Matching treatment options for risk sub-groups in musculoskeletal pain: a consensus groups study
Matching treatment options for risk sub-groups in musculoskeletal pain: a consensus groups study
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DOI：
10.1186/s12891-019-2587-z
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发表时间：
2019-06-01
影响因子：
2.3
通讯作者：
Foster, Nadine E.
中科院分区：
文献类型：
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作者：
Protheroe, Joanne;Saunders, Benjamin;Foster, Nadine E.
背景：肌肉骨骼（MSK）疼痛是全球范围内相当大的医疗负担。本研究旨在获得与MSK疼痛患者一起工作的从业人员的共识，基于持续致残性疼痛的预后风险，为患者亚组提供最合适的初级保健治疗方案。针对五种最常见的MSK疼痛表现（背部、颈部、膝关节、肩部和多部位疼痛），在三个风险亚组（低、中、高）中寻求治疗方案的一致意见。使用名义组技术与多学科从业者组（n=20）进行了三次共识组会议，采用一种系统的方法，通过利益攸关方的结构化面对面会议建立共识，会议遵循一系列不同的阶段。对于所有五种疼痛表现，“教育和建议”和“简单的口服和局部止痛药”被认为适用于所有亚组。对于低风险患者，在所有五种疼痛表现中，“如果6周后没有改善，则由初级保健医生进行审查”也达成了共识。中度风险患者的治疗选择在疼痛表现上略有不同，但都包括：考虑转诊到物理治疗，并考虑转诊到MSK接口诊所。高风险患者的治疗选择也因疼痛表现而异。其中包括一些与中等风险患者相同的选择，其他选择包括：“阿片类药物”;考虑转诊至专家患者计划（针对所有疼痛表现）;以及“考虑转诊以征求手术意见”（背部、膝盖、颈部、肩部）。考虑转介到风湿病同意在中，高风险的患者有multisite pain.Conclusion：在解决目前缺乏强有力的证据对MSK疼痛的不同治疗方案的有效性，这项研究产生的共识，从从业者对MSK患者的最适当的初级保健治疗方案分层根据预后风险。这些发现有助于为未来的临床决策提供信息，也影响了MSK疼痛患者分层初级护理试验中的匹配治疗方案。
Background: Musculoskeletal (MSK) pain represents a considerable worldwide healthcare burden. This study aimed to gain consensus from practitioners who work with MSK pain patients, on the most appropriate primary care treatment options for subgroups of patients based on prognostic risk of persistent disabling pain. Agreement was sought on treatment options for the five most common MSK pain presentations: back, neck, knee, shoulder and multisite pain, across three risk subgroups: low, medium and high.Methods: Three consensus group meetings were conducted with multi-disciplinary groups of practitioners (n=20) using Nominal Group Technique, a systematic approach to building consensus using structured in-person meetings of stakeholders which follows a distinct set of stages.Results: For all five pain presentations, "education and advice" and "simple oral and topical pain medications" were agreed to be appropriate for all subgroups. For patients at low risk, across all five pain presentations "review by primary care practitioner if not improving after 6 weeks" also reached consensus. Treatment options for those at medium risk differed slightly across pain-presentations, but all included: consider referral to physiotherapy and consider referral to MSK-interface-clinic. Treatment options for patients at high risk also varied by pain presentation. Some of the same options were included as for patients at medium risk, and additional options included: "opioids"; consider referral to expert patient programme (across all pain presentations); and "consider referral for surgical opinion" (back, knee, neck, shoulder). Consider referral to rheumatology was agreed for patients at medium and high risk who have multisite pain.Conclusion: In addressing the current lack of robust evidence on the effectiveness of different treatment options for MSK pain, this study generated consensus from practitioners on the most appropriate primary care treatment options for MSK patients stratified according to prognostic risk. These findings can help inform future clinical decision-making and also influenced the matched treatment options in a trial of stratified primary care for MSK pain patients.