Fritz Julie M, Delitto Anthony, Erhard Richard E
Department of Physical Therapy, University of Pittsburgh, PA 15260, USA.
Spine (Phila Pa 1976). 2003 Jul 1;28(13):1363-71; discussion 1372. doi: 10.1097/01.BRS.0000067115.61673.FF.
A randomized clinical trial was conducted.
To compare the effectiveness of classification-based physical therapy with that of therapy based on clinical practice guidelines for patients with acute, work-related low back pain.
Clinical practice guidelines recommend minimal intervention during the first few weeks after acute low back injury. However, studies supporting this recommendation have not attempted to identify which patients are likely to respond to particular interventions.
For this study, 78 subjects with work-related low back pain of less than 3 weeks duration were randomized to receive therapy based on a classification system that attempts to match patients to specific interventions or therapy based on the Agency for Health Care Policy and Research guidelines. The subjects were followed for 1 year. Outcomes included the impairment index, Oswestry scale, SF-36 component scores, satisfaction, medical costs, and return to work status.
After adjustment for baseline factors, subjects receiving classification-based therapy showed greater change on the Oswestry (P = 0.023) and the SF-36 physical component (P = 0.029) after 4 weeks. Patient satisfaction was greater (P = 0.006) and return to full-duty work status more likely (P = 0.017) after 4 weeks in the classification-based group. After 1 year, there was a trend toward reduced Oswestry scores in the classification-based group (P = 0.063). Median total medical costs for 1 year after injury were 1003.68 dollars for the guideline-based group and 774.00 dollars for the classification-based group (P = 0.13).
For patients with acute, work-related low back pain, the use of a classification-based approach resulted in improved disability and return to work status after 4 weeks, as compared with therapy based on clinical practice guidelines. Further research is needed on the optimal timing and methods of intervention for patients with acute low back pain.
进行了一项随机临床试验。
比较基于分类分类分类的物理治疗与基于临床实践指南的治疗方法对急性、与工作相关的腰痛患者的有效性。
临床实践指南建议在急性腰痛损伤后的最初几周内进行最小干预。然而，支持该建议的研究并未试图确定哪些患者可能对特定干预措施有反应。
在本研究中，78名病程少于3周的与工作相关的腰痛患者被随机分组，分别接受基于分类系统的治疗（该系统试图将患者与特定干预措施相匹配）或基于医疗保健政策与研究机构指南的治疗。对这些受试者进行了为期1年的随访。结果包括损伤指数、奥斯威斯利量表、SF-36分量表评分、满意度、医疗费用以及重返工作岗位状况。
在对基线因素进行调整后，接受基于分类治疗的受试者在4周后奥斯威斯利量表（P = 0.023）和SF-36身体分量表（P = 0.029）上的变化更大。基于分类治疗组在4周后的患者满意度更高（P = 0.006），重返全职工作岗位的可能性更大（P = 0.017）。1年后，基于分类治疗组的奥斯威斯利量表评分有降低趋势（P = 0.063）。损伤后1年的总医疗费用中位数，基于指南治疗组为1003.68美元，基于分类治疗组为774.00美元（P = 0.13）。
对于急性、与工作相关的腰痛患者，与基于临床实践指南的治疗相比，采用基于分类的方法在4周后可改善残疾状况并提高重返工作岗位的可能性。对于急性腰痛患者的最佳干预时机和方法，还需要进一步研究。
