骨盆活動度訓練結合穿戴式生理回饋系統對退化性腰椎疾病患者步態表現之影響

Abstract

背景：退化性腰椎疾病（DLD）患者常因腰椎和骨盆區域的疼痛和本體感覺受損而導致步態表現不佳，造成患者在走路時骨盆傾斜幅度和腰椎屈曲範圍均減少。但過往的控制訓練在沒有回饋的提示下容易使用不正確的關節，從而產生代償性動作，降低訓練效果。為了改善這問題，本研究開發創新的訓練介入，專注於骨盆活動度訓練，並結合穿戴式裝置回饋系統，以提升患者對骨盆活動度的感知。 目的：探討結合穿戴式生理回饋之骨盆活動度訓練對退化性腰椎疾病患者步態表現之影響。 實驗設計：準實驗研究。 實驗方法：受試者將分為退化性腰椎疾病患者組和同年齡之健康控制組，兩組受試者皆接受約二十分鐘的穿戴式生理回饋之骨盆活動度訓練。並於介入前後分別以舒適的速度進行十公尺步行測試。步態動作將通過兩顆無線感測器、兩台手機和OpenCap軟體(v3.0)錄製影片，經處理後可獲得動作數據。本研究主要的測量結果為步態參數，而次要測量結果則包括走路時骨盆活動度、骨盆相對加速度、下肢關節活動度與關節力矩，以及腰椎與骨盆之間的協調性，並以視覺類比量表(VAS)來測量疼痛。所有測試皆於介入前後進行，並比較患者組的變化以及與健康控制組之間的差異，以評估訓練成效。 實驗結果：共招募了三十名退化性腰椎疾病患者（平均年齡 67.53 ± 7.60 歲）和三十名同年齡層的健康人（平均年齡 66.00 ± 7.59 歲）。退化性腰椎疾病患者在介入後，步長、步頻和步速皆顯著增加（p < 0.01），每步之持續時間(step duration)則是顯著下降（p < 0.01）；其中步長與步速在介入後與健康控制組間已無顯著差異。骨盆於前後方向與內外方向之活動度及相對加速度亦顯著增加（p < 0.01），髖關節活動度以及髖、膝伸直力矩亦有顯著提升（p < 0.01）。此外，腰椎與骨盆之間的協調模式出現顯著變化，呈現較少關節間同向且較多反向的協調趨勢（p < 0.01），顯示動作協調性改善，而VAS疼痛指數在介入後亦顯著下降（p < 0.01）。 結論：骨盆活動度訓練結合穿戴式生理回饋在改善退化性腰椎疾病患者步態參數有顯著的效果，尤其在增加步長和步速。這些結果表明了骨盆活動度訓練結合即時回饋此介入可能增加了骨盆和髖關節的活動度、髖膝關節的力矩，並改善腰椎與骨盆間的協調性，以及減輕了患者的疼痛，使其能夠邁出更大步長並以更快的速度行走，從而有助於更有效率且更佳的步態表現。 臨床應用：骨盆活動度訓練結合穿戴式生理回饋介入有助於改善退化性腰椎疾病患者的步態功能，並為物理治療師提供更有效的治療方法。

Background: Patients with degenerative lumbar disease (DLD) commonly suffer from pain and impaired proprioception in the lumbar and pelvic regions, leading to poor gait performance. In DLD patients, both the range of pelvic tilt and lumbar flexion are reduced during walking. However, patients are likely to use incorrect joints for movement without feedback cues, leading to compensatory motions. Compensation reduces the effectiveness of the exercise. To address this, we developed an innovative training program focused on pelvic mobility exercises, incorporating a wearable biofeedback system to enhance patient-perceived mobility of the pelvis. It is important to investigate the effectiveness of this training on gait performance for DLD patients, as it would have benefited both patients and physical therapists. Purpose: This study aimed to investigate the effects of pelvic mobility exercises with a wearable biofeedback system on the gait performance of DLD patients. Design: A quasi-experimental study. Methods: The participants were categorized into DLD and healthy control groups. Participants in both groups underwent a 20-minute pelvic mobility exercise session with a wearable biofeedback system. Participants were asked to perform a 10-meter walk test at a comfortable speed before and after the intervention. Gait movements were recorded using two inertial measurement units and OpenCap (v0.3) with video recorded on two iPhone 14 devices. The primary outcomes were spatiotemporal gait parameters. Secondary outcomes included pelvic joint excursions, relative pelvic acceleration, lower extremity joint excursions and moments, coordination between the lumbar and pelvis during walking, and the visual analog scale (VAS) for pain. Assessments were conducted pre- and post-intervention for both groups. This study investigated changes in gait performance in DLD patients before and after the intervention, and compared the results with those of healthy controls. Results: Thirty DLD patients (mean age 67.53 ± 7.60 years) and thirty healthy controls (mean age 66.00 ± 7.59 years) were recruited. In the DLD group, step length, cadence, and velocity significantly increased, while step duration decreased after intervention (all p < 0.01). Step length and velocity no longer differed from healthy controls. Pelvic excursion and relative acceleration in the anterior-posterior and mediolateral directions significantly increased (all p < 0.01). In addition, hip joint excursion and hip and knee extension moments also showed significant improvements (all p < 0.01). Coordination between the lumbar and pelvis shifted toward less in-phase and more anti-phase patterns (p < 0.01). VAS scores also decreased significantly, indicating reduced pain after intervention in the DLD group (p < 0.01). Conclusion: Pelvic mobility exercises with a wearable biofeedback system demonstrated efficacy in improving gait parameters in DLD patients, particularly in increasing step length and velocity. The findings suggest that the intervention may enhance pelvic and hip joint mobility, increase hip and knee joint moments, and improve lumbo-pelvic coordination. It also contributed to pain reduction, enabling them to take longer steps and walk at a faster pace, thereby supporting more efficient and improved gait performance. Clinical implication: Pelvic mobility exercises with wearable biofeedback could be an alternative therapeutic option for improving gait in DLD patients in clinical settings.