Will This Patient Develop Persistent Disabling Low Back Pain?
Will This Patient Develop Persistent Disabling Low Back Pain?
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DOI：
10.1001/jama.2010.344
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发表时间：
2010-04-07
影响因子：
120.7
通讯作者：
Shekelle, Paul
中科院分区：
文献类型：
--
作者：
Chou, Roger;Shekelle, Paul
背景下腰痛是非常常见的。早期识别更有可能出现持续性致残症状的患者，有助于指导有关随访和治疗的决策。目的系统地回顾单个风险因素或风险预测工具在识别更有可能发展为持续性致残下腰痛的患者方面的有用性。数据来源：电子检索MEDLINE(1966-2010年1月)和EMBASE(1974-2010年2月)，并回顾检索到的文章的参考文献。研究选择对腰痛持续时间少于8周的患者进行前瞻性研究，计算似然比(LRs)以预测持续性致残下腰痛，以获得在临床评估中可获得的结果两位作者独立评估了这些研究，并提取了数据来估计LRR。数据综合总共确定了20项研究，评估了10842名患者。存在非器质性体征(中位数[范围]LR，3.0[1.7-4.6])，高水平的不适应疼痛应对行为(中位数[范围]LR，2.5[2.2-2.8])，高基线功能损害(中位数[范围]LR，2.1[1.2-2.7])，存在精神合并症(中位数[范围]LR，2.2[1.9-2.3])，以及一般健康状况较低(中位数[范围]LR，1.8[1.1-2.0])是1年后预后更差的最有用的预测因子。低水平的恐惧回避(中位数[范围]LR，0.39[0.38-0.40])和低基线功能损害(中位数[范围]LR，0.40[0.10-0.52])是预测1年后康复的最有用的项目。3到6个月的结果相似。与工作环境、基线疼痛和是否存在神经根病相关的变量对预测更糟糕的结果用处较小(中位数LRS约为1.5)，既往腰痛发作史和人口统计变量也没有用处(中位数LRS约为1.0)。有几种风险预测工具可用于预测结果，但没有一种得到广泛验证，一些验证研究显示LRs与单个风险因素的估计值相似。结论对预测持续性下腰痛最有帮助的成分是适应不良疼痛应对行为、非器质性体征、功能障碍、一般健康状况和存在精神疾病并存。贾玛2010；303(13)：1295-1302
Context Low back pain is extremely common. Early identification of patients more likely to develop persistent disabling symptoms could help guide decisions regarding follow-up and management.Objective To systematically review the usefulness of individual risk factors or risk prediction instruments for identifying patients more likely to develop persistent disabling low back pain.Data Sources Electronic searches of MEDLINE (1966-January 2010) and EMBASE (1974-February 2010) and review of the bibliographies of retrieved articles.Study Selection Prospective studies of patients with fewer than 8 weeks of low back pain from which likelihood ratios (LRs) were calculated for prediction of persistent disabling low back pain for findings attainable during the clinical evaluation.Data Extraction Two authors independently assessed studies and extracted data to estimate LRs.Data Synthesis A total of 20 studies evaluating 10 842 patients were identified. Presence of nonorganic signs (median [range] LR, 3.0 [1.7-4.6]), high levels of maladaptive pain coping behaviors (median [range] LR, 2.5 [2.2-2.8]), high baseline functional impairment (median [range] LR, 2.1 [1.2-2.7]), presence of psychiatric comorbidities (median [range] LR, 2.2 [1.9-2.3]), and low general health status (median [range] LR, 1.8 [1.1-2.0]) were the most useful predictors of worse outcomes at 1 year. Low levels of fear avoidance (median [range] LR, 0.39 [0.38-0.40]) and low baseline functional impairment (median [range] LR, 0.40 [0.10-0.52]) were the most useful items for predicting recovery at 1 year. Results were similar for outcomes at 3 to 6 months. Variables related to the work environment, baseline pain, and presence of radiculopathy were less useful for predicting worse outcomes (median LRs approximately 1.5), and a history of prior low back pain episodes and demographic variables were not useful (median LRs approximately 1.0). Several risk prediction instruments were useful for predicting outcomes, but none were extensively validated, and some validation studies showed LRs similar to estimates for individual risk factors.Conclusion The most helpful components for predicting persistent disabling low back pain were maladaptive pain coping behaviors, nonorganic signs, functional impairment, general health status, and presence of psychiatric comorbidities. JAMA. 2010;303(13):1295-1302