背景:下腰痛(LBP)是最常见的肌肉骨骼疾病之一。患有LBP的人经常表现出神经肌肉控制和躯干机械性能的变化,包括躯干刚度。尽管一些个体研究已经检查了患有LBP的个体的背部肌肉僵硬度,似乎缺乏综合证据。因此,本系统综述采用meta分析,目的是综合和评估研究腰背肌僵硬与LBP相关的现有文献.
方法:我们根据PRISMA指南对文献进行了系统综述。我们搜索了Pubmed,Scopus,WebofScienceandScienceDirect用于研究,与背部肌肉僵硬相比,通过基于超声的弹性成像或肌力学测量,有和没有LBP的个体之间。纳入研究的汇总数据以描述性方式呈现。此外,我们进行了两项荟萃分析,以计算两组间的多裂肌和竖脊肌静息硬度的标准化平均差.对于这两种荟萃分析,使用随机效应模型,并使用逆方差法计算个体研究的权重.纳入研究的质量使用JoannaBriggs研究所关键评估清单进行分析横截面研究。此外,使用等级方法评估证据的确定性。
结果:9项研究纳入我们的系统评价。我们的结果表明,患有LBP的个体具有较高的多裂硬度(SMD=0.48,95%CI:0.15-0.81,p<0.01;I2=48%,p=0.11)和静止时的竖脊肌(SMD=0.37,95%CI:0.11-0.62,p<0.01;I2=39%,p=0.14)与无症状对照相比。另一方面,关于亚最大收缩期间肌肉僵硬的证据有些矛盾。
结论:根据这项系统评价的结果,我们得出结论,与无症状对照组相比,患有LBP的人可能有更高的背部肌肉僵硬度。解决肌肉僵硬可能是LBP治疗的重要目标。然而,由于证据质量有限,我们的发现应该极其谨慎地解释,纳入的研究数量少,测量方法存在差异。
BACKGROUND: Low back pain (LBP) is one of the most common musculoskeletal conditions. People with LBP often display changes of neuromuscular control and trunk mechanical properties, including trunk stiffness. Although a few individual studies have examined back muscle stiffness in individuals with LBP, a synthesis of the evidence appears to be lacking. Therefore, the aim of this systematic
review with meta-analysis was to synthesize and evaluate the available literature investigating back muscle stiffness in association with LBP.
METHODS: We conducted a systematic
review of the literature according to the PRISMA guidelines. We searched Pubmed, Scopus, Web of Science and ScienceDirect for studies, that compared back muscle stiffness, measured either by ultrasound-based elastography or myotonometry, between individuals with and without LBP. Pooled data of the included studies were presented descriptively. Additionally, we performed two meta-analyses to calculate the standardized mean difference between the two groups for resting stiffness of the multifidus and erector spinae muscle. For both meta-analyses, the random effect model was used and the weight of individual studies was calculated using the inverse-variance method. The quality of the included studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional studies. Furthermore, the certainty of evidence was evaluated using the GRADE approach.
RESULTS: Nine studies were included in our systematic
review. Our results suggest that individuals with LBP have higher stiffness of the multifidus (SMD = 0.48, 95% CI: 0.15 - 0.81, p < 0.01; I2 = 48 %, p = 0.11) and erector spinae at rest (SMD = 0.37, 95% CI: 0.11 - 0.62, p < 0.01; I2 = 39 %, p = 0.14) compared to asymptomatic controls. On the other hand, the evidence regarding muscle stiffness during submaximal contractions is somewhat contradictory.
CONCLUSIONS: Based on the findings of this systematic
review we conclude that people with LBP may have higher back muscle stiffness compared to asymptomatic controls. Addressing muscle stiffness might represent an important goal of LBP treatment. Nevertheless, our findings should be interpreted with extreme caution due to a limited quality of evidence, small number of included studies and differences in measurement methodology.