| Summary: | 碩士 === 國立成功大學 === 物理治療研究所 === 92 === Background and Purpose. Conflicting reports existed concerning the efficacy of trunk flexion and extension exercise in patients with degenerative spondylolisthesis (DS), possibly due to lack of direct evidence on the improvement of lumbar stability and thoroughly objective evaluation for stability related performance. Contrary to the theoretical basis of flexion exercise, the results of functional radiography have further shown significantly larger anterior lumbar translation during trunk flexion in comparison with that during trunk extension in patient with DS The purpose of this study is to compare the effect of flexion with that of extension exercise on lumbar stability and stability related performance in patients with DS for providing better suggestions to effective intervention. Methods. Twenty-one subjects with L4-5 DS randomly assigned to attend flexion (Flex) or extension exercises (Ext) for 3 months. Another 8 subjects with L4-5 DS were recruited as control subjects. Outcome measurements including lumbar stability, pain, back function, flexibility, local muscle strength, and the ability of lumbar control were conducted prior treatment at 1 month (1M), and at 3 months (3M) afterwards. To compare the differences among different treatment groups, several Kruskal-Wallis one-way analysis of variance procedures were conducted for examining all continuous variables and Chi-square tests were conducted for examining all nominal variables. Friedman two-way analysis of variance procedures were used to examine treatment effects at different stages of assessment for each treatment group. Results. Significant improvements in back pain, back function, and muscle strength were found in exercise group but not in control group at 3 months after initial assessment, however no significant differences were found between Flex group and Ext group. However, Flex group was found to exhibit more degree of spondylolisthesis at L4-5 after 3M treatment in lateral radiographs. (p<0.05) In addition, while significant improvements in leg pain and the velocity of lumbar extension movement from forward bended position was soon found at 1M for Flex group (p<0.05).These effects did not last long enough to the end of treatment (3M). In contrast, Ext group showed gradually significant improvements in these aspects especially at the end of treatment (3M) (p<0.05). Discussion and Conclusion. Both Flex and Ext groups showed significantly more improvements than control group in pain, back function, muscle strength, and the ability of lumbar control after 3-month intervention. However, significantly more anterior spondylolisthesis was also found in Flex group after 3-month intervention. Although significant short-term effect on pain status and back function was soon found at 1-month after flexion intervention, extension intervention is the one to be recommended because of better lumbar stability shown in the long round(3M). Further study is needed to follow up the long-term effect of exercise intervention on lumbar stability.
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