A prospective cohort study of arm pain in primary care and physiotherapy - prognostic determinants
A prospective cohort study of arm pain in primary care and physiotherapy - prognostic determinants
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DOI：
10.1093/rheumatology/kel320
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发表时间：
2007-03-01
期刊：
影响因子：
5.5
通讯作者：
Palmer, K. T.
中科院分区：
文献类型：
--
作者：
Ryall, C.;Coggon, D.;Palmer, K. T.
客观的。调查初级保健和物理治疗服务中手臂疼痛的结果和预后决定因素。方法。患有手臂疼痛的患者在接受初级保健和物理治疗服务时被招募，并进行了 12 个月的随访。在基线时，使用经过验证的检查计划根据诊断对他们进行分类。使用标准定义确定抑郁症、躯体化倾向、健康焦虑、回避恐惧信念和手臂外慢性疼痛。考虑了三个结果：随访最后一个月的同一部位疼痛（持续疼痛）；该月的大部分时间都会出现疼痛；随访 7 天后仍出现疼痛（“持续性”疼痛）。在多级逻辑回归模型中探讨关联性，并总结为优势比 (OR)，置信区间为 95% (95% CI)。结果。总共 375 名受试者中有 313 名 (83%) 完成了随访，其中 53% 的受试者表示“持续”疼痛，24% 的受试者表示“持续”疼痛。对“持续”疼痛的预测最强烈的是男性（OR 1.9，95% CI 1.2-3.2）（这种关联主要限于肘部）、基线时过去一个月的疼痛频率较高（OR 2.5，95% CI 1.1-5.6）、手臂以外部位的慢性疼痛（不同部位的 OR 1.6-2.4）和当前吸烟（OR 3.3，95% CI） 1.6-6.6）。还有迹象表明，心理健康和避免恐惧的信念会影响预后。其他两种不良结果的预测因素相似。结论。就医的患者经常会出现手臂疼痛。持续性的预测因素包括男性（仅肘部）、基线疼痛频率、其他部位的慢性疼痛和吸烟。
Objective. To investigate outcome and prognostic determinants for arm pain presenting to primary care and physiotherapy services.Methods. Patients with arm pain were recruited as they presented to primary care and physiotherapy services, and were followed for 12 months. At baseline, they were classified by diagnosis using a validated examination schedule. Depression, somatizing tendency, health anxiety, fear-avoidance beliefs and chronic pain outside the arm were ascertained using standard definitions. Three outcomes were considered: same-site pain during the final month of follow-up (continuing pain); pain present on most days of that month; and pain present without a break of 7 days over follow-up ('unremitting' pain). Associations were explored in multi-level logistic regression models and summarized as odds ratios (ORs) with 95% confidence intervals (95% CIs).Results. Altogether, 313 (83%) of 375 subjects completed follow-up, including 53% with 'continuing' and 24% with 'unremitting' pain. 'Continuing' pain was predicted most strongly by male sex (OR 1.9, 95% CI 1.2-3.2) (this association was restricted largely to the elbow), higher frequency of pain in the past month at baseline (OR 2.5, 95% CI 1.1-5.6), chronic pain at sites outside the arm (ORs 1.6-2.4 for different sites) and current smoking (OR 3.3, 95% CI 1.6-6.6). There were also indications that mental health and fear-avoidance beliefs influenced prognosis. Predictors for the other two adverse outcomes were similar.Conclusion. Arm pain often persists in patients who consult medical services. Predictors of persistence include male sex (elbow only), frequency of pain at baseline, chronic pain at other sites and smoking.