Abstract：
BACKGROUND: Altered lumbar multifidus (LM) activation has been found in populations with non-specific chronic low back pain (NSCLBP).
OBJECTIVE: To detect differences in LM muscle thickness at rest and during active manoeuvres between patients with NSCLBP and pain-free controls and to analyze the ability of LM thickness change during the active straight leg raise (ASLR) with rehabilitative ultrasound imaging to detect patients with NSCLBP.
METHODS: Cross-sectional observational study.
METHODS: Seventy volunteers (50% patients NSCLBP) were recruited. 18 B-mode images of LM at L4-L5 or L5-S1 level selecting the most symptomatic level (both sides, six at rest and three during ASLR) were collected by a blinded assessor. Differences between patients and controls in LM muscle thickness at rest, during ASLR (holding 3sec), and 5 s after ASLR were calculated. In addition, discriminant validity was evaluated by calculating the area under the receiver operating characteristic curve (ROC), sensitivity, specificity and positive and negative likelihood ratio.
RESULTS: Significant LM thickness change differences during ASLR were found within and between groups: bilaterally, LM thickness change during ASLR was significantly higher in healthy controls than in NSCLBP patients. Ipsilateral LM muscle thickness change was sensitive to detect individuals with NSCLBP (ROC = 0.79-0.80).
CONCLUSIONS: Pain-free individuals exhibited significantly greater LM thickness changes bilaterally during the ASLR compared to patients with NSCLBP. LM thickness change during the ASLR has good validity for discriminating patients with NSCLBP. Further studies should assess benefits of LM training programs in the management of these patients.
OBJECTIVE: To detect differences in LM muscle thickness at rest and during active manoeuvres between patients with NSCLBP and pain-free controls and to analyze the ability of LM thickness change during the active straight leg raise (ASLR) with rehabilitative ultrasound imaging to detect patients with NSCLBP.
METHODS: Cross-sectional observational study.
METHODS: Seventy volunteers (50% patients NSCLBP) were recruited. 18 B-mode images of LM at L4-L5 or L5-S1 level selecting the most symptomatic level (both sides, six at rest and three during ASLR) were collected by a blinded assessor. Differences between patients and controls in LM muscle thickness at rest, during ASLR (holding 3sec), and 5 s after ASLR were calculated. In addition, discriminant validity was evaluated by calculating the area under the receiver operating characteristic curve (ROC), sensitivity, specificity and positive and negative likelihood ratio.
RESULTS: Significant LM thickness change differences during ASLR were found within and between groups: bilaterally, LM thickness change during ASLR was significantly higher in healthy controls than in NSCLBP patients. Ipsilateral LM muscle thickness change was sensitive to detect individuals with NSCLBP (ROC = 0.79-0.80).
CONCLUSIONS: Pain-free individuals exhibited significantly greater LM thickness changes bilaterally during the ASLR compared to patients with NSCLBP. LM thickness change during the ASLR has good validity for discriminating patients with NSCLBP. Further studies should assess benefits of LM training programs in the management of these patients.
摘要：
背景：在患有非特异性慢性下腰痛（NSCLBP）的人群中发现腰椎多裂（LM）激活改变。
目的：检测NSCLBP患者和无痛对照组在静息和主动动作时LM肌厚度的差异，并分析主动直腿抬高（ASLR）过程中LM厚度变化的能力康复超声成像检测NSCLBP患者。
方法：横断面观察性研究。
方法：招募70名志愿者（50%为NSCLBP患者）。18LM在L4-L5或L5-S1水平选择最症状水平的B模式图像（两侧，休息时6例，ASLR期间3例）由盲法评估员收集。患者和对照组在休息时LM肌肉厚度的差异，ASLR期间（保持3秒），计算ASLR后5s。此外,通过计算受试者工作特征曲线下面积(ROC)来评估判别效度，灵敏度,特异性和正负似然比。
结果：在ASLR过程中发现了显着的LM厚度变化差异，健康对照组ASLR期间LM厚度变化明显高于NSCLBP患者。同侧LM肌厚度变化对NSCLBP患者的检测敏感（ROC=0.79-0.80）。
结论：与NSCLBP患者相比，无痛个体在ASLR期间表现出显著更大的双侧LM厚度变化。ASLR过程中LM厚度变化对区分NSCLBP患者具有良好的有效性。进一步的研究应评估LM培训计划在这些患者管理中的益处。
目的：检测NSCLBP患者和无痛对照组在静息和主动动作时LM肌厚度的差异，并分析主动直腿抬高（ASLR）过程中LM厚度变化的能力康复超声成像检测NSCLBP患者。
方法：横断面观察性研究。
方法：招募70名志愿者（50%为NSCLBP患者）。18LM在L4-L5或L5-S1水平选择最症状水平的B模式图像（两侧，休息时6例，ASLR期间3例）由盲法评估员收集。患者和对照组在休息时LM肌肉厚度的差异，ASLR期间（保持3秒），计算ASLR后5s。此外,通过计算受试者工作特征曲线下面积(ROC)来评估判别效度，灵敏度,特异性和正负似然比。
结果：在ASLR过程中发现了显着的LM厚度变化差异，健康对照组ASLR期间LM厚度变化明显高于NSCLBP患者。同侧LM肌厚度变化对NSCLBP患者的检测敏感（ROC=0.79-0.80）。
结论：与NSCLBP患者相比，无痛个体在ASLR期间表现出显著更大的双侧LM厚度变化。ASLR过程中LM厚度变化对区分NSCLBP患者具有良好的有效性。进一步的研究应评估LM培训计划在这些患者管理中的益处。
