Initial treatment approaches and healthcare utilization among veterans with low back pain: a propensity score analysis.
Initial treatment approaches and healthcare utilization among veterans with low back pain: a propensity score analysis.
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DOI：
10.1186/s12913-023-09207-y
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发表时间：
2023-03-21
影响因子：
2.8
通讯作者：
中科院分区：
文献类型：
--
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尽管PT是一种医疗风险较低的治疗选择，但患有腰痛（LBP）的退伍军人的阿片类药物处方仍然存在。治疗模式和随后的医疗保健利用退伍军人与LBP是未知的。本研究的目的是评估物理治疗（PT）和阿片类药物与脊柱手术和慢性阿片类药物使用的退伍军人与事件LBP的结果之间的关联。我们进行了一项回顾性队列研究，使用2012年至2017年退伍军人管理局国家数据库中的ICD代码识别新诊断为LBP的退伍军人。退伍军人被分为三个治疗组的基础上接受的第一次治疗事件LBP的30天内：接受PT，阿片类药物，或既没有PT也没有阿片类药物。结果，脊柱手术和慢性阿片类药物使用的事件，确定从第31天开始，直到一年后的初始治疗。我们使用倾向评分匹配来解释在评估初始治疗和结果之间的关联时潜在的选择偏倚。2012年至2017年期间，共有373，717例LBP事件。其中28，850例（7.7%）接受PT，48，978例（13.1%）接受阿片类药物，295，889例（79.2%）既未接受PT也未接受阿片类药物。疼痛、婚姻状况和心血管、肺部或代谢性慢性疾病的存在在治疗组之间具有最强的统计学显著性差异。接受阿片类药物治疗的退伍军人与未接受治疗的退伍军人相比，接受脊柱手术（2.04，99% CI：1.67，2.49）和进展为慢性阿片类药物使用（11.8，99% CI：11.3，12.3）的几率更高。与接受PT治疗的退伍军人相比，接受阿片类药物治疗的退伍军人接受脊柱手术并进展为长期使用阿片类药物的几率更高（1.69，99% CI：1.21，2.37）（17.8，99% CI：16.0，19.9）。与PT相比，开始阿片类药物治疗与脊柱手术和慢性阿片类药物使用的可能性更高相关。与PT相比，更多的退伍军人接受阿片类药物作为LBP事件的初始治疗。我们的研究结果可以为退伍军人的LBP事件提供康复护理实践。在线版本包含补充材料，可通过10.1186/s12913 - 023 - 09207-y获得。
Opioid prescriptions for Veterans with low back pain (LBP) persist despite the availability of PT, a lower medical risk treatment option. Patterns of treatment and subsequent healthcare utilization for Veterans with LBP are unknown. The purpose of this study was to evaluate the association of physical therapy (PT) and opioids and outcomes of spinal surgery and chronic opioid use for Veterans with incident LBP. We conducted a retrospective cohort study identifying Veterans with a new diagnosis of LBP using ICD codes from the Veterans Administration national database from 2012 to 2017. Veterans were classified into three treatment groups based on the first treatment received within 30 days of incident LBP: receipt of PT, opioids, or neither PT nor opioids. Outcomes, events of spinal surgery and chronic opioid use, were identified beginning on day 31 up to one year following initial treatment. We used propensity score matching to account for the potential selection bias in evaluating the associations between initial treatment and outcomes. There were 373,717 incident cases of LBP between 2012 and 2017. Of those 28,850 (7.7%) received PT, 48,978 (13.1%) received opioids, and 295,889 (79.2%) received neither PT or opioids. Pain, marital status and the presence of cardiovascular, pulmonary, or metabolic chronic conditions had the strongest statistically significant differences between treatment groups. Veterans receiving opioids compared to no treatment had higher odds of having a spinal surgery (2.04, 99% CI: 1.67, 2.49) and progressing to chronic opioid use (11.8, 99% CI: 11.3, 12.3). Compared to Veterans receiving PT those receiving opioids had higher odds (1.69, 99% CI: 1.21, 2.37) of having spinal surgery and progressing to chronic opioid use (17.8, 99% CI: 16.0, 19.9). Initiating treatment with opioids compared to PT was associated with higher odds of spinal surgery and chronic opioid use for Veterans with incident LBP. More Veterans received opioids compared to PT as an initial treatment for incident LBP. Our findings can inform rehabilitation care practices for Veterans with incident LBP. The online version contains supplementary material available at 10.1186/s12913-023-09207-y.
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影响因子：
39.2
作者：
Qaseem, Amir;Wilt, Timothy J.;Forciea, Mary Ann
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DOI：
10.3122/jabfm.2017.06.170064
发表时间：
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