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Stabilization exercise and disorders of the lumbar spine: Neuromuscular implications and clinical efficacy in nonoperative and postoperative populations.

机译：稳定运动和腰椎疾病：非手术和术后人群的神经肌肉影响和临床疗效。

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摘要

Disorders of the lumbar spine are highly prevalent and impose a large socioeconomic burden. The lumbar multifidus (LM) is a muscle which serves a unique stabilizing role in the lumbar spine. Neuromuscular impairments in LM morphology and function have been reported to result from lumbar spine disorders, and lumbar stabilization exercises are commonly prescribed to address these impairments. Therefore, the purpose of this dissertation was to enhance the understanding of stabilization exercise and the role of the LM among nonoperative and postoperative populations with lumbar spine disorders.;A preliminary step in this process was to systematically review the literature with respect to the rater reliability of quantitative estimates of trunk muscle morphology and function using rehabilitative ultrasound imaging (RUSI). Seven-hundred fifty-six studies were considered with 24 studies included in the review. The results indicated that RUSI measures of trunk muscles demonstrate good rater reliability.;The construct validity of prognostic factors thought to predict a favorable clinical outcome for patients with LBP undergoing a lumbar stabilization exercise program was then investigated. A cross-sectional design was used to examine the relationship between the factors and RUSI measures of LM activation among 40 individuals with nonspecific LBP. The construct validity of the prognostic factors was supported by the univariate and multivariate relationships identified between the prognostic factors and LM activation, with the presence of the prognostic factors identifying those individuals with greater functional impairments.;In the primary study, we performed a parallel group randomized clinical trial investigating the efficacy of two exercise approaches following lumbar disc surgery as well as the relationship between change in LM muscle function and clinical outcome. Thirty-eight subjects were randomized to receive motor control exercises emphasizing LM function or general trunk stabilization exercises initiated after 2 postoperative weeks. Study outcomes included pain, disability, global change, and sciatica frequency and bothersomeness. No significant between group differences were identified. However, there was a relationship between improved LM function on the side of surgery and global improvement. This finding may highlight the importance of maximizing LM function following lumbar disc surgery.
机译：腰椎疾病非常普遍，并给社会经济带来沉重负担。腰椎多裂肌（LM）是一种在腰椎中发挥独特稳定作用的肌肉。据报导，LM形态和功能的神经肌肉损伤是由腰椎疾病引起的，通常规定进行腰椎稳定锻炼以解决这些损伤。因此，本论文的目的是增进对腰椎疾病的非手术人群和术后人群稳定锻炼的了解以及LM的作用。；该过程的第一步是系统地复习有关评估者可靠性的文献。康复超声成像（RUSI）定量评估躯干肌肉的形态和功能。该评价纳入了76项研究，其中24项研究纳入了评价。结果表明，RUSI度量的躯干肌表现出良好的评分者信度。;然后研究了预后因素的构造效度，该预后因素被认为可以预测接受腰椎稳定锻炼的LBP患者的临床结局。横断面设计用于检查40名非特异性LBP个体中LM激活的因素与RUSI量度之间的关系。预后因素与LM激活之间的单因素和多因素关系支持了预后因素的结构效度，并通过预后因素识别了功能受损程度更大的个体。在主要研究中，我们进行了平行分组一项随机临床试验，研究腰椎间盘手术后两种锻炼方法的功效以及LM肌肉功能的变化与临床结局之间的关系。 38名受试者被随机分配接受运动控制练习，以强调LM功能或术后2周后开始的一般躯干稳定训练。研究结果包括疼痛，残疾，整体变化以及坐骨神经痛的频度和困扰。组间差异无显着性。但是，手术方面的LM功能改善与整体改善之间存在关联。该发现可能突出了在腰椎间盘手术后最大化LM功能的重要性。

著录项

  • 作者

    Hebert, Jeffrey J.;

  • 作者单位

    The University of Utah.;

  • 授予单位 The University of Utah.;
  • 学科 Health Sciences Rehabilitation and Therapy.;Health Sciences Medicine and Surgery.;Health Sciences Health Care Management.
  • 学位 Ph.D.
  • 年度 2010
  • 页码 97 p.
  • 总页数 97
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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