全身阻力懸吊核心運動(TRX)於非特異性下背痛患者在生活品質、功能活動、滿意度之效益

The effects of TRX core muscle exercise on quality of life, functional activities and satisfaction in patient with nonspecific low back pain

高得又(Te-Yu Kao)

指導教授 ： 張乃仁

高雄醫學大學/醫學院/運動醫學系碩士在職專班/碩士(2017年)

摘要

背景: 下背痛已成為全世界主要的公共健康問題。全身阻力懸吊核心運動(Total body Resistance eXercise, TRX)是近年來常見的不穩定平面的懸吊系統訓練，目前研究證實能針對健康族群增加核心穩定、核心肌群的肌電訊號活化與核心肌力。然而，當今研究主要族群以健康受試者為主，尚未有進一步評估於非特異性下背痛患者的效益。
目的: 非特異性下背痛患者介入8週不穩定平面的TRX核心運動後是否能比穩定平面的墊上運動治療或儀器治療在生活品質、功能活動、滿意度之效益更有改善。
方法: 本研究招募下背痛患者被隨機分成三組:TRX組：參與8週總共16次TRX核心運動；墊上運動組：參與8週總共16次墊上運動。TRX組和墊上運動組，使用棒式(plank)、交替捲曲(cross curl-ups)、撐體勾腿(hamstring curl)、跪姿推出(kneeling roll-out)此4個核心動作做為核心運動；儀器治療組：僅接受儀器治療。所有人都接受儀器治療且在實驗前，先做前測評估基本值，包含: 視覺類比量表(Visual Analogue Scale,VAS)、歐氏下背痛失能量表(Oswestry Low Back Pain Disability Questionnaire,ODI) 、核心肌耐力(McGill's trunk muscle endurance test、Biering-Sorensen test)、壓力反饋測試(Sahrmann test)的核心穩定度，並於8週實驗後，再做後測評估。此外，TRX組會額外評估滿意度問卷。數據分析包含各組間差異和前後介入後的改善率。
結果: 在8週介入後，在VAS方面：TRX組和墊上運動組分別與儀器治療組均顯著具有降低疼痛效果，同時也達到臨床最小顯著差異；在ODI方面：TRX組相較於墊上運動組和儀器治療組均有顯著性改善失能狀況。此外，TRX組與墊上運動組均有達到臨床最小顯著差異。在軀幹彎曲肌耐力方面：TRX組相較於墊上運動組和儀器治療組均有顯著性改善；在軀幹伸直肌耐力方面：TRX組跟儀器治療組有顯著改善；在壓力反饋測試：TRX組跟儀器治療組有顯著改善。此外，以改善率方面分析，TRX相較於墊上運動組和儀器治療組達到最顯著性差異的改善。在滿意度方面：所有受試者在身體活動、自信心變化、自覺健康程度達到滿意以上為93%，症狀緩解滿意以上為80%。在TRX核心運動中，受試者自覺棒式最輕鬆;而撐體勾腿感到最困難。
結論: 8週的不穩定平面的TRX核心運動相較於穩定平面的墊上運動和儀器治療能更有效改善下背痛患者的生活品質、功能活動及核心穩定度。

關鍵字

懸吊運動 ； 下背痛 ； 核心運動 ； 物理治療

並列摘要

Background: Low back pain becomes the major public health problem of the world. Total body Resistance eXercise (TRX) is a common unstable surface training of suspension system in recent years. The studies have reported that the TRX exercise can improve stabilization, strength, and the electromyogramphyactivation of the core muscles on heathy populations. However, there is no research to investigate the effects of TRX on patients with non-specific low back pain.
Purpose: The patients with non-specific low back pain whether after 8-weeks TRX core exercise of unstable surface can improve the quality of life, functional activity, and satisfaction compared to mat exercise therapy of stable surface or modality therapy.
Methods: Participants with recurrent pain were recruited and randomly divided into one of the three groups. In the TRX group, they participated in 8-weeks (16 times) TRX core exercise; in the mat exercise group, they participated in 8-weeks (16 times) mat exercise. The TRX group and mat exercise group, using plank, cross curl-ups, hamstring curl, kneeling roll-out of this four core movement as the core exercise; in the modality group, they only received the modality treatments. All participants received the modality treatments and were tested before the experiment, including: Visual Analogue Scale (VAS), Oswestry Low Back Pain Disability Questionnaire (ODI), trunk muscle endurance test, Biering-Sorensen test, Sahrmann test core stability test, and post-evaluations after 8 weeks of intevention. Furthermore, the TRX group evaluated the satisfaction questionnaire.
Results: After 8 weeks of intevention, overall, in the VAS aspect: the TRX group and the mat exercise group had significantly lowered the pain socores compared to the modality group. In the ODI part: the TRX group had significantly improved diasblity compared with the mat exercise group and modality group. In addition, both TRX group and the mat exercise group have reached the minimal clinically important difference. In the trunk flexor endurance: the TRX group had significantly improved compared with the mat exercise group and the modality group; in the trunk extensor endurance: the TRX group had significantly improved compared to the modality group. Furthermore, in terms of improvement ratio, the TRX group showed the most significant differences in all of evlation items as compared to mat exercise group and modality groups. Regarding satisfaction: all subjects in the TRX group had a significant improvement in physical activity, self-confidence and self-healthy corresponding to 93% health satisfaction, more than 80% satisfaction with symptoms of relief. In the TRX core exercise, the patients felt plank was the most relaxed, but hamstring curl was most difficult.
Conclusion: An 8-weeks TRX core exercise of unstable surface on patients with lower back pain provides more postivie effects in improving the quality of life, functional activities and trunk muscle endurance, core stability as compared to the mat exercise of stable surface and only modality use.

並列關鍵字

suspension exercise ； lower back pain ； core muscle exercise ； physical therapy

參考文獻

1. Balagué, F., et al., Non-specific low back pain. The Lancet, 2012. 379(9814): p. 482-491.

2. Crow, W.T. and D.R. Willis, Estimating cost of care for patients with acute low back pain: a retrospective review of patient records. The Journal of the American Osteopathic Association, 2009. 109(4): p. 229-233.

3. Ivanova, J.I., et al., Real-world practice patterns, health-care utilization, and costs in patients with low back pain: the long road to guideline-concordant care. The Spine Journal, 2011. 11(7): p. 622-632.

4. Mientjes, M. and J. Frank, Balance in chronic low back pain patients compared to healthy people under various conditions in upright standing. Clinical Biomechanics, 1999. 14(10): p. 710-716.

5. Hodges, P.W. and C.A. Richardson, Delayed postural contraction of transversus abdominis in low back pain associated with movement of the lower limb. Clinical Spine Surgery, 1998. 11(1): p. 46-56.