臺灣博碩士論文加值系統

Background: The principles of Pilates exercises, which teach awareness of spinal alignment and an understanding of how to engage the deep postural muscles in order to support this alignment, have recently gained considerable attention for the management of non-specific chronic low back pain (NSCLBP). However, the empirical evidence in support of the effectiveness of Pilates is not only scant but also controversial, as most of the data rely on patient self-reported outcomes, which are often criticized as lacking objectivity necessary to demonstrate clinically meaningful efficacy.
Objectives: The overall objectives of this study were to investigate and document the influence of Pilates-based physical therapy exercises on radiographically-determined dynamic segmental and global range of motion (ROM), as well as to investigate the influence of the exercise intervention on lumbar lordosis and functional status in NSCLBP patients. Overall, the study attempted to examine the correlational relationship between global ROM, segmental ROM and patient’s reported functional disability.
Hypothesis: It was hypothesized that a 6–8-week Pilates-based physical therapy exercise program would result in objectively measurable increases in both global and segmental ROM, lumbar lordosis as well as improvement in functional disability. Moreover, it was hypothesized that there will be interaction between these variables.
Design: A case series design was adopted with analyses at study entry and post-intervention.
Methods: Eighteen patients aged 20-65 years with NSCLBP enrolled in a 6–8-week Pilates-based physical therapy program. All participants underwent lateral lumbar spine and pain-tolerable full flexion and extension radiographs prior to and following a Pilates-based physical therapy exercise intervention. Global ROM at intervertebral levels L1–S1, as well as individual segmental motion values, were determined using computer-assisted software. Change scores were calculated for the change from baseline to 6–8-week scores in global ROM and individual segmental ROMs, as well as lumbar lordosis. The patient-reported levels of disability were recorded by LBP condition-specific tools (Oswestry Disability Index, and Roland Morris Disability Questionnaire) at study entry and post-intervention.
Results: The exercise intervention was associated with an overall increase in the global ROM and a general trend of a gradual increase in the individual segmental ROMs. Increases were statistically significant for the global ROM (p<0.001) as well as the segmental ROMs in L3–4 (p=0.011) and L5–S1 (p=0.014). Post-exercise intervention also showed a significant improvement in patient-reported levels of disability scores (p<0.05). However, despite the positive improvement observed for both ROM and patient reported functional disability, no statistically significant correlational relationship was found.
Conclusion: A 6–8-week Pilates-based physical therapy exercise program improved functional disability and ROM with participants demonstrating a more physiologically consistent pattern of movement of the lumbar spine post-exercise intervention.

Background: The principles of Pilates exercises, which teach awareness of spinal alignment and an understanding of how to engage the deep postural muscles in order to support this alignment, have recently gained considerable attention for the management of non-specific chronic low back pain (NSCLBP). However, the empirical evidence in support of the effectiveness of Pilates is not only scant but also controversial, as most of the data rely on patient self-reported outcomes, which are often criticized as lacking objectivity necessary to demonstrate clinically meaningful efficacy.
Objectives: The overall objectives of this study were to investigate and document the influence of Pilates-based physical therapy exercises on radiographically-determined dynamic segmental and global range of motion (ROM), as well as to investigate the influence of the exercise intervention on lumbar lordosis and functional status in NSCLBP patients. Overall, the study attempted to examine the correlational relationship between global ROM, segmental ROM and patient’s reported functional disability.
Hypothesis: It was hypothesized that a 6–8-week Pilates-based physical therapy exercise program would result in objectively measurable increases in both global and segmental ROM, lumbar lordosis as well as improvement in functional disability. Moreover, it was hypothesized that there will be interaction between these variables.
Design: A case series design was adopted with analyses at study entry and post-intervention.
Methods: Eighteen patients aged 20-65 years with NSCLBP enrolled in a 6–8-week Pilates-based physical therapy program. All participants underwent lateral lumbar spine and pain-tolerable full flexion and extension radiographs prior to and following a Pilates-based physical therapy exercise intervention. Global ROM at intervertebral levels L1–S1, as well as individual segmental motion values, were determined using computer-assisted software. Change scores were calculated for the change from baseline to 6–8-week scores in global ROM and individual segmental ROMs, as well as lumbar lordosis. The patient-reported levels of disability were recorded by LBP condition-specific tools (Oswestry Disability Index, and Roland Morris Disability Questionnaire) at study entry and post-intervention.
Results: The exercise intervention was associated with an overall increase in the global ROM and a general trend of a gradual increase in the individual segmental ROMs. Increases were statistically significant for the global ROM (p<0.001) as well as the segmental ROMs in L3–4 (p=0.011) and L5–S1 (p=0.014). Post-exercise intervention also showed a significant improvement in patient-reported levels of disability scores (p<0.05). However, despite the positive improvement observed for both ROM and patient reported functional disability, no statistically significant correlational relationship was found.
Conclusion: A 6–8-week Pilates-based physical therapy exercise program improved functional disability and ROM with participants demonstrating a more physiologically consistent pattern of movement of the lumbar spine post-exercise intervention.

TABLE OF CONTENTS

Acknowledgments i
ABSTRACT ii
Abbreviations vi
List of Tables vii
List of Figures viii
List of Appendix ix
Chapter 1: Introduction 1
1.1 Background of the study 1
1.2 Statement of the problem 2
1.3 Purpose of the study 3
1.4 Significance of the study 3
1.5 Primary research questions 4
1.6 Secondary research question 4
1.7 Hypothesis 4
Chapter 2: Review of literature 5
2.1 Non-Specific Low Back Pain(NSLBP) 5
2.1.1 Definition of Mechanical LBP or NSLBP 5
2.1.2 Prevalence of LBP 5
2.1.3 Contributing risk factors for LBP development 7
2.1.4 Mechanism of NSLBP 8
2.2 Core Stability 9
2.2.1 What is the core? 9
2.2.2 Theory concerning core stability 10
2.2.3 Anatomy and functional mechanisms of the core 12
2.2.4 How is core stability affected in LBP? 13
2.2.5 Therapeutic exercise - core stabilization exercise - as treatment of NSLBP 14
2.3 Pilates-based exercises 15
2.3.1 Description and evolutional history of Pilates exercise 15
2.3.2 How Pilates-based exercises improve LBP 15
2.3.3 Evidence for effects of Pilates-based exercise 16
2.4 Selection of outcome measures 19
2.4.1 Objective outcome measures 19
2.4.2 Patient Self-Reported Outcome Measures 19
Chapter 3: Materials and Methodology 21
3.1 Research design 21
3.2 Participants 22
3.3 Sample size 22
3.4 Inclusion and exclusion criteria 23
3.5 Instruments 24
3.5.1 Radiographic measurement 24
3.5.2 Functional outcome measures 25
3.5.2.1 The Roland Morris Disability Questionnaire (RMDQ) 25
3.5.2.2 Oswestry Disability Index 26
3.6 Interventions 26
3.7 Statistical analysis 27
Chapter 4: Results 28
4.1 Participant enrolment and procedure 28
4.2 Outcome measures: 29
4.2.1 Level of disability: 29
4.2.2 Global Range of Motion (ROM) 29
4.2.3 Segmental ROM 30
4.2.4 Relative segmental contribution towards the overall global ROM 30
4.2.5 Lumbar lordosis 31
4.2.6 Relationship between changes in lumbar global ROM and functional status 32
Chapter 5: Discussion 33
Chapter 6: Conclusion 37
References 38
Appendices 48

List of Tables

Table 1: Global and local muscles for spinal stability 13
Table 2: Studies investigating the effectiveness of Pilates-based exercise incorporating objective outcome measures 18
Table 3: Functional outcome measures 25
Table 4: Level of disability pre- and post-intervention of a 6–8-week Pilates-based Physical Therapy program 29
Table 5: Non-parametric Correlation coefficient (Spearman’s) between change in global ROM and level of disability prior and post-intervention 32

List of Figures
Figure 1: Mechanism of NSLBP 9
Figure 2: Panjabi Core Stability Model (1992) [77] 11
Figure 3: Six subsystems of movement (adapted from Hoffman and Gabel, 2013) [89] 12
Figure 4: Study Flowchart 22
Figure 5: Illustration of the computer-assisted measurement of the global lumbar range of motion (α) and individual lumbar segmental range of motion (θ) when performing pain-tolerable movements from (A) Neutral position to (B) Full Flexion and (C) Full Extension using dynamic radiographs. 25
Figure 6: Participant enrolment and procedures 28
Figure 7: Global ROM prior to and after a 6–8-week Pilates-based Physical Therapy program 29
Figure 8: Segmental ROM before and after a 6–8-week Pilates-based Physical Therapy program 30
Figure 9: A summary of segmental contribution to the overall global ROM at pre- and post-intervention 31
Figure 10: Lumbar Cobb angles prior to and after a 6–8-week Pilates based Physical Therapy program 31

List of Appendices

Appendix A: Approval Letter from CMUH Research Ethics Committee 48
Appendix B: CMUH Consent Form 49
Appendix C: Roland Morris Disability Questionnaire (RMDQ) 51
Appendix D: Oswestry Disability Index (ODI) 52
Appendix E: Intervention Program/ in-Home Exercise Program Sheet 54

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