韦斯特恩德坐骨神经痛试验：急性坐骨神经痛卧床休息与物理治疗的随机对照研究。

Westeinde sciatica trial: randomized controlled study of bed rest and physiotherapy for acute sciatica.

作者信息

Hofstee Derk J, Gijtenbeek Johanna M M, Hoogland Peter H, van Houwelingen Hans C, Kloet Alfred, Lötters Freek, Tans Joseph Th J

机构信息

Department of Neurology, Medical Center Haaglanden, Westeinde, The Hague, The Netherlands.

出版信息

J Neurosurg. 2002 Jan;96(1 Suppl):45-9. doi: 10.3171/spi.2002.96.1.0045.

DOI:10.3171/spi.2002.96.1.0045

PMID:11797655

Abstract

OBJECT

The authors conducted a study to compare the efficacies of three nonsurgical treatment strategies in patients with sciatica. Their hypothesis was that bed rest, physiotherapy, and continuation of activities of daily living (ADLs) (control treatment) are each of equivalent efficacy.

METHODS

This randomized controlled trial was designed for comparison of bed rest, physiotherapy, and continuation of ADLs. The setting was an outpatient clinic. General practitioners were asked to refer patients for treatment as soon as possible. The authors enrolled 250 patients (< 60 years of age) with sciatica of less than 1-month's duration and who had not yet been treated with bed rest or physiotherapy. Primary outcome measures were radicular pain (based on a visual analog pain scale [VAPS]) and hampered ADLs (Quebec Disability Scale [QDS]). Secondary outcome measures were the rates of treatment-related failure and surgical treatment. Measures were assessed at baseline and during follow up at 1, 2, and 6 months. Mean differences in VAPS and QDS scores between bed rest and control treatment were 2.5 (95% confidence interval [CI] -6.4 to 11.4) and -4.8 (95% CI -10.6 to 0.9) at 1 month and 0.9 (95% CI -8.7 to 10.4) and -2.7 (95% CI -9.9 to 4.4) at 2 months, respectively. The respective differences between physiotherapy and control treatment were 0.8 (95% CI -8.2 to 9.8) and -0.5 (95% CI -6.3 to 5.3) at 1 month and -0.3 (95% CI -9.4 to 10) and 0.0 (95% CI -7.2 to 7.3) at 2 months. The respective odds ratios for treatment failure and surgical treatment of bed rest compared with control treatment were 1.6 (95% CI 0.8-3.5) and 1.5 (95% CI 0.7-3.6) at 6 months. When physiotherapy was compared with control treatment, these ratios were 1.5 (95% CI 0.7-3.2) and 1.2 (95% CI 0.5-2.9) at 6 months, respectively.

CONCLUSIONS

Bed rest and physiotherapy are not more effective in acute sciatica than continuation of ADLs.

摘要

目的

作者开展了一项研究，比较三种非手术治疗策略对坐骨神经痛患者的疗效。他们的假设是卧床休息、物理治疗以及日常生活活动（ADL）持续进行（对照治疗）的疗效相当。

方法

本随机对照试验旨在比较卧床休息、物理治疗和ADL持续进行的效果。研究地点为一家门诊诊所。要求全科医生尽快将患者转介进行治疗。作者纳入了250名年龄小于60岁、坐骨神经痛病程小于1个月且尚未接受过卧床休息或物理治疗的患者。主要结局指标为神经根性疼痛（基于视觉模拟疼痛量表[VAPS]）和受限的ADL（魁北克残疾量表[QDS]）。次要结局指标为治疗相关失败率和手术治疗率。在基线以及随访的1个月、2个月和6个月时对各项指标进行评估。卧床休息组与对照治疗组在1个月时VAPS和QDS评分的平均差异分别为2.5（95%置信区间[CI] -6.4至11.4）和-4.8（95% CI -10.6至0.9），在2个月时分别为0.9（95% CI -8.7至10.4）和-2.7（95% CI -9.9至4.4）。物理治疗组与对照治疗组在1个月时的相应差异分别为0.8（95% CI -8.2至9.8）和-0.5（95% CI -6.3至5.3），在2个月时分别为-0.3（95% CI -9.4至10）和0.0（95% CI -7.2至7.3）。与对照治疗相比，卧床休息组在6个月时治疗失败和手术治疗的相应比值比分别为1.6（95% CI 0.8 - 3.5）和1.5（95% CI 0.7 - 3.6）。与对照治疗相比，物理治疗组在6个月时的这些比值比分别为1.5（95% CI 0.7 - 3.2）和1.2（95% CI 0.5 - 2.9）。