Maria Alice Mainenti Pagnez , Maria Silveira Mello , Juliana Valentim Bittencourt , François Ricard , Leandro Alberto Calazans Nogueira
{"title":"屈曲牵引技术在慢性腰痛患者 L5-S1 距离和局部疼痛中的不同暴露时间:可行性研究","authors":"Maria Alice Mainenti Pagnez , Maria Silveira Mello , Juliana Valentim Bittencourt , François Ricard , Leandro Alberto Calazans Nogueira","doi":"10.1016/j.ijosm.2024.100714","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>Low back pain (LBP) is a worldwide public health problem. The flexion-distraction technique (FDT) has been considered to treat LBP. However, the adequate dosage and the treatment effects are not clearly understood. This feasibility study aimed to assess the effects of different exposure times with 5 and 10 min of the FDT on the L5-S1 distance and pressure pain threshold (PPT) of patients with chronic LBP.</p></div><div><h3>Methods</h3><p>A two-arm, examiner-blinded, randomized controlled feasibility trial with participants with chronic LBP enrolled in an outpatient clinic. Participants were randomly assigned to FDT-T5 (5 min) or FDT-T10 (10 min). The distance between the L5 lamina and the sacral promontory, and the PPT at the L5 spinous process was measured before and immediately after FDT. Ultrasound imaging was used to measure L5-S1 distance, and the pressure algometry examined the PPT. Pre- and post-intervention data were compared between two groups by two-way analysis of variance (ANOVA) for repeated measures. We also calculated the intra- and inter-rater reliability of the L5-S1 measurement.</p></div><div><h3>Results</h3><p>Seventeen participants [10 (58.8 %) females, mean age 45 (±12) years] completed all procedures. Improvements in the intervertebral space [FDT-T5 mean change = 2.65 (95 %CI 1.45, 3.85) mm; FDT-T10 mean change = 1.88 (95 %CI -1.86, 5.63) mm] and decreases in PPT values [FDT-T5 mean change = −0.55 (95 %CI -1.35, 0.26) Kgf; FDT-T10 mean change = −0.79 (95 %CI -1.92, 0.34) Kgf] were observed, although there was no significant difference between the two groups for the distance between the L5 lamina and the sacral promontory (p = 0.595) or the spinous process L5 PPT (p = 0.672) after the intervention. Good reliability values were found for inter- and intra-rater measurements ranging between ICC = 0.81 to ICC = 0.88).</p></div><div><h3>Conclusion</h3><p>In this feasibility trial, both groups showed an increased distance between L5-S1 and decreased the PPT in the L5 spinous process, indicating greater pain sensitivity after the intervention. These quantitative methods may measure distance and pain in definitive studies.</p></div><div><h3>Implications for practice</h3><p></p><ul><li><span>•</span><span><p>This is the first study to compare the distance between the L5 lamina and the sacral promontory after the flexion-distraction technique (FDT) using ultrasound imaging (USI).</p></span></li><li><span>•</span><span><p>The present study could not determine the effect of a particular time of exposure to FDT (FDT-T5 or FDT-T10 min).</p></span></li><li><span>•</span><span><p>Both groups (FDT-T5 and FDT-T10 min) increased the lumbar distance, corresponding to mobilization of the lumbar region.</p></span></li><li><span>•</span><span><p>Both groups presented decreased values of PPT in the L5 spinous process immediately after the technique.</p></span></li><li><span>•</span><span><p>A single session of FDT showed improvements in the distance between L5 and S1 and reduced L5 pressure pain threshold in the feasibility study.</p></span></li></ul></div>","PeriodicalId":51068,"journal":{"name":"International Journal of Osteopathic Medicine","volume":null,"pages":null},"PeriodicalIF":1.1000,"publicationDate":"2024-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Different exposure times of flexion distraction technique in the L5-S1 distance and local pain of patients with chronic low back pain: A feasibility study\",\"authors\":\"Maria Alice Mainenti Pagnez , Maria Silveira Mello , Juliana Valentim Bittencourt , François Ricard , Leandro Alberto Calazans Nogueira\",\"doi\":\"10.1016/j.ijosm.2024.100714\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>Low back pain (LBP) is a worldwide public health problem. The flexion-distraction technique (FDT) has been considered to treat LBP. However, the adequate dosage and the treatment effects are not clearly understood. This feasibility study aimed to assess the effects of different exposure times with 5 and 10 min of the FDT on the L5-S1 distance and pressure pain threshold (PPT) of patients with chronic LBP.</p></div><div><h3>Methods</h3><p>A two-arm, examiner-blinded, randomized controlled feasibility trial with participants with chronic LBP enrolled in an outpatient clinic. Participants were randomly assigned to FDT-T5 (5 min) or FDT-T10 (10 min). The distance between the L5 lamina and the sacral promontory, and the PPT at the L5 spinous process was measured before and immediately after FDT. Ultrasound imaging was used to measure L5-S1 distance, and the pressure algometry examined the PPT. Pre- and post-intervention data were compared between two groups by two-way analysis of variance (ANOVA) for repeated measures. We also calculated the intra- and inter-rater reliability of the L5-S1 measurement.</p></div><div><h3>Results</h3><p>Seventeen participants [10 (58.8 %) females, mean age 45 (±12) years] completed all procedures. Improvements in the intervertebral space [FDT-T5 mean change = 2.65 (95 %CI 1.45, 3.85) mm; FDT-T10 mean change = 1.88 (95 %CI -1.86, 5.63) mm] and decreases in PPT values [FDT-T5 mean change = −0.55 (95 %CI -1.35, 0.26) Kgf; FDT-T10 mean change = −0.79 (95 %CI -1.92, 0.34) Kgf] were observed, although there was no significant difference between the two groups for the distance between the L5 lamina and the sacral promontory (p = 0.595) or the spinous process L5 PPT (p = 0.672) after the intervention. Good reliability values were found for inter- and intra-rater measurements ranging between ICC = 0.81 to ICC = 0.88).</p></div><div><h3>Conclusion</h3><p>In this feasibility trial, both groups showed an increased distance between L5-S1 and decreased the PPT in the L5 spinous process, indicating greater pain sensitivity after the intervention. These quantitative methods may measure distance and pain in definitive studies.</p></div><div><h3>Implications for practice</h3><p></p><ul><li><span>•</span><span><p>This is the first study to compare the distance between the L5 lamina and the sacral promontory after the flexion-distraction technique (FDT) using ultrasound imaging (USI).</p></span></li><li><span>•</span><span><p>The present study could not determine the effect of a particular time of exposure to FDT (FDT-T5 or FDT-T10 min).</p></span></li><li><span>•</span><span><p>Both groups (FDT-T5 and FDT-T10 min) increased the lumbar distance, corresponding to mobilization of the lumbar region.</p></span></li><li><span>•</span><span><p>Both groups presented decreased values of PPT in the L5 spinous process immediately after the technique.</p></span></li><li><span>•</span><span><p>A single session of FDT showed improvements in the distance between L5 and S1 and reduced L5 pressure pain threshold in the feasibility study.</p></span></li></ul></div>\",\"PeriodicalId\":51068,\"journal\":{\"name\":\"International Journal of Osteopathic Medicine\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.1000,\"publicationDate\":\"2024-01-24\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"International Journal of Osteopathic Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1746068924000075\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Journal of Osteopathic Medicine","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1746068924000075","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
Different exposure times of flexion distraction technique in the L5-S1 distance and local pain of patients with chronic low back pain: A feasibility study
Background
Low back pain (LBP) is a worldwide public health problem. The flexion-distraction technique (FDT) has been considered to treat LBP. However, the adequate dosage and the treatment effects are not clearly understood. This feasibility study aimed to assess the effects of different exposure times with 5 and 10 min of the FDT on the L5-S1 distance and pressure pain threshold (PPT) of patients with chronic LBP.
Methods
A two-arm, examiner-blinded, randomized controlled feasibility trial with participants with chronic LBP enrolled in an outpatient clinic. Participants were randomly assigned to FDT-T5 (5 min) or FDT-T10 (10 min). The distance between the L5 lamina and the sacral promontory, and the PPT at the L5 spinous process was measured before and immediately after FDT. Ultrasound imaging was used to measure L5-S1 distance, and the pressure algometry examined the PPT. Pre- and post-intervention data were compared between two groups by two-way analysis of variance (ANOVA) for repeated measures. We also calculated the intra- and inter-rater reliability of the L5-S1 measurement.
Results
Seventeen participants [10 (58.8 %) females, mean age 45 (±12) years] completed all procedures. Improvements in the intervertebral space [FDT-T5 mean change = 2.65 (95 %CI 1.45, 3.85) mm; FDT-T10 mean change = 1.88 (95 %CI -1.86, 5.63) mm] and decreases in PPT values [FDT-T5 mean change = −0.55 (95 %CI -1.35, 0.26) Kgf; FDT-T10 mean change = −0.79 (95 %CI -1.92, 0.34) Kgf] were observed, although there was no significant difference between the two groups for the distance between the L5 lamina and the sacral promontory (p = 0.595) or the spinous process L5 PPT (p = 0.672) after the intervention. Good reliability values were found for inter- and intra-rater measurements ranging between ICC = 0.81 to ICC = 0.88).
Conclusion
In this feasibility trial, both groups showed an increased distance between L5-S1 and decreased the PPT in the L5 spinous process, indicating greater pain sensitivity after the intervention. These quantitative methods may measure distance and pain in definitive studies.
Implications for practice
•
This is the first study to compare the distance between the L5 lamina and the sacral promontory after the flexion-distraction technique (FDT) using ultrasound imaging (USI).
•
The present study could not determine the effect of a particular time of exposure to FDT (FDT-T5 or FDT-T10 min).
•
Both groups (FDT-T5 and FDT-T10 min) increased the lumbar distance, corresponding to mobilization of the lumbar region.
•
Both groups presented decreased values of PPT in the L5 spinous process immediately after the technique.
•
A single session of FDT showed improvements in the distance between L5 and S1 and reduced L5 pressure pain threshold in the feasibility study.
期刊介绍:
The International Journal of Osteopathic Medicine is a peer-reviewed journal that provides for the publication of high quality research articles and review papers that are as broad as the many disciplines that influence and underpin the principles and practice of osteopathic medicine. Particular emphasis is given to basic science research, clinical epidemiology and health social science in relation to osteopathy and neuromusculoskeletal medicine.
The Editorial Board encourages submission of articles based on both quantitative and qualitative research designs. The Editorial Board also aims to provide a forum for discourse and debate on any aspect of osteopathy and neuromusculoskeletal medicine with the aim of critically evaluating existing practices in regard to the diagnosis, treatment and management of patients with neuromusculoskeletal disorders and somatic dysfunction. All manuscripts submitted to the IJOM are subject to a blinded review process. The categories currently available for publication include reports of original research, review papers, commentaries and articles related to clinical practice, including case reports. Further details can be found in the IJOM Instructions for Authors. Manuscripts are accepted for publication with the understanding that no substantial part has been, or will be published elsewhere.