Predicting Recurrent Care Seeking of Physical Therapy for Musculoskeletal Pain Conditions.
Predicting Recurrent Care Seeking of Physical Therapy for Musculoskeletal Pain Conditions.
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预测肌肉骨骼疼痛状况的物理治疗的复发性护理寻求。
DOI：
10.1093/pm/pnab154
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
Bhavsar,NrupenA
中科院分区：
文献类型：
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作者：
George,StevenZ;Giczewska,Anna;Alhanti,Brooke;Lutz,AdamD;Shanley,Ellen;Thigpen,CharlesA;Bhavsar,NrupenA
目的肌肉骨骼疼痛是国际上疼痛和残疾的主要原因，也是寻求医疗保健的常见原因。准确预测因肌肉骨骼疾病而寻求医疗保健的复发可以更好地定制治疗。该项目的目的是表征寻求肌肉骨骼疼痛条件的复发性物理治疗的模式，并建立一个初步的预测模型，以确定那些复发性护理寻求的风险增加。DesignRetrospective队列。SettingAmbulatory护理。患者（n = 578,461）寻求门诊物理治疗（美国）。方法从电子病历中提取潜在的预测变量，并将患者分为三种不同的复发治疗类别。Logistic回归模型用于识别反复求医的个体预测因子，最小绝对收缩和选择算子（LASSO）用于建立多变量预测模型。结果不同定义的复发治疗模型的准确度在0.59 ~ 0.64之间（c统计量），并从多变量模型中识别出个体预测因子。反复治疗风险增加的预测因素包括：接受工人赔偿和医疗保险、患有合并症关节炎、首次发作时为术后患者、年龄范围为44-64岁、报告盗汗或夜痛。复发性护理风险降低的预测因素包括腰痛、慢性损伤、颈部疼痛、怀孕、25-44岁的年龄范围和吸烟。结论初步建立了物理治疗患者求诊复发的预测模型，但模型的准确性有待提高，以更好地指导临床决策。
ObjectiveMusculoskeletal pain conditions are a leading cause of pain and disability internationally and a common reason to seek health care. Accurate prediction of recurrence of health care seeking due to musculoskeletal conditions could allow for better tailoring of treatment. The aim of this project was to characterize patterns of recurrent physical therapy seeking for musculoskeletal pain conditions and to develop a preliminary prediction model to identify those at increased risk of recurrent care seeking.DesignRetrospective cohort.SettingAmbulatory care.SubjectsPatients (n = 578,461) seeking outpatient physical therapy (United States).MethodsPotential predictor variables were extracted from the electronic medical record, and patients were placed into three different recurrent care categories. Logistic regression models were used to identify individual predictors of recurrent care seeking, and the least absolute shrinkage and selection operator (LASSO) was used to develop multivariate prediction models.ResultsThe accuracy of models for different definitions of recurrent care ranged from 0.59 to 0.64 (c-statistic), and individual predictors were identified from multivariate models. Predictors of increased risk of recurrent care included receiving workers’ compensation and Medicare insurance, having comorbid arthritis, being postoperative at the time of the first episode, age range of 44–64 years, and reporting night sweats or night pain. Predictors of decreased risk of recurrent care included lumbar pain, chronic injury, neck pain, pregnancy, age range of 25–44 years, and smoking.ConclusionThis analysis identified a preliminary predictive model for recurrence of care seeking of physical therapy, but model accuracy needs to improve to better guide clinical decision-making.