A systematic review of psychological factors as predictors of chronicity/disability in prospective cohorts of low back pain.
A systematic review of psychological factors as predictors of chronicity/disability in prospective cohorts of low back pain.
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DOI：
10.1097/00007632-200203010-00017
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发表时间：
2002-03-01
期刊：
影响因子：
3
通讯作者：
Field, Andy P
中科院分区：
文献类型：
--
作者：
Pincus, Tamar;Burton, A Kim;Field, Andy P
研究设计：腰痛前瞻性队列研究的系统综述。目的：评估暗示心理因素与腰痛慢性化发展有关的证据。背景数据摘要：生物心理社会模型在腰痛方面越来越被接受，并为筛查测量、指南和干预措施提供了基础;然而，迄今为止，心理因素在从急性表现向慢性转变中的独特作用尚未得到严格评估。一个系统的文献检索后，应用三套标准，每项研究：方法学质量，心理因素的测量质量，统计分析的质量。两名评审员对每项研究进行盲法编码，然后由统计学家进行独立评估。研究分为三个环境：初级保健设置，疼痛诊所，workings.RESULTS：25出版物（18个队列）包括心理因素在基线。其中6项符合方法学、心理测量和统计分析的可接受标准。主要发现是心理困扰/抑郁情绪和躯体化（程度较低）导致慢性化（持续症状和/或残疾）的风险增加。可接受的证据一般没有发现其他的心理因素，虽然弱支持出现的作用，灾难化作为一种应对策略。结论：心理因素（特别是苦恼，抑郁情绪，和躯体化）有牵连的过渡到慢性腰痛。指出了专门针对这些因素的临床干预措施的开发和测试。鉴于其他心理因素（特别是应对策略和恐惧回避）的重要性，有必要通过严格的前瞻性研究，澄清它们在背部相关残疾中的作用。
STUDY DESIGN: A systematic review of prospective cohort studies in low back pain.OBJECTIVES: To evaluate the evidence implicating psychological factors in the development of chronicity in low back pain.SUMMARY OF BACKGROUND DATA: The biopsychosocial model is gaining acceptance in low back pain, and has provided a basis for screening measurements, guidelines and interventions; however, to date, the unique contribution of psychological factors in the transition from an acute presentation to chronicity has not been rigorously assessed.METHODS: A systematic literature search was followed by the application of three sets of criteria to each study: methodologic quality, quality of measurement of psychological factors, and quality of statistical analysis. Two reviewers blindly coded each study, followed by independent assessment by a statistician. Studies were divided into three environments: primary care settings, pain clinics, and workplace.RESULTS: Twenty-five publications (18 cohorts) included psychological factors at baseline. Six of these met acceptability criteria for methodology, psychological measurement, and statistical analysis. Increased risk of chronicity (persisting symptoms and/or disability) from psychological distress/depressive mood and, to a lesser extent, somatization emerged as the main findings. Acceptable evidence generally was not found for other psychological factors, although weak support emerged for the role of catastrophizing as a coping strategy.CONCLUSION: Psychological factors (notably distress, depressive mood, and somatization) are implicated in the transition to chronic low back pain. The development and testing of clinical interventions specifically targeting these factors is indicated. In view of the importance attributed to other psychological factors (particularly coping strategies and fear avoidance) there is a need to clarify their role in back-related disability through rigorous prospective studies.