Prognostic Indicators of Low Back Pain in Primary Care: Five-Year Prospective Study
Prognostic Indicators of Low Back Pain in Primary Care: Five-Year Prospective Study
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DOI：
10.1016/j.jpain.2013.03.013
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发表时间：
2013-08-01
期刊：
影响因子：
4
通讯作者：
Dunn, Kate M.
中科院分区：
文献类型：
--
作者：
Campbell, Paul;Foster, Nadine E.;Dunn, Kate M.
背部疼痛很常见，许多人都经历了长期的问题，但人们对哪些预后因素预测长期结果知之甚少。这项研究的目的是确定哪些因素可以预测患有下腰痛(LBP)的初级保健咨询者的短期和长期结果。对488名向医生咨询过LBP的患者进行了分析。随访6个月和5年。临床上有意义的LBP在随访时被定义为慢性疼痛等级的2、3或4分，表明有实质性的疼痛和残疾。用COX回归估计32个潜在预测因素(人口、生理、心理和职业)的相对风险(RR)，其可信区间(CLS)为95%。基线疼痛强度使风险增加12%(RR=1.12，95%CI=1.03~1.20)，患者相信自己的LBP将持续存在，导致6个月后预后不良的风险增加4%(RR=1.04，95%CI=1.01~1.07)。用与6个月模型相同的因素预测5年的结果最好：疼痛强度增加风险9%(RR=1.09，95%CI=.997-1.20)，相信他们会持续LBP的风险增加6%(RR=1.06，95%CI=1.03-1.09)。这两个预测因素都有可能成为临床干预的目标。观点：很少有研究调查预测长期背部疼痛的因素。这项研究表明，在初级保健咨询期间经历的疼痛强度，以及患者对其背部疼痛是否会持续的看法，是6个月和5年后预后较差的显著预测因素。(C)2013年度美国疼痛协会
Back pain is common and many people experience long-term problems, yet little is known about what prognostic factors predict long-term outcomes. This study's objective was to determine which factors predict short- and long-term outcomes in primary care consulters with low back pain (LBP). Analysis was carried out on 488 patients who had consulted their physician about LBP. Patients were followed up at 6 months and 5 years. Clinically significant LBP at follow-up was defined as a score of 2, 3, or 4 on the Chronic Pain Grade, indicating substantial pain and disability. Cox regression was used to estimate relative risks (RRs) with 95% confidence intervals (Cls) on 32 potential predictive factors, organized into domains (demographic, physical, psychological, and occupational). Baseline pain intensity conferred a 12% increase in risk (RR = 1.12, 95% Cl = 1.03-1.20), and patients' belief that their LBP would persist conferred a 4% increase in risk (RR = 1.04, 95% Cl = 1.01-1.07) for poor outcome at 6 months. Outcome at 5 years was best predicted by a model with the same factors as in the 6-month model: pain intensity increased risk by 9% (RR = 1.09, 95% Cl = .997-1.20), and a belief that their LBP would persist increased risk by 6% (RR = 1.06, 95% Cl = 1.03-1.09). Both predictors have the potential to be targets for clinical intervention.Perspective: Few studies have investigated factors that predict long-term back pain. This study has shown that pain intensity experienced during a period of primary care consultation, and patients' perception about whether their back pain will persist, were significant predictors of poor outcome at 6 months and at 5 years. (C) 2013 by the American Pain Society