvie R, et al. Exercise therapy for chronic low back pain[J]. Cochrane Database Syst Rev, 2021, 9(9):CD009790. DOI: 10.1002/14651858.CD009790.pub2.
[13] Wong CK, Mak RY, Kwok TS, et al. Prevalence, incidence, and factors associated with non-specific chronic low back pain in community-dwelling older adults aged 60 years and older: a systematic review and meta-analysis[J]. J Pain, 2022, 23(4):509-534. DOI: 10.1016/j.jpain.2021. 07.012.
[14] 危娟,冯燕英,郭佩芬,等.慢性下腰痛患者健康促进生活方式现状及影响因素分析[J].中华现代护理杂志,2020,26(33):4607-4613.DOI:10.3760/cma.j.cn115682- 20200416-02805.
[15] 刘菲,侯芳,王霞,等.积极心理学视角下老年慢性腰背痛患者希望水平及其影响因素研究[J].现代临床护理,2023,22(6):46-52.DOI:10.3969/j.issn.1671-8283.2023.07.007.
[16] Dawson LP, Smith K, Cullen L, et al. Care models for acute chest pain that improve outcomes and efficiency: JACC state-of-the-art review[J]. J Am Coll Cardiol, 2022, 79(23):2333-2348. DOI: 10.1016/j.jacc.2022.03.380.
[17] Ashar YK, Gordon A, Schubiner H, et al. Effect of pain reprocessing therapy vs placebo and usual care for patients with chronic back pain: a randomized clinical trial[J]. JAMA Psychiatry, 2022, 79(1):13-23. DOI: 10.1001/jamapsychiatry.2021.2669.
[18] Bailly F, Trouvin AP, Bercier S, et al. Clinical guidelines and care pathway for management of low back pain with or without radicular pain[J]. Joint Bone Spine, 2021, 88(6):105227. DOI: 10.1016/j.jbspin.2021.105227.
[19] 郭钰玮,徐宁,韩文斌,等.普拉提运动联合肌内效贴对慢性非特异性颈痛的临床疗效观察[J].中国康复,2022,37(5):284-288.DOI:10.3870/zgkf.2022.05.007.
[20] 罗明辉.普拉提运动对慢性下腰痛患者的疼痛和腰椎功能的影响[J].基因组学与应用生物学,2019,38(7):3263-3267.DOI:10.13417/j.gab.038.003263.
[21] Almeida MO, Narciso Garcia A, Menezes Costa LC, et al. The McKenzie method for (sub)acute non-specific low back pain[J]. Cochrane Database Syst Rev, 2023, 4(4):CD009711. DOI: 10.1002/14651858.CD009711.pub2.
[22] Zaina F, Côté P, Cancelliere C, et al. A systematic review of clinical practice guidelines for persons with non-specific low back pain with and without radiculopathy: identification of best evidence for rehabilitation to develop the WHO's package of interventions for rehabilitation[J]. Arch Phys Med Rehabil, 2023, 104(11):1913-1927. DOI: 10.1016/j.apmr.2023.02.022.
[23] 刘彦会,程亚栋,陈东宁.系统性疼痛护理在下胫腓联合损伤术后患者中的应用效果[J].国际医药卫生导报,2024,30(3):448-452.DOI:10.3760/cma.j.issn.1007-1245.2024.03.020.
[24] Owen PJ, Miller CT, Mundell NL, et al. Which specific modes of exercise training are most effective for treating low back pain? Network meta-analysis[J]. Br J Sports Med, 2020, 54(21):1279-1287. DOI: 10.1136/bjsports- 2019-100886.
[25] 刘颖,宁宁.正念干预在慢性疼痛护理中的应用进展[J].护理研究,2019,33(15):2647-2650.DOI:10.12102/j.issn.1009-6493.2019.15.023.
[26] 许恒正,高亮,肖留根,等.八段锦锻炼对"体弱"大学生身体自尊与运动动机的影响[J].成都体育学院学报,2020,46(5):102-108.DOI:10.15942/j.jcsu.2020.05.016.
[27] 孟佳,杜少英,王彦,等.信息-动机-行为技巧模型联合动机性访谈在社区冠心病患者心脏康复中的应用[J].中国全科医学,2021,24(31):3990-3994.DOI:10.12114/j.issn.1007- 9572.2021.00.256.
[28] Michalsen H, Wangberg SC, Anke A, et al. Family members and health care workers' perspectives on motivational factors of participation in physical activity for people with intellectual disability: a qualitative study[J]. J Intellect Disabil Res, 2020, 64(4):259-270. DOI: 10.1111/jir.12716.
[29] 肖彬娥,陈衍尧,范伟锋,等.核心肌群训练联合平衡罐疗法在慢性非特异性下腰痛患者中的应用[J].中华现代护理杂志,2021,27(8):1060-1064.DOI:10.3760/cma.j.cn115682- 20200724-04570.
[30] 万琴,刘芳,胡文清,等.认知行为训练对慢性腰痛患者疼痛自我效能的影响[J].颈腰痛杂志,2021,42(3):322-325.DOI:10.3969/j.issn.1005-7234.2021.03.009.