Classification of patients with incident non-specific low back pain: implications for research.
Classification of patients with incident non-specific low back pain: implications for research.
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DOI：
10.1016/j.spinee.2015.08.015
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发表时间：
2016-05
期刊：
影响因子：
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通讯作者：
Burgess JF Jr
中科院分区：
文献类型：
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作者：
Norton G;McDonough CM;Cabral HJ;Shwartz M;Burgess JF Jr
由于异质性，比较腰痛的研究是困难的。研究人员对纳入标准或发作的定义没有达成共识。本研究旨在从27个月收集的数据中确定复发性非特异性腰痛的模式。本研究采用回顾性队列研究，使用来自多个支付者的行政索赔。尽管索赔是为获取成本而不是临床复杂性而设计的，但它们对于描述使用模式是有效的，不受潜在“升级编码”的影响。患者样本包括以人群为基础的、全国可推广的65,790名成年人，他们连续接受医疗和医药商业健康保险，并因偶发性、非特异性腰痛接受医疗保健。潜在的受试者因合理的疼痛原因、严重的精神疾病或认知障碍而被排除。诊断和治疗卫生保健服务，包括内科、外科、药物和补充，在住院、门诊和急诊环境中接受是本研究的结果测量指标。本研究采用的方法是对2009年1月至3月发生的非特异性腰痛的指数诊断后27个月（9个季度）的医疗保健利用情况进行潜在分类分析，分析样本为60%的受试者（n=39,597）和40%的验证样本（n=26,193）。确定并验证了四组不同的患者。1组（53.4%）患者立即康复。三分之一的患者（31.7%）可能在6个月后恢复，但在随后的每个季度中仍有37-48%的可能性因腰痛接受治疗，这意味着频繁复发。其余两组患者每个季度都保持非常高的接受护理的概率（65-78%和84-90%），分别主要使用治疗服务和止痛药。相对于备选方案的概率分组非常高（89.6-99.3%）。分组与人口学或临床特征无关。这四组不同的患者经历对研究有明确的影响。纳入标准应明确偶发或复发病例。6个月的清洁期可能不足以评估发病率。报告应详细说明立即恢复的比例，以防止平均恢复率掩盖组间差异。连续测量疼痛或残疾可能比测量不同终点的结果更可靠。
Comparing research studies of low back pain is difficult because of heterogeneity. There is no consensus among researchers on inclusion criteria or the definition of an episode. This study aimed to determine pattern(s) of recurrent non-specific low back pain from data collected over 27 months. This study used retrospective cohort study using administrative claims from multiple payers. Although claims are designed for capturing costs, not clinical complexity, they are valid for describing utilization patterns, which are not affected by potential “upcoding.” The patient sample consisted of population-based, nationally generalizable sample of 65,790 adults with continuous medical and pharmaceutical commercial health insurance who received health care for incident, non-specific low back pain. Potential subjects were excluded for plausible cause of the pain, severe mental illness, or cognitive impairment. Diagnostic and therapeutic health-care services, including medical, surgical, pharmaceutical, and complementary, received in inpatient, outpatient, and emergency settings were the outcome measures for this study. The methods used for this study were latent class analysis of health-care utilization over 27 months (9 quarters) following index diagnosis of non-specific low back pain occurring in January–March 2009 and an analysis sample with 60% of subjects (n=39,597) and validation sample of 40% (n=26,193). Four distinct groups of patients were identified and validated. One group (53.4%) of patients recovered immediately. One third of patients (31.7%) may appear to recover over 6 months, but maintain a 37–48% likelihood of receiving care for low back pain in every subsequent quarter, implying frequent relapse. Two remaining groups of patients each maintain very high probabilities of receiving care in every quarter (65–78% and 84–90%), predominantly utilizing therapeutic services and pain medication, respectively. Probabilistic grouping relative to alternatives was very high (89.6–99.3%). Grouping was not related to demographic or clinical characteristics. The four distinct sets of patient experiences have clear implications for research. Inclusion criteria should specify incident or recurrent cases. A 6-month clean period may not be sufficiently long to assess incidence. Reporting should specify the proportion recovering immediately to prevent mean recovery rates from masking between-group differences. Continuous measurement of pain or disability may be more reliable than measuring outcomes at distinct endpoints.