دانلود رایگان مقاله انگلیسی اثربخشی تمرین کنترل حرکتی بر بیماران مبتلا به اختلالات کمردرد غیر متمرکز و کنترل حرکت - الزویر 2018

ABSTRACT

Background: Patients with low back pain (LBP) and movement control impairment (MVCI) show altered spinal movement patterns. Treatment that aims to change movement behaviour could benefit these patients. Objective: To assess the effectiveness of movement control exercise (MVCE) in terms of clinically relevant measures (disability and pain) on patients with NSLBP. Methods: A systematic review and meta-analysis were conducted. CINAHL, MEDLINE, PUBMED and PEDro databases were searched for RCT’s evaluating MVCE treatment in patients with NSLBP from review inception to April 2017. Authors were contacted to obtain missing data and outcomes. PEDro was used to assess methodological quality of the studies and the GRADE approach was used to assess the overall quality of evidence Data were combined using a random effects metaanalysis and reported as standardized mean differences (SMD). Results: Eleven eligible RCT’s including a total of 781 patients were found. Results show ‘very low to moderate quality’ evidence of a positive effect of MVCE on disability, both at the end of treatment and after 12 months (SMD -0.38 95%CI -0.68, -0.09 respectively 0.37 95%CI -0.61,-0.04). Pain intensity was significantly reduced after MVCE at the end of treatment (SMD -0.39 95%CI -0.69, -0.04), but not after 12 months (SMD -0.27, 95%CI -0.62, 0.09). Conclusions: MVCE intervention for people with NSLBP and MVCI appears to be more effective in improving disability compared to other interventions, both over the short and long term. Pain was reduced only in the short term. An important factor is the initial identification of patients with MVCI.

Conclusions

MVCE treatment may be more effective in improving disability in the short and long term for people with NSLBP and MVCI compared to other interventions. Pain was reduced through MVCE treatment in the short term, but not over the long term. The heterogeneity of the selected studies was considerable. This was somewhat reduced through subgrouping the studies according to their sample restrictions or control interventions. Therefore, other factors, such as pain duration, might be equally important and warrant future research. Larger and higher-quality RCTs with longterm follow-ups are recommended for future studies. Future research should pay close attention to the selection of participants with regard to duration of NSLBP and the presence of MVCI.