What have we learned from ten years of trajectory research in low back pain?
What have we learned from ten years of trajectory research in low back pain?
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DOI：
10.1186/s12891-016-1071-2
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发表时间：
2016-05-21
影响因子：
2.3
通讯作者：
Dunn KM
中科院分区：
文献类型：
--
作者：
Kongsted A;Kent P;Axen I;Downie AS;Dunn KM
非特异性腰痛（LBP）通常通过关注当前发作的持续时间来分类为急性，亚急性或慢性。然而，二十多年前，人们认识到腰痛往往是一种发作性疾病，这一概念受到了挑战。这种偶发性也意味着LBP的病程不能很好地用总体平均值来描述。因此，研究已经调查了是否可以确定更好地反映个人课程模式的特定LBP轨迹。在Dunn等人于2006年发表的关于LBP轨迹的开创性研究之后，许多后续研究也确定了LBP轨迹，现在是时候提供他们的研究结果的概述，并讨论这些轨迹的见解如何有助于提高我们对LBP及其临床管理的理解。成人的LBP轨迹已经通过十个队列中的数据驱动方法确定，并且这些一致地证明存在不同的轨迹模式。尽管研究之间存在一些差异，但在不同的环境和国家中已经确定了共同的轨迹，这些轨迹与来自不同健康领域的许多患者特征有关。一项研究表明，许多人的这种轨迹在几年内是稳定的。LBP轨迹似乎是可识别的患者，并呼吁临床医生，我们讨论了其潜在的有用性作为预后因素，效果调节，并作为一种工具，以支持与患者的沟通。对轨迹的研究支持了急性和慢性LBP之间的区分过于简单化的观点，我们认为现在是时候从这种范式转变为关注随时间推移的轨迹。我们认为，轨迹模式可能代表LBP的实际表型，可以改善与患者的临床对话，并可能有潜力支持临床决策，但其有用性仍有待探索。
Non-specific low back pain (LBP) is often categorised as acute, subacute or chronic by focusing on the duration of the current episode. However, more than twenty years ago this concept was challenged by a recognition that LBP is often an episodic condition. This episodic nature also means that the course of LBP is not well described by an overall population mean. Therefore, studies have investigated if specific LBP trajectories could be identified which better reflect individuals’ course patterns. Following a pioneering study into LBP trajectories published by Dunn et al. in 2006, a number of subsequent studies have also identified LBP trajectories and it is timely to provide an overview of their findings and discuss how insights into these trajectories may be helpful for improving our understanding of LBP and its clinical management. LBP trajectories in adults have been identified by data driven approaches in ten cohorts, and these have consistently demonstrated that different trajectory patterns exist. Despite some differences between studies, common trajectories have been identified across settings and countries, which have associations with a number of patient characteristics from different health domains. One study has demonstrated that in many people such trajectories are stable over several years. LBP trajectories seem to be recognisable by patients, and appealing to clinicians, and we discuss their potential usefulness as prognostic factors, effect moderators, and as a tool to support communication with patients. Investigations of trajectories underpin the notion that differentiation between acute and chronic LBP is overly simplistic, and we believe it is time to shift from this paradigm to one that focuses on trajectories over time. We suggest that trajectory patterns may represent practical phenotypes of LBP that could improve the clinical dialogue with patients, and might have a potential for supporting clinical decision making, but their usefulness is still underexplored.