The Role of Classification of Chronic Low Back Pain
The Role of Classification of Chronic Low Back Pain
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DOI：
10.1097/brs.0b013e31822ef72c
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发表时间：
2011-10-01
期刊：
影响因子：
3
通讯作者：
Andersson, Gunnar
中科院分区：
文献类型：
--
作者：
Fairbank, Jeremy;Gwilym, Stephen E.;Andersson, Gunnar
研究设计。系统回顾。客观。描述慢性腰痛 (CLBP) 的各种分类方式，确定分类系统是否可靠，并评估分类特异性干预措施是否已被证明对治疗 CLBP 有效。背景数据摘要。一个分类系统可以识别 CLBP 患者并指导其采取有效的治疗方案，这将是有益的。那些指导治疗的系统对患者的治疗结果具有最大的潜在影响。方法。在 MEDLINE 和 Cochrane 协作图书馆中对截至 2011 年 1 月发表的英语文献进行了系统检索。我们纳入了专门描述 CLBP 临床分类系统、报告分类系统可靠性或评估分类特定干预措施有效性的文章。结果。初审共60篇文章。我们确定了 28 个符合纳入标准的分类系统：16 个诊断系统、7 个预后系统和 5 个基于治疗的系统。此外，我们还发现了 10 项 CLBP 治疗的随机对照试验，从中比较了纳入和排除标准。基于治疗的系统均针对非手术治疗。 5 个基于治疗的系统中有 4 个经过了可靠性测试，结果发现观察者间的一致性为 70% 至 100%。可靠性随着培训和对给定分类的熟悉而增加。随着分类中子组数量的增加，观察者间的一致性下降。在一项随机对照试验中，经过 8 个月的随访后，接受 McKenzie 分类系统治疗的患者与接受动态强化训练的患者的功能和疼痛相似。一项前瞻性队列研究报告称，使用加拿大背部研究所分类系统比标准康复治疗具有更好的疼痛和功能。对最近非手术治疗或另一种手术干预的随机研究的入院标准进行分析，为细化考虑手术的患者要满足的标准提供了一种方法。结论。目前CLBP有多种分类系统；有些是描述性的，有些是预后性的，还有一些试图指导治疗。我们建议不要采用一种分类系统来满足所有目的。我们进一步建议，未来开发分类系统的工作重点是有助于指导手术和非手术治疗的分类系统。临床建议。目前CLBP有多种分类系统；有些是描述性的，有些是预后性的，还有一些试图指导治疗。我们建议不要采用一种分类系统来满足所有目的。我们进一步建议，未来开发分类系统的工作重点是有助于指导手术和非手术治疗的分类系统。
Study Design. Systematic review.Objective. To describe the various ways chronic low back pain (CLBP) is classified, to determine if the classification systems are reliable and to assess whether classification-specific interventions have been shown to be effective in treating CLBP.Summary of Background Data. A classification system by which individual patients with CLBP could be identified and directed to an effective treatment protocol would be beneficial. Those systems that direct treatment have the greatest potential influence on patient outcomes.Methods. A systematic search was conducted in MEDLINE and the Cochrane Collaboration Library for English language literature published through January 2011. We included articles that specifically described a clinical classification system for CLBP, reported on the reliability of a classification system, or evaluated the effectiveness of classification-specific interventions.Results. A total of 60 articles were initially reviewed. We identified 28 classification systems that met inclusion criteria: 16 diagnostic systems, 7 prognostic systems, and 5 treatment-based systems. In addition, we found 10 randomized controlled trials of CLBP treatment from which we compared inclusion and exclusion criteria. Treatment-based systems were all directed at nonoperative management. Four of the 5 treatment-based systems underwent reliability testing and were found to have interobserver agreement of 70% to 100%. Reliability increased with training and familiarity with a given classification. As the number of subgroups within a classification increased, interobserver agreement decreased. Function and pain were similar between patients treated with the McKenzie classification system and those treated with dynamic strengthening training after 8 months of follow-up in one randomized controlled trial. One prospective cohort study reported better pain and function using the Canadian Back Institute Classification system than with standard rehabilitation. An analysis of the admission criteria to recent randomized studies with either nonoperative care or another surgical intervention provided a methodology for refining criteria to be met by patients considering surgery.Conclusion. There currently are many classification systems for CLBP; some that are descriptive, some prognostic, and some that attempt to direct treatment. We recommend that no one classification system be adopted for all purposes. We further recommend that future efforts in developing a classification system focus on one that helps to direct both surgical and nonsurgical treatments.Clinical Recommendations. There currently are many classification systems for CLBP; some that are descriptive, some prognostic, and some that attempt to direct treatment. We recommend that no one classification system be adopted for all purposes. We further recommend that future efforts in developing a classification system focus on one that helps to direct both surgical and nonsurgical treatments.