Prognostic indicators for poor outcomes in low back pain patients consulted in primary care
Prognostic indicators for poor outcomes in low back pain patients consulted in primary care
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DOI：
10.1371/journal.pone.0229265
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发表时间：
2020-03-27
期刊：
影响因子：
3.7
通讯作者：
Nunes, Carla
中科院分区：
文献类型：
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作者：
Cruz, Eduardo B.;Canhao, Helena;Nunes, Carla
非特异性下腰痛（Non-specific low back pain，NSLBP）是西方国家最常见的肌肉骨骼疾病，与持续性残疾和高医疗资源消耗有关。NSLBP患者首先寻求初级卫生保健服务，但结果往往不确定。本研究的目的是检查临床过程中的结果，并确定预后指标不良的NSLBP患者谁咨询primary care.MethodsA前瞻性队列研究的115例患者寻求治疗NSLBP在初级保健进行。参与者由他们的全科医生（GP）连续招募，然后在基线和2个月和6个月后进行评估。基线评估包括社会人口统计学和临床数据、心理社会因素、疼痛、残疾和健康相关生活质量（HRQoL）。在2个月和6个月随访时，还评估了疼痛、残疾、HRQoL和整体变化感知。此外，还收集了有关全科医生做法的信息。根据用于定义持续性残疾状况的截止点以及为残疾、疼痛和整体变化感知确定的最小重要变化确定不良结局。通过二元逻辑回归分析调整基线变量与不良结局之间的关系。协会的意义进行了评估。0.05结果110例（94.8%）和104例（89.7%）受试者分别在2个月和6个月时完成了随访评估。平均年龄（+/- SD）为48.06 +/- 11.41，53.9%（N = 62）报告了NSLBP的急性表现。在全科医生咨询后6个月，53.8%（N = 56）的参与者报告了持续的残疾状况。“LBP发作少于12周”[AOR：0.26; 95% CI（0.10，0.65）; AOR：0.34; 95% CI（0.14，0.81）; AOR：0.21; 95% CI（0.09，0.53）]，“适应不良的心理社会因素”[AOR：2.06; 95%CI（1.40，3.04）; AOR：1.82; 95% CI（1.27，2.59）; AOR：1.72; 95% CI（1.20，2.47）]分别与残疾、疼痛和整体变化感知的不良结局显著相关。除了这些因素，被雇用的机会减少残疾的不良结果[AOR 0.31; 95%CI（0.11，0.92）]。ConclusionsA大比例的LBP患者寻求初级卫生保健报告不良结果6个月后，家庭医生咨询。报告慢性LBP、适应不良心理社会因素和失业的患者预后不良的风险显著增加。这些研究结果表明，需要实施有效的护理模式，能够为那些最有可能出现不良结局的人提供早期筛查和适当治疗。
BackgroundNon-specific low back pain (NSLBP) is the most prevalent musculoskeletal condition in western countries and is associated with persistent disability and high consumption of health care resources. NSLBP patients first seek primary health care services but the outcomes are often uncertain. This study aimed to examine the clinical course of the outcomes and to identify prognostic indicators for poor outcomes in NSLBP patients who consulted primary care.MethodsA prospective cohort study of 115 patients seeking treatment for NSLBP in primary care was conducted. Participants were consecutively recruited by their General Practitioners (GPs) and then assessed at baseline and 2 and 6 months later. Baseline assessment included socio-demographic and clinical data, psychosocial factors, pain, disability, and health related quality of life (HRQoL). Pain, disability, HRQoL and global perception of change were also assessed at 2 and 6-months' follow-up. In addition, information regarding the GP' practice was collected. Poor outcomes were determined according to the cut-off point used to define a persistent disabling condition and the minimal important change established for disability, pain and for global perception of change. The relationship between variables on baseline and poor outcomes was modulated through binary logistic regression analysis. The significance of associations was evaluated at. 0.05 p-value with 95% confidence intervals (CI) and adjusted odds ratios (AOR).Results110 (94.8%) and 104 (89.7%) participants completed the follow-up assessment at 2 and 6 months, respectively. The mean age (+/- SD) was 48.06 +/- 11.41, with 53.9%, (N = 62) reporting an acute presentation of NSLBP. Six months after GP consultation, 53.8% (N = 56) of the participants reported a persistent disabling condition. An "LBP episode of less than 12 weeks" [AOR: 0.26; 95% CI (0.10, 0.65); AOR: 0.34; 95% CI (0.14, 0.81); AOR: 0.21; 95% CI (0.09, 0.53)],"maladaptive psychosocial factors" [AOR: 2.06; 95% CI (1.40, 3.04); AOR: 1.82; 95% CI (1.27, 2.59); AOR: 1.72; 95% CI (1.20, 2.47)] were significantly associated with poor outcomes on disability, pain and global perception of change, respectively. Besides these factors, being employed reduces the chances of poor outcomes on disability [AOR 0.31; 95% CI (0.11, 0.92)].ConclusionsA large proportion of LBP patients seeking primary health care reported poor outcomes 6 months after GP consultation. Patients who report chronic LBP, maladaptive psychosocial factors and are unemployed have a significant increase in the risk of poor outcome. These findings suggest the need of implementing effective models of care able to provide early screening and appropriate treatment to those at greatest risk of a poor outcome.