Investigating patient expectations and treatment outcome in a chronic low back pain population.
Investigating patient expectations and treatment outcome in a chronic low back pain population.
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DOI：
10.2147/jpr.s28636
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发表时间：
2012
影响因子：
2.7
通讯作者：
Robinson ME
中科院分区：
文献类型：
--
作者：
Sanderson KB;Roditi D;George SZ;Atchison JW;Banou E;Robinson ME
这项研究旨在衡量患者认为具有临床意义的四个治疗领域的结果-(1)疼痛，(2)疲劳，(3)情绪困扰，(4)干扰水平-并确定患者是否满足他们自己的成功标准。此外，还检查了期望在治疗结果中的作用。这项研究还旨在确定疼痛、疲劳、残疾和干扰水平的变化如何随参与者接受的治疗类型而变化。从大学附属疼痛诊所招募了47名慢性下腰痛患者。研究设计是纵向的，由两个随机分配的治疗条件组成。第一种治疗条件只使用阿片类药物，第二种情况下既使用阿片类药物，又使用短暂的认知行为治疗。进行了治疗前和治疗后的评估，评估发生在治疗开始后大约3个月。在治疗前和治疗后的评估中，参与者都完成了以患者为中心的结果问卷。结果表明，患者在这四个领域中的任何一个领域都没有达到他们自己的成功标准。疼痛程度存在显著的时间主效应，表明两个治疗组在治疗后疼痛程度均有降低，F(1，45)=11.98，P<；0.001。干扰域水平存在显著的时间主效应，表明两组患者的日常活动中疼痛相关干扰水平均有所降低，F(1，45)=5.46，P<；0.05。时间对情绪困扰或疲劳没有显著影响，也没有任何按时间分组的显著交互作用。与我们的假设相反，在四个领域中，治疗前的期望和治疗后的正常水平评分之间没有发现显著的相关性。与治疗后相比，患者寻求更大程度的减轻疼痛、疲劳、痛苦程度和干扰程度。通过短暂的认知行为疗法加强阿片类药物治疗，并没有在慢性下腰痛患者的四个领域产生额外的改善。
This study aimed to measure the outcomes that patients consider clinically meaningful across four treatment domains – (1) pain, (2) fatigue, (3) emotional distress, and (4) level of interference – and determine if patients met their own success criteria. Additionally, the role of expectations in treatment outcome was examined. This study also aimed to determine how change in levels of pain, fatigue, disability, and level of interference varied according to the type of treatment delivered to participants. Forty-seven chronic low back pain patients were recruited from university-affiliated pain clinics. The study design was longitudinal, consisting of two randomly assigned treatment conditions. The first treatment condition used opioid medication only and the second used both opioid medication and brief cognitive behavioral therapy. Pre- and post-treatment assessments were conducted, which occurred approximately 3 months after the initiation of treatment. A patient-centered outcomes questionnaire was completed by participants at both pre- and post-treatment assessment. Results suggest that patients did not meet their own success criteria in treatment across any of the four domains. There was a significant main effect of time for level of pain indicating that both treatment groups had a decrease in their level of pain at post-treatment, F(1, 45) = 11.98, P < 0.001. There was a significant main effect of time for level of interference domain indicating that both groups experienced a reduction in the level of pain-related interference with daily activities, F(1, 45) = 5.46, P < 0.05. There were no significant effects of time for emotional distress or fatigue or any significant group by time interactions. Contrary to our hypothesis, no significant correlations were found between pretreatment expectations and usual level ratings at post-treatment across the four domains. Patients sought larger reductions in pain, fatigue, level of distress, and level of interference than they attained at post-treatment. Enhancing opioid treatment with brief cognitive behavioral therapy did not yield additional improvements for the four domains assessed in patients with chronic low back pain.