Prognosis for patients with chronic low back pain: inception cohort study.
Prognosis for patients with chronic low back pain: inception cohort study.
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DOI：
10.1136/bmj.b3829
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发表时间：
2009-10-06
期刊：
影响因子：
--
通讯作者：
Henschke N
中科院分区：
文献类型：
--
作者：
Costa Lda C;Maher CG;McAuley JH;Hancock MJ;Herbert RD;Refshauge KM;Henschke N
目的在初始队列中描述慢性腰痛的病程，并确定慢性发作时的预后标志物。设计初始队列研究，随访一年。在澳大利亚悉尼设立初级保健诊所。研究样本是973名因急性腰痛（持续时间<2周）而接受初级保健的连续患者的初始队列中的一个亚队列。406名疼痛持续3个月的参与者组成了慢性腰痛患者的初始队列。主要结果测量：在初始表现、慢性发作（研究入组）以及9个月和12个月随访时测量的结果和推定预测因子。根据疼痛强度、残疾和工作状态来确定恢复情况。潜在预后因素与恢复时间之间的关系采用Cox回归建模。结果所有结果的随访完成率为总时间的97%。9个月和12个月的累积无痛概率分别为35%和42%，9个月和12个月的完全恢复概率分别为35%和41%。在259名在慢性研究开始时没有从疼痛相关残疾中恢复的参与者中，47%的人在12个月后康复。由于腰痛、高残疾程度或慢性发作时的高疼痛强度、低教育水平、更大的持续疼痛的感知风险以及出生在澳大利亚以外而导致的先前病假与延迟恢复有关。结论近期发病的非神经根性慢性腰痛患者超过三分之一在12个月内康复。对于那些之前因腰痛请过病假、在慢性腰痛发病时残疾程度高或疼痛强度高、受教育程度较低、认为自己有持续疼痛的高风险、出生在澳大利亚以外的人，预后较差。
Objectives To describe the course of chronic low back pain in an inception cohort and to identify prognostic markers at the onset of chronicity. Design Inception cohort study with one year follow-up. Setting Primary care clinics in Sydney, Australia. Participants The study sample was a subcohort of an inception cohort of 973 consecutive patients presenting to primary care with acute low back pain (<2 weeks’ duration). 406 participants whose pain persisted for three months formed the inception cohort of patients with chronic low back pain. Main outcome measures Outcomes and putative predictors measured at initial presentation, onset of chronicity (study entry), and follow-up at nine and 12 months. Recovery was determined from measures of pain intensity, disability, and work status. The association between potential prognostic factors and time to recovery was modelled with Cox regression. Results Completeness of follow-up was 97% of total person time for all outcomes. The cumulative probability of being pain-free was 35% at nine months and 42% at 12 months and for complete recovery was 35% at nine months and 41% at 12 months. Of the 259 participants who had not recovered from pain related disability at entry to the chronic study, 47% had recovered by 12 months. Previous sick leave due to low back pain, high disability levels or high pain intensity at onset of chronicity, low levels of education, greater perceived risk of persistent pain, and being born outside Australia were associated with delayed recovery. Conclusion More than one third of patients with recent onset, non-radicular chronic low back pain recover within 12 months. The prognosis is less favourable for those who have taken previous sick leave for low back pain, have high disability levels or high pain intensity at onset of chronic low back pain, have lower education, perceive themselves as having a high risk of persistent pain, and were born outside Australia.
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影响因子：
8.8
作者：
Peto R;Pike MC;Armitage P;Breslow NE;Cox DR;Howard SV;Mantel N;McPherson K;Peto J;Smith PG
通讯作者：
Smith PG
影响因子：
--
作者：
Bland, JM;Altman, DG
通讯作者：
Altman, DG
影响因子：
3
作者：
vandenHoogen, H
通讯作者：
vandenHoogen, H
影响因子：
5.2
作者：
Watson, KD;Papageorgiou, AC;Macfarlane, GJ
通讯作者：
Macfarlane, GJ
影响因子：
3
作者：
Grotle, M;Vollestad, NK;Brox, JI
通讯作者：
Brox, JI