Discographic, MRI and psychosocial determinants of low back pain disability and remission: a prospective study in subjects with benign persistent back pain.
Discographic, MRI and psychosocial determinants of low back pain disability and remission: a prospective study in subjects with benign persistent back pain.
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DOI：
10.1016/j.spinee.2004.05.250
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发表时间：
2005-01-01
期刊：
影响因子：
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通讯作者：
Carragee, John M
中科院分区：
文献类型：
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作者：
Carragee, Eugene J;Alamin, Todd F;Carragee, John M
背景：一系列的形态学和心理社会变量被认为是严重下腰痛（LBP）疾病的危险因素。虽然结构和社会心理变量的相对贡献是激烈的争论，不同的假设的有效性已被证明难以测试，因为严重致残性LBP疾病的发病率在健康受试者是低的。这些因素决定了需要大样本量、广泛的结构成像和扩展的纵向研究。以前的研究包括密集的影像学检查的小队列研究或没有建立详细形态学基线的大人群研究。目的：使用严格的患者样本设计，在没有既往LBP残疾或临床LBP疾病的受试者中，建立严重LBP疾病的结构和心理社会决定因素的相对贡献。一项前瞻性、纵向研究，对具有严重腰痛高危因素的受试者进行研究，这些高危因素是由结构和心理社会特征确定的。1慢性比率（非腰椎）疼痛综合征患者从易患椎间盘退行性疾病的研究人群中招募，进行基线检查，测试和5年的随访结果：观察在6个月的时间间隔超过4至6年（平均值，5.3）对于术后主要结局指标：严重背痛发作（视觉模拟量表[VAS] ≥ 6），职业残疾发作少于1周，职业残疾发作持续1周，所有背痛症状的缓解发作至少6个月，并且主要进行LBP评估和治疗的医疗访问。方法：在基线进行腰椎磁共振成像（MRI）、腰椎激发性椎间盘造影（在心理测量正常的受试者中）、体格检查、医疗和工作史以及心理测量测试。影像学和心理测试由盲法检查者进行评分。在随访期间，由独立研究助理每6个月进行一次脚本访谈，这些研究助理也对患者基线数据不知情。访谈涵盖了间隔医疗，职业和事故或伤害histors.RESULTS：心理社会变量强烈预测长期和短期残疾事件，持续时间和卫生保健访问LBP问题（p
BACKGROUND CONTEXT: A range of morphologic and psychosocial variables has been suggested as risk factors for serious low back pain (LBP) illness. Although the relative contributions of structural and psychosocial variables are intensely debated, the validity of differing hypotheses has proven difficult to test because the incidence of serious disabling LBP illness is low in healthy subjects. These factors dictate the requirement for large sample sizes, extensive structural imaging and extended longitudinal study. Previous studies included either small cohorts with intensive imaging testing or large population studies that do not establish a detailed morphologic baseline.PURPOSE: To establish, using a strict patient sample design, the relative contribution of structural and psychosocial determinants of serious LBP illness among subjects with no previous LBP disability or clinical LBP illness.STUDY DESIGN/SETTING: A prospective, longitudinal study of subjects with high risk factors for serious LBP as determined by structural and psychosocial characteristics.PATIENT SAMPLE: One hundred subjects with known mild persistent low back pain and a 2:1 ratio of chronic (non-lumbar) pain syndrome were recruited from a study population with a predisposition to disc degenerative disease, to undergo baseline examination, testing and 5-year follow-up.OUTCOME MEASURES: Observations were made at 6-month intervals over 4 to 6 years (mean, 5.3) for the after primary outcomes measures: episodes of serious back pain (visual analogue scale [VAS] > or =6), episodes of occupational disability less than 1 week, episodes of occupational disability for 1 week, remission episodes of all back pain symptoms at least 6 months and medical visits primarily for LBP evaluation and treatment.METHODS: Lumbar magnetic resonance imaging (MRI), lumbar provocative discography (in psychometrically normal subjects), physical examinations, medical and work histories and psychometric testing were performed at baseline. Imaging and psychometric testing were graded by blinded examiners. A scripted interview was conducted every 6 months during follow-up by independent research assistants who also were blinded to patient baseline data. The interview covered interval medical, occupational and accident or injury histories.RESULTS: Psychosocial variables strongly predicted both long- and short-term disability events, duration and health-care visits for LBP problems (p