Distinctiveness of psychological obstacles to recovery in low back pain patients in primary care.
Distinctiveness of psychological obstacles to recovery in low back pain patients in primary care.
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DOI：
10.1016/j.pain.2009.11.002
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发表时间：
2010-03
期刊：
影响因子：
7.4
通讯作者：
Main CJ
中科院分区：
文献类型：
--
作者：
Foster NE;Thomas E;Bishop A;Dunn KM;Main CJ
许多心理因素被认为是从腰痛中恢复的重要障碍，但大多数研究都集中在有限的因素上。我们比较了一个更全面的20个因素在预测结果的初级保健。符合条件的患者咨询8个一般的做法，参加了前瞻性队列研究; 1591提供的数据在基线和810在6个月。使用罗兰和莫里斯残疾问卷（RMDQ）定义临床结局。使用调整的多元线性回归技术研究基线心理测量预测结果的相对强度。该样本与其他初级保健队列相似（平均年龄44岁，59%为女性，平均基线RMDQ 8.6）。这20个因素各占基线RMDQ评分方差的0.04%-33.3%。一个多变量模型，包括所有11个尺度，与结果相关的单变量分析占47.7%的方差在6个月的RMDQ评分，上升到55.8%后调整。在多变量模型中，四个尺度与结果显著相关，解释了56.6%的方差：个人控制感、急性/慢性时间轴、疾病识别和疼痛自我效能感。当所有的独立因素都包括在内时，抑郁、灾难化和恐惧回避不再重要。因此，少数心理因素对初级保健腰痛患者的预后具有很强的预测作用。心理因素的测量存在明显的冗余。这些发现应该有助于在未来集中针对背痛的干预措施。
Many psychological factors have been suggested to be important obstacles to recovery from low back pain, yet most studies focus on a limited number of factors. We compared a more comprehensive range of 20 factors in predicting outcome in primary care. Consecutive patients consulting 8 general practices were eligible to take part in a prospective cohort study; 1591 provided data at baseline and 810 at 6 months. Clinical outcome was defined using the Roland and Morris Disability Questionnaire (RMDQ). The relative strength of the baseline psychological measures to predict outcome was investigated using adjusted multiple linear regression techniques. The sample was similar to other primary care cohorts (mean age 44 years, 59% women, mean baseline RMDQ 8.6). The 20 factors each accounted for between 0.04% and 33.3% of the variance in baseline RMDQ score. A multivariate model including all 11 scales that were associated with outcome in the univariate analysis accounted for 47.7% of the variance in 6 months RMDQ score; rising to 55.8% following adjustment. Four scales remained significantly associated with outcome in the multivariate model explaining 56.6% of the variance: perceptions of personal control, acute/chronic timeline, illness identify and pain self-efficacy. When all independent factors were included, depression, catastrophising and fear avoidance were no longer significant. Thus, a small number of psychological factors are strongly predictive of outcome in primary care low back pain patients. There is clear redundancy in the measurement of psychological factors. These findings should help to focus targeted interventions for back pain in the future.
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