Measuring practitioner/therapist effects in randomised trials of low back pain and neck pain interventions in primary care settings
Measuring practitioner/therapist effects in randomised trials of low back pain and neck pain interventions in primary care settings
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DOI：
10.1016/j.ejpain.2010.04.002
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发表时间：
2010-11-01
影响因子：
3.6
通讯作者：
Main, Chris J.
中科院分区：
文献类型：
--
作者：
Lewis, Martyn;Morley, Stephen;Main, Chris J.
在心理健康治疗研究中，已经表明治疗师之间的差异解释了治疗的一些非特异性效果，但这种现象迄今尚未在肌肉骨骼疾病中进行系统研究。在这项研究中，我们评估和比较的大小和潜在的影响，“医生的效果”（或“治疗师的效果”）在三个随机治疗试验的腰痛和颈部疼痛患者在初级保健。我们计算了可归因于不同从业者之间差异的结果方差比例，即修正方差分配系数（p-vpc）。作为结果的衡量标准，我们把自我报告的残疾作为主要结果，但我们也调查了评估的心理结果。各试验和时间点（治疗后和随访）残疾指标的p-vpc范围为2.6%至7.1%。在试验中，治疗亚组之间的估计值存在差异;在分配到基于心理社会的干预措施的治疗亚组中最高。“从业者效应”确实存在，并且在涉及更大的心理社会强调的治疗中更为明显。这对这一临床领域的实践和研究都有影响。它强调了患者与医生互动的重要性，以及在设计和分析初级保健中腰痛和颈痛的结局研究时解决医生影响的必要性。(C)2010年，国际疼痛分会研究协会欧洲联合会。由爱思唯尔有限公司出版。保留所有权利。
In psychological health treatment studies it has been shown that differences between therapists account for some of the non-specific effect of treatment but this phenomenon has not so far systematically been investigated in musculoskeletal disorders. In this study we evaluated and compared the size and potential influence of the 'practitioner effect' (or 'therapist effect') in three randomised treatment trials of low back pain and neck pain patients in primary care. We calculated the proportion of variance in outcomes attributable to differences across practitioners, i.e. the practitioner-variance partition coefficient (p-vpc). As measures of outcome, we focused on self-reported disability as the primary outcome, but we also investigated assessed psychological outcomes. The p-vpc for the disability measures ranged from 2.6% to 7.1% across trials and time points (post treatment and follow up). Estimates differed between treatment subgroups within trials; being highest in treatment subgroups assigned to psychosocial-based interventions. A 'practitioner effect' does exist and is more pronounced in treatments involving greater psychosocial emphasis. This has implications for both practice and research in this clinical area. It highlights the importance of patient-practitioner interactions, and the need to address practitioner effects in designing and analysing outcome studies in low back pain and neck pain in primary care. (C) 2010 European Federation of International Association for the Study of Pain Chapters. Published by Elsevier Ltd. All rights reserved.