Predictors of poor outcome in patients with neck pain treated by physical therapy
Predictors of poor outcome in patients with neck pain treated by physical therapy
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DOI：
10.1097/ajp.0b013e3181468e67
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发表时间：
2007-10-01
影响因子：
2.9
通讯作者：
Dziedzic, Krysia
中科院分区：
文献类型：
--
作者：
Hill, Jonathan C.;Lewis, Martyn;Dziedzic, Krysia
目的：本研究评估了物理治疗颈部疼痛的患者预后不良的预测因素，并试图比较经验数据的结果与物理治疗从业者的主观看法的预测outputtors.Methods：本研究是一个二次分析的数据从一个随机对照试验评估物理治疗颈部疼痛（n = 346）。基线调查问卷提供了随访时不良结局的一些潜在风险因素的数据。在6周和6个月时通过邮寄问卷进行随访，结果分别由Northwick Park颈部疼痛问卷（MCID-NPQ）中的感知（总体）变化和最小临床重要差异定义。治疗师的看法预测治疗结果被捕获使用一个单独的问卷，和评级比较来自6个月的试验data.Results：基线特征占更大比例的解释方差为全球变化相比，MCID-NPQ在6个月。独立的生物心理社会特征包括手动社会阶层、灾难化、焦虑和抑郁、低治疗期望、基线颈部疼痛/残疾的严重程度、共病背痛的存在和年龄较大。物理治疗师的排名高度相关的那些来自试验data.Conclusions：结果的显着预测，特别是在6个月，包括社会心理，功能和人口统计学指标。我们的研究结果表明，物理治疗师集体意识到物理和心理社会因素在预测临床结果中的相对重要性。然而，在我们的预后模型中，结果的显著变化在很大程度上仍然无法解释，这表明我们需要探索进一步的潜在因素来为临床决策提供信息。
Objectives: This study evaluated predictors of poor outcome in patients with neck pain treated by physical therapy, and sought to compare the findings of empirical data with physical therapy practitioners' subjective perceptions about predictors of outcome.Methods: This study was a secondary analysis of data from a randomized controlled trial assessing physical therapy treatments for neck pain (n = 346). A baseline questionnaire provided data on a number of potential risk factors of poor outcome at follow-up. Follow-up was conducted at 6 weeks and 6 months by postal questionnaire with outcome defined separately by perceived (global) change and minimal clinically important differences in the Northwick Park Neck Pain Questionnaire (MCID-NPQ). Therapists' perceptions of predictors for treatment outcome were captured using a separate questionnaire, and the ratings compared with ranks derived from the 6-month trial data.Results: Baseline characteristics accounted for a much greater proportion of explained variance for global change compared with MCID-NPQ at 6 months. Independent biopsychosocial characteristics included manual social class, catastrophizing, anxiety and depression, low treatment expectations, severity of baseline neck pain/disability, presence of comorbid back pain, and older age. Physical therapist ranks correlated highly with those derived from the trial data.Conclusions: Significant predictors of outcome were identified, particularly at 6 months, including psychosocial, functional, and demographic indicators. Our findings suggest that physical therapists are collectively aware of the relative importance of physical and psychosocial factors in predicting clinical outcome. However, a significant amount of variability in outcomes in our prognostic models remained largely unexplained, indicating that we need to explore further underlying factors to inform clinical decision-making.