The prognosis of low back pain in general practice
The prognosis of low back pain in general practice
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DOI：
10.1097/00007632-199707010-00019
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发表时间：
1997-07-01
期刊：
影响因子：
3
通讯作者：
vandenHoogen, H
中科院分区：
文献类型：
--
作者：
vandenHoogen, H
研究设计。一项关于全科连续患者腰痛的前瞻性队列研究，在基线和1年随访检查时的潜在预后指标通过每周一次的问卷进行评估。目的：确定一般情况下腰痛持续时间和复发发生的预后指标。一般情况下，人们对腰痛的预后知之甚少。以往研究的设计不同，结果也不同，因此很难得出一般临床中腰痛病程预后指标的结论。在2年的时间里，来自阿姆斯特丹及周边地区的15名全科医生对慢性腰痛患者和近期腰痛患者进行了连续研究。在初次就诊时评估了大量潜在的预后指标。初次就诊后，对每位患者进行为期12个月的监测。后续评估是通过每周邮寄四份问卷进行的。分别采用多因素Cox回归和logistic回归分析潜在预后指标、指标发作时间和复发发生率之间的相关性。在确定的605例患者中，443例纳入随访评估期；269名患者完成了问卷调查。一般来说，腰痛较轻的患者较少参与或未完成随访研究。35%的人在12周后仍然感到腰痛，10%的人在1年后仍然感到腰痛。在随访期结束前指数发作结束的患者中，大约有四分之三的患者在一年内有一次或多次复发。分析产生了一个模型，该模型包含四个变量，预测腰痛的持续时间，包括“首次就诊前腰痛的持续时间，‘’ ‘’接受物理治疗，‘’ ‘’疼痛强度”和“背部手术史”。“日常功能似乎是唯一与复发发生显著相关的变量。”在一般实践中，只有几个变量似乎与腰痛的临床过程有关。特别是，初次就诊前的持续时间和出乎意料的接受物理治疗的时间都与腰痛的持续时间延长有关。
Study Design. A prospective cohort study on low back pain in consecutive patients in general practice, in which potential prognostic indicators at baseline and at the 1-year follow-up examination were assessed by means of four weekly questionnaires.Objectives. To identify prognostic indicators of the duration of low back pain in general practice and the occurrence of a relapse.Background. Little is known about the prognosis of low back pain in general practice. Different designs and different results of preceding studies make drawing conclusions about the prognostic indicators, if any, of the course of low back pain in general practice difficult.Methods. For a period of 2 years, 15 general practitioners from Amsterdam and surrounding areas studied consecutive patients with chronic low back pain and those with a recent onset of low back pain. A large number of potential prognostic indicators were assessed at the initial visit. After the initial visit, each patient was monitored for a period of 12 months. The follow-up assessment was conducted with four weekly postal questionnaires. The associations among the potential prognostic indicators, the duration of the index episode, and the occurrence of a relapse were analyzed using multivariate Cox regression and logistic regression analysis, respectively.Results. Of the 605 patients identified, 443 were included in the follow-up period of assessment; the questionnaires were completed by 269 patients. In general, patients with less severe low back pain participated less often or did not complete the follow-up study. Thirty-five percent of the population still experienced low back pain after 12 weeks, and 10% still experienced it after 1 year. Approximately three of every four patients whose index episode ended before the end of the follow-up period had one or more relapses within a year. The analysis resulted in a model with four variables predicting the duration of the low back pain, including ''the duration of the low back pain preceding the initial visit,'' ''receiving physical therapy,'' ''pain intensity,'' and ''history of back surgery.'' Daily functioning appeared to be the only variable that was significantly associated with the occurrence of a relapse.Conclusions. Only a few variables appear to be related to the clinical course of low back pain seen in general practice. In particular, the duration preceding the initial visit and, unexpectedly, receiving physical therapy were both associated with a longer duration of low back pain.