Associação entre recrutamento de músculos abdominais com desfechos clínicos e risco prognóstico em indivíduos com dor lombar crônica não específica: estudo preliminar
DOI:
https://doi.org/10.1590/1809-2950/14560723012016Resumo
Este estudo investigou a associação entre testes clínicos, desfechos clínicos e risco prognóstico de pacientes com dor lombar crônica não específica. Para esta pesquisa, 20 pacientes, maiores de 18 anos, foram selecionados por conveniência e submetidos à avaliação dos desfechos clínicos por meio de Escala numérica de dor e Questionário de incapacidade. Para classificação de risco prognóstico utilizou-se o questionário STarT Back, e para avaliar o recrutamento do músculo transverso do abdome foram utilizados os seguintes testes clínicos: Escala de classificação clínica (ECC); e medida da espessura dos músculos do abdome por meio de imagens ultrassonográficas (MEM-US). Os testes foram realizados em um único dia por avaliador treinado, e a ordem dos testes foi aleatória. Os coeficientes de correlação de Pearson (r) e Spearman (rS) foram utilizados para investigar a associação. Os resultados mostraram que as associações entre o risco prognóstico de dor lombar com os desfechos clínicos, dor e incapacidade foram moderadas (r=0,68 e r=0,57, respectivamente). Para ECC, as associações com incapacidade e risco prognóstico foram consideradas razoáveis (r=-0,34 e r=-0,36, respectivamente). Não houve associações com a MEM-US. Na amostra de baixo risco prognóstico, a relação do ECC com a incapacidade foi considerada moderada para boa, enquanto para dor a correlação foi razoável (rS=-0,62 e rS=-0,24, respectivamente). Concluímos que existe associação entre ECC com desfechos clínicos e risco prognóstico, e a estratificação, segundo o risco prognóstico, aumenta a relação observada. Futuros estudos devem ser conduzidos com novas medidas para avaliação do recrutamento muscular abdominal com amostras maiores.Downloads
Referências
Van Tulder M, Becker A, Bekkering T, Breen A, del Real MT,
Hutchinson A, et al. Chapter 3. European guidelines for the
management of acute nonspecific low back pain in primary
care. Eur Spine J. 2006;15:S169-91.
Airaksinen O, Brox JI, Cedrashi C, Hildebrandt J, KlaberMoffet J, Kovacs F, et al, on behalf of the COST B13 Working
Group on Guidelines for Chronic Low Back Pain. European
guidelines for the management of chronic nonspecific low
back pain. Eur Spine J. 2006;15:s192-300.
Nolet PS, Kristman VL, Côté P, Carrol LJ, Cassidy JD. Is low
back pain associated with worse health-related quality of life
months later? Eur Spine J. 2014;
Hoy DG, March L, Brooks P, Woolf A, Blyth F, Vos T, et al.
Measuring the global burden of low back pain. Best Pract Res
Clin Rheumatol. 2010;24:155-65
Hodges P, Ferreira P, Ferreira M. Lumbar spine: Treatment
of instability and disorders of movement control. In: Magee,
D.J; Zachazewski, J.E; Quillen, W.S. editors. Pathology and
Intervention in Musculoskeletal Rehabilitation. St. Louis:
Saunders Elsevier p. 401.
Hides JA, Jull GA, Richardson CA. Long-term effects of
specific stabilizing exercises for first-episode low back pain.
Spine. 2001;26(11):243-8.
Hodges PW, Richardson CA. Inefficient muscular stabilization
of the lumbar spine associated with low back pain: a
motor control evaluation of transversus abdominis. Spine.
;21:2640-50.
Hogdes PW, Richardson CA. Delayed postural contraction of
the transversus abdominis in low back pain associated with
movement of the lower limb. J Spinal Disord .1998;11(1):45-56.
Van Dieen JH, Cholewicki J, Radebold A. Trunk muscle
recruitment patterns in patients with low back pain enhance
the stability of the lumbar spine. Spine. 2003;28:834-16.
Panjabi MM. The stabilizing system of the spine. I. Function,
dysfunction, adaptation, and enhancement. J Spinal Dis.
;5:383-389.
Bergmark A. Stability of the lumbar spine: a study in mechanical
engineering, Acta Orthop Scand. 1989;60(Suppl 230):1-54.
Ferreira PH, Ferreira ML, Hodges PW. Changes in recruitment
of the abdominal muscles in people with low back pain:
ultrasound measurement of muscle activity. Spine.
;29:2560-6.
Lima POP, Oliveira RR, Filho AG, Raposo MCF, Costa
LOP. Laurentino, G.E.C. Reproducibility of the pressure
biofeedback unit in measuring transversus abdominis muscle
activity in patients with chronic nonspecific low back pain. J
Bodyw Mov Ther. 2012;16(2):251-7.
Hagins M, Adler K, Cash M, Daugherty J, Mitrani G. Effects
of practice on the ability to perform lumbar stabilization
exercises. J Orthop Sports Phys Ther. 1999;29:546-55.
Storheim K, Bo K, Pederstad O, Jahnsen R. Intra-tester
reproducibility of pressure biofeedback in measurement
of transversus abdominis function. Physiother Res Int.
;7:239-49.
Sedaghat N, Latimer J, Maher C, Wisbey-Roth T. The
reproducibility of a clinical grading system of motor control
in patients with low back pain. J Manipulative Physiol Ther.
;30(7):501-8.
Hodges PW, Pengel LH, Herbert RD, Gandevia SC.
Measurement of muscle contraction with ultrasound
imaging. Muscle Nerve. 2003b ;27(6):682-92
Moons KG, Altman DG, Vergouwe Y, Royston P. Prognosis and
prognostic research: application and impact of prognostic
models in clinical practice. BMJ. 2009;338:b606.
Hill JC, Dunn KM, Lewis M, Mullis R, Main CJ, Foster NE, et
al. A primary care back pain screening tool: identifying
patient subgroups for initial treatment. Arthritis Rheum.
;59(5):632-41.
Ross RLP. Assessment in occupational therapy and physical
therapy. Philadelphia: WB Saunders; 1997. p. 123-33.
Nusbaum L, Natour J, Ferraz MB, Goldenberg J. Translation,
adaptation and validation of the Roland-Morris questionnaireBrazil Roland-Morris. Braz J Med Biol Res. 2001;34:203-10.
Pilz B, Vasconcelos RA, Marcondes FB, Lodovichi SS, Mello W,
Grossi DB. The Brazilian version of STarT Back Screening Tool
- translation, cross-cultural adaptation and reliability. Braz J
Phys Ther, 2014;18(5):453-61.
Portney LG, Watkins MP. Foundations of clinical research:
applications to practice (3 ed). Upper Saddle River, New
Jersey: Prentice-Hall, 2009.
Hill JC, Whitehurst DG, Lewis M, Bryan S, Dunn KM,
Foster NE, et al. Comparison of stratified primary care
management for low back pain with current best practice
(STarT Back): a randomised controlled trial. The Lancet.
;378(9802):1560-71.
Kovacs FM, Abraira V, Zamora J, et al. Correlation between
pain, disability, and quality of life in patients with common
low back pain. Spine. (Phila Pa 1976). 2004;29:206-10.
Fritz JM, Beneciuk JM, George SZ. Relationship between
categorization with the STarT Back Screening Tool and
prognosis for people receiving physical therapy for low back
pain. Phys Ther. 2011;91:722-32.
Pinto RZ, Franco HR, Ferreira PH, Ferreira ML, Franco MR,
Hodges PW. Reliability and discriminatory capacity of a
clinical scale for assessing abdominal muscle coordination. J
Manipulative Physiol Ther. 2011;34(8):562-9.
Wong AYL, Parent EC, Funabashi M, Kawchuk GN. Do Changes
in transversus abdominis and lumbar multifidus during
conservative treatment explain changes in clinical outcomes
related to nonspecific Low Back Pain? A Systematic Review.
J Pain. 2013;15(4):377.
Mannion AF, Caporaso F, Pulkovski N, Sprott H. Spine
stabilisation exercises in the treatment of chronic low back
pain: a good clinical outcome is not associated with improved
abdominal muscle function. Eur Spine J. 2012;21:1301-10.
Ferreira PH, Ferreira ML, Maher CG, Refshauge K, Herbert
RD, Hodges PW. Changes in recruitment of transversus
abdominis correlate with disability in people with chronic
low back pain. Br J Sports Med. 2010;44:1166-72.
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