Why is a treatment aimed at psychosocial factors not effective in patients with (sub)acute low back pain?
Why is a treatment aimed at psychosocial factors not effective in patients with (sub)acute low back pain?
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DOI：
10.1016/j.pain.2005.09.002
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发表时间：
2005-12-05
期刊：
影响因子：
7.4
通讯作者：
Stalman, WAB
中科院分区：
文献类型：
--
作者：
Jellema, P;van der Windt, DAWM;Stalman, WAB
心理社会因素已被证明在慢性下腰痛(LBP)的发生中起着重要作用。然而，在我们最近完成的整群随机试验中，我们没有发现针对心理社会因素的最小干预策略(MIS)对(亚)急性LBP患者的效果高于常规护理(UC)的证据。为了探讨其中的原因，本文对管理信息系统有效性的潜在过程进行了评估。全科医生(GP)的态度通过疼痛态度和信念量表和另外两个问题进行评估。通过分析治疗登记表和患者对有关治疗内容的项目的反应来评估全科医生行为。患者还对满意度和依从性进行了评分。通过分析6周和52周后恐惧回避和信念问卷、应对策略问卷和4维症状问卷的变化来评估心理社会测量的修改。共有60名全科医生和314名患者参与了这项研究。与UC组相比，MI组的GPS采用了较少的生物医学导向态度，但在识别心理社会因素方面只取得了中等程度的成功。患者感知的治疗内容和患者满意度在两组之间有显著差异。然而，心理社会测量的变化在不同的组之间没有不同。心理社会因素在管理信息系统组中的次优识别，以及缺乏对心理社会因素的相关影响，可能解释了为什么管理信息系统不比UC更有效。(C)2005年国际疼痛研究协会。爱思唯尔出版，版权所有。
Psychosocial factors have been shown to play an important role in the development of chronic low back pain (LBP). In our recently completed cluster-randomized trial we found, however, no evidence of an effect of our minimal intervention strategy (MIS) aimed at psychosocial factors, over usual care (UC) in patients with (sub)acute LBP. To explore the reasons why, this paper presents an evaluation of the processes presumably underlying the effectiveness of MIS. General practitioner (GP) attitude was evaluated by the Pain Attitudes and Beliefs Scale and two additional questions. GP behaviour was evaluated by analysing treatment registration forms and patients' responses to items regarding treatment content. Patients also scored items on satisfaction and compliance. Modification of psychosocial measures was evaluated by analysing changes after 6 and 52 weeks on the Fear Avoidance and Beliefs Questionnaire, the Coping Strategies Questionnaire and the 4-Dimensional Symptom Questionnaire. A total of 60 GPs and 314 patients participated in the study. GPs in the MIS-group adopted a less biomedical orientated attitude than in the UC-group, but were only moderately successful in identification of psychosocial factors. Treatment contents as perceived by the patient and patient satisfaction differed significantly between both groups. Changes on psychosocial measures, however, did not differ between groups. The suboptimal identification of psychosocial factors in the MIS-group and the absence of a relevant impact on psychosocial factors may explain why MIS was not more effective, than UC. (c) 2005 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.