Development of a collaborative model of low back pain: report from the 2017 NASS consensus meeting
Development of a collaborative model of low back pain: report from the 2017 NASS consensus meeting
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DOI：
10.1016/j.spinee.2018.11.014
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发表时间：
2019-06-01
期刊：
影响因子：
4.5
通讯作者：
Hodges, Paul W.
中科院分区：
文献类型：
--
作者：
Cholewicki, Jacek;Popovich, John M., Jr.;Hodges, Paul W.
背景：腰痛（LBP）是一个多因素的问题，许多生物、心理和社会因素之间存在复杂的相互作用。完全理解这种复杂性是困难的，因为这样做所需的知识分布在跨越生物心理社会领域的许多专业领域。目的：本研究描述了协作建模过程，在一组具有不同LBP专业知识的参与者之间进行，以建立一个模型，以增强对LBP问题复杂性的理解和交流。研究设计：该研究包括使用模糊认知映射（FCM）生成代表参与者对LBP问题理解的个体模型，以及随后与参与者协商和达成共识的4个阶段，以表征和完善FCM的解释。方法：模型组件聚类的分类建议阶段；对参赛者fcm的结构、组成和重点领域进行初步评估；通过协商一致会议改进类别和组成部分；生成个体参与者fcm的最终结构和组成。描述性统计应用于单个fcm的结构和组成指标，以帮助解释。结果：38位受邀贡献者中，29位（76%）同意参与。他们代表了9个学科和8个国家。参与者的模型包括729个组件，每个模型平均25个（SD = 7）。在最后的FCM细化过程之后（来自使用相似术语的单独FCM的组件被合并，来自包含多个术语的FCM的组件被分离），有147个组件被分配到10个类别。尽管个体模型的结构和组成各不相同，但人们普遍认为心理因素在LBP的表现中尤为重要。总的来说，分配给“心理学”类别的组件在几乎一半（14/29）的单个模型中是最核心的。结论：本文概述的协作建模过程为更好地理解和传达LBP问题的复杂性提供了基础。下一步是将单个fcm聚合到元模型中，并开始解开其组件之间的交互。这将导致对LBP复杂性的更好理解，并有望改善患有这种疾病的患者的预后。(C) 2018爱思唯尔公司版权所有。
BACKGROUND CONTEXT: Low back pain (LBP) is a multifactorial problem with complex interactions among many biological, psychological and social factors. It is difficult to fully appreciate this complexity because the knowledge necessary to do so is distributed over many areas of expertise that span the biopsychosocial domains.PURPOSE: This study describes the collaborative modeling process, undertaken among a group of participants with diverse expertise in LBP, to build a model to enhance understanding and communicate the complexity of the LBP problem.STUDY DESIGN: The study involved generating individual models that represented participants' understanding of the LBP problem using fuzzy cognitive mapping (FCM), and 4 subsequent phases of consultation and consensus with the participants to characterize and refine the interpretation of the FCMs.METHODS: The phases consisted of: proposal of Categories for clustering of model Components; preliminary evaluation of structure, composition and focal areas of participant's FCMs; refinement of Categories and Components with consensus meeting; generation of final structure and composition of individual participant's FCMs. Descriptive statistics were applied to the structural and composition metrics of individual FCMs to aid interpretation.RESULTS: From 38 invited contributors, 29 (76%) agreed to participate. They represented 9 disciplines and 8 countries. Participants' models included 729 Components, with an average of 25 (SD = 7) per model. After the final FCM refinement process (Components from separate FCMs that used similar terms were combined, and Components from an FCM that included multiple terms were separated), there were 147 Components allocated to ten Categories. Although individual models varied in their structure and composition, a common opinion emerged that psychological factors are particularly important in the presentation of LBP. Collectively, Components allocated to the "Psychology" Category were the most central in almost half (14/29) of the individual models.CONCLUSIONS: The collaborative modeling process outlined in this paper provides a foundation upon which to build a greater understanding and to communicate the complexity of the LBP problem. The next step is to aggregate individual FCMs into a metamodel and begin disentangling the interactions among its Components. This will lead to an improved understanding of the complexity of LBP, and hopefully to improved outcomes for those suffering from this condition. (C) 2018 Elsevier Inc. All rights reserved.